Parenting a Child with Prenatal Exposure

What are the long-term impacts of prenatal alcohol and drug exposure and how can we parent these kids to help them thrive. In this episode, we talk with Dr. Mona Delahooke, a clinical child psychologist and the author of Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children’s Behavioral Challenges.

In this episode, we cover:

Long term impact of prenatal alcohol and drug exposure: Research has found that most drugs that are commonly abused easily cross the placenta and can affect fetal brain development. In utero exposures to drugs and alcohol thus can have long-lasting implications for brain development resulting in behavioral challenges and mental and physical health implication. Some things to consider:

• The amount of drugs and alcohol used by the mom and the timing in the pregnancy matter, although this is information that is seldom available to adoptive or foster parents.
• Very often children are exposed to more than one substance in utero. For example, it is not uncommon for a pregnant woman who is drinking alcohol to also use drugs. 
• Untreated drug abuse/addiction often coincides with poor nutrition and prenatal care, which increases the risk further for pre-natal and post-natal trauma with potentially lifelong impacts. 

It helps to begin with understanding how alcohol and drugs exposure in pregnancy can affect the child not just in infancy but throughout their life.

• Alcohol
   Fetal Alcohol Spectrum Disorders (FASDs) is characterized with a broad range of deficits. Children with FASD may not have the facial dysmorphology and other physical abnormalities associated with Fetal Alcohol Syndrome (FAS).
•  FASDs currently represent the leading cause of mental retardation in North America.
•  Of all the substances of abuse (including cocaine, heroin, and methamphetamines), alcohol produces by far the most serious neurobehavioral effects in the child and into adulthood.
•  Alcohol exposure can cause a host of cognitive and behavioral impairments, including:
  • Low to average IQs (IQ can range from mental retardation to normal)
  •  Poor executive functioning skills
  •  Poor information processing skills
  •  Lack of social and communication skills
  •  Lack of appropriate initiative
  •  Discrepancy between their behavioral age and their chronological age (i.e., acting younger than they are)
  •  Difficulty with abstract concepts, such as time and money
  •  Poor judgment
  •  Failure to consider consequences of actions. Doesn’t learn from mistakes.
  •  Poor concentration and attention
  •  Social withdrawal
•  Other drugs: Methamphetamines, Amphetamines (speed and also some of the medications used to treat ADHD), 3,4-Methylenedioxymethamphetamine (MDMA)- street name Ecstasy, Opioids-(including heroin, fentanyl), Methadone or Suboxone, cocaine (including crack), and marijuana. While there are distinctions, after re

Transcript

0:00  
Welcome everyone to Creating a Family: Talk about Adoption and Foster Care. I'm Dawn Davenport. I am both the host of this show as well as the director of the nonprofit creating a family. And you can find out more about us and about all the resources we provide weekly new resources added weekly, at our website, creating a family.org.

0:23  
Today we're going to be talking about parenting a child with prenatal exposure, we will be talking with Dr. Mona della hook. She is a clinical child psychologist with a passion for supporting families and children. She is a senior faculty member of the protect them Foundation, and as a trainer consultant to schools, private and public agencies as well as parents. She has both a blog and a book, beyond behavior using brain science and compassion to understand and solve children's behavioral challenges. It details a new approach to behavioral challenges. And it's it's an invaluable resource for those of us who are parenting kids who have behaviors. And what I particularly appreciate it is that it's taking the it's approaching it from a brain standpoint. So welcome, Dr. della hook. We are so happy to have you here to talk with us today. Oh, thank you so much for having me done. It's a pleasure to be here. All right, I thought we would start talking about some of the long term or actually I will say I'm just going to give us a brief overview of some of the long term impacts of prenatal alcohol and drug exposure. I think that parents often focus when they are adopting or fostering a child who may have had prenatal exposures. They focus on the short term, what's going to be happening within that first year of life. And it's easy to forget, as our children age, that many of the impacts that brain damage caused by these exposures. Many of those do not even become apparent until our kids sometimes often not until our kids reach school age. And at that point, it's easy to forget that our children have had prenatal exposure, and that perhaps what we are seeing is the result of this prenatal exposure. And it's important to realize why our kids are behaving the way they do and because it changes the way we parent. So I want to start by talking about what you may be seeing, because the reality is that we often don't know how much are out and when or what our kids have been exposed to. Alright, so research has found that most drugs that are commonly abused, easily cross the placenta at the placental barrier, and can affect fetal brain development. in utero exposures to drugs and alcohol thus have long lasting implications primarily for brain development. And that's important for us as parents to know because it can result in behavioral challenges as well as mental and physical health implications. So a couple of things before I go into the specific things you may see, I put couple things to consider. First, the amount of drugs and alcohol used by a mom and the timing in the pregnancy absolutely matter. But this information is seldom available to adoptive and foster parents. Also, keep net keep in mind that very often children are exposed to more than one substance in utero, for example, it is not uncommon for a pregnant woman who is drinking alcohol to also use drugs. Also note that untreated drug abuse and addiction often coincides with poor nutrition and prenatal care, which increases further the risk of pre and post Natal trauma and which also might have lifelong impacts. So with that, I think it helps to begin to understand how alcohol and drug exposure in pregnancy can affect a child, not just an infancy but throughout their life. Let's start with alcohol the terms you may have heard fetal alcohol spectrum disorder FASD is characterized by a broad range of deficits in children with FASD may well not have the facial dysmorphology the facial characteristics and other physical abnormalities that are associated with fetal alcohol syndrome, fa s. I think we can think of it as FASD it's oral or exposure alcohol exposure expresses itself along a spectrum. And often the most impacted kids will be called Bowlby diagnosed with fetal alcohol syndrome FA s. But children all along the spectrum can have various abnormalities and various issues, lifelong issues. f ASD currently is the leading cause of mental retardation in North America, which is pretty amazing. We think of things like a Down syndrome and others but FASD is a more common of all of those and

5:00  
Sadly, of all the substances that are abused, and that includes heroin, cocaine, opiates, opioids, methamphetamines, alcohol produces by far the most serious neuro behavioral effects in children well into adulthood. And let me just tell you some of the things you could look for that would indicate alcohol exposure. And it could be a host of both cognitive and behavioral impairments, including low to average IQ and IQ could honestly range from the level of that would be in the mental retardation range all the way up to normal, poor executive functioning skills, poor information processing skills, lack of social and communication skills, lack of appropriate initiative, motivation, discrepancy between their behavioral age and their chronological age, ie acting younger than they are difficulties with abstract concepts like time and money. And this becomes more apparent as these children reach adolescence and of course into adulthood. poor judgment, a failure to understand consequences or to consider consequences. We often hear parents say they don't seem to learn from their mistakes. And a very common thing that represents is poor concentration and attention and impulsivity. Many children are also diagnosed with ADHD. And while these two conditions can coexist in the same child, they there are absolutely some distinctions and the treatments are often different. Now I'm going to kind of generalize some of the other commonly abused drug that to long term impacts as some of the other commonly used drugs. And those drugs would include meth amphetamines, amphetamines, which would be speed as well as some of the other medications that are used to treat ADHD or or are abused. One MDMA, which street name is ecstasy, opioids, which would include heroin and fentanyl, methadone, and Suboxone cocaine including crack cocaine and marijuana. And, and while there absolutely are distinctions between the long term impacts, after spending a lot of time reviewing the research, I think it's fair to say that the following long term impacts are often found and regardless of the type of exposure to what the child the infant or the fetus was exposed to. So in newborns, we might see growth restrictions, decreased weight, lengthen head circumference, but these don't necessarily follow the child throughout life. executive function impairments I mentioned that is one of the things under children along the fetal alcohol spectrum. And that, but what we mean by executive function is it's a set of, of mental processes that we use to manage cognitive operations. It includes things like attention, behavior, cognition, working memory, information, and problem solving. All of those are what we call executive function. And that's one of the things you often don't see in young children, because it's only when those executive functions are expected of a child, ie when they reach school, that we see the impairments. Attention in impulse control issues is another long term effect of drug exposure and pregnancy. Sometimes learning difficulties not always increase in child's externalized behaviors, tantrums acting out that type of thing. And sometimes neonatal abstinence syndrome acts so called NAS, but that's really only for the more addictive drugs. And I think it's very important for parents to realize that the absence of withdrawal or the absence of a child being dependent at birth, does not indicate the absence of the brain damage caused by prenatal exposure. So I think that's a very important thing, because we often hear parents say, well, they weren't born, they weren't born addicted, or they they didn't, there was no diagnosis of NAS Therefore, I you know, I didn't even think that my child would have any long term impacts. So the bottom line is that prenatal exposure to alcohol or drugs can cause brain damage, and that brain damage impacts how a child behaves and learns. And adoptive Foster and kinship. parents may not know if a child has been exposed or how much or when. So ultimately, I think it's important to know that we can't change the brain damage caused by prenatal exposure to alcohol and drugs. But we can learn parenting techniques that can prevent some of the what we call secondary impacts such as you know, feelings of inadequacy, frustration and low self worth that when you are not measuring up and you're not able to do the things people expect, that these are the things that could happen that can lead to defiance and other difficult behaviors. So that is my very short summary or not so short summary of the of the typical things we see. So now we're going

10:00  
Gonna be talking with Dr. della hook about more detail about parenting kids who have these, the brain damage caused by prenatal exposure? So let me start with Dr. Del hook. Thank you for your patience. Now let's dive in. Oh, no, that's a great. It's a great summary. So thank you for. for that. I'm sure everybody learned something there. Yeah, well, hopefully. So how does the long term impact of prenatal exposure impact parenting? I know, it's a general question. But I think it's good to start maybe in a general level? Well, it's a great question, because we can extend it to how does an individual child's differences, right, because all children are born with unique brains and bodies. And no two children are alike. So how does it impact a baby, and the baby's ability to be in a relationship to signal to signal the caregiver to be in a relationship from the moment a baby is born, but humans are in the process of communicating with other humans. That's that drive. So how does that particular baby's individual differences, these are two words that are very important for parents and, and providers to understand these individual differences, impact the baby's ability to communicate with the world and to experience the world as well. And our and the world includes their mommies and daddies. And their adoptive mommies and daddies and their, their kinship, their foster parents, their teachers, their caregivers, everybody in the circle is impacted by these individual differences, which, as you mentioned, are hard to predict. We don't know the the, the word that best describes an exposed baby's brain is complexity. Because as you said, you have other factors that we may not even know about, such as the nutrition of the mother, the ambient environment, the relational stress or trauma that that person was under, during the pregnancy, their physical health, their community of support. So there are there's a complex mix, but let's just say that it does impact parenting. And I have a tremendous amount of compassion, and really respect for parents who go into this journey, knowing that their child has been through a journey before you even get to them. Mm hmm. And the interesting thing is, complexity is a really good word, because it can fall. I mean, that that many years ago, when crack cocaine was a robot, I don't know if it was worse than it is now. But it was certainly in the news more. And we heard all about the crack babies, which I just absolutely hated that term. But that was certainly in all the news. And we expected, you know, just really horrible outcomes. And many of these children have done quite well, we now have some good longitudinal research. But we also see other children who have significant impacts. So it is complexity is a really good word. It's a really good word. And it's a word of caution, too, because I really caution us to not make a one to one association between the prenatal environment and what will happen to this child what this child will achieve. And I'll have to say that one of my pet peeves in being in hundreds and hundreds of IEP s throughout my decades of practice, that we cannot ever say this baby had was exposed to x, or this baby, or this child or student is autistic, or, or had trauma, and therefore it means that this is the reason they are doing x. It's not that simple. And I've seen foster children in particular, because they have fewer advocates than then basically anybody very well mis understood and under estimated in their capabilities, because we only look at one single metric, you know, or we use standardized tests, or some other very outdated metric system. Are there behavioral challenges, or quite frankly, they're overdiagnosed I mean, they are they are they and and if you don't have an advocate to say that their diagnosis does not define them. Yes, thank you

14:58  
and and the advocates for foster children.

15:00  
But in my, in my estimation are heroes because those advocates know the student, the child, the teenager, and they can say, Wait, wait, wait, I have an explanation for what you saw. Let's step back and really look at this person as a whole and not at this as the sum of their test scores are their behaviors. Exactly. And we do not want people to leave this interview thinking that we are saying that if your child was prenatally exposed, that what we are saying is going to be predictive that that they are going to have all these host of issues, they may or they may not be, but we do want you as a parent to go in for forewarned, so that you're on the lookout so that you can advocate and you can, you can address and make certain that you are parenting in the best way to help this child overcome and thrive. So that's the bet you're so right.

15:58  
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16:55  
In your book, beyond behaviors, you talk about a new way of understanding behaviors and how this is relevant to children who have been exposed to. And my question is How is this relevant to children who have been exposed to alcohol and drugs prenatally? I think it's especially important for these children. Because this whole idea that we use behaviors as a useful guide as to what to do with the child is frankly, outdated and harmful, because we behaviors are the signal behaviors, as I as I talked about it in the book are at the tip of the iceberg. So as you know, an iceberg has tons of stuff underneath the surface of the water that you can't see. So behaviors are the signal behaviors are the useful information that gives us data about the child. And oftentimes, our treatment approaches go right for the behaviors, reduce the behavior, make a childbirth look more compliant. Focus on the behavior our education system is, is really grounded in behavior theory. And so with prenatal exposure, as you've aleut alluded to, we have a question mark, as to what is going on inside that brain and body connection. And much of the time the differences are invisible. Yeah, they're in visible. And so we are holding these children up to these outdated standards about behaviors, which, frankly, in education are related to compliance, the child's ability to be compliant to do their job to have in their homework to keep their bodies still.

18:48  
And

18:50  
example, okay, we know from neuroscience, that one of the best ways to regulate a body that is feeling distressed, which many of our prenatally exposed children and our children who've been exposed to relational trauma or environment, environmental trauma, which will include most all of our foster kids need to move their bodies, their bodies move for them. And yet when they are deemed as being, you know,

19:19  
when that is associated with a with a social problem, like they are inappropriate with peers, or bumping into people or or, you know, clearing things off their desk, that's viewed as some sort of deficit rather than a really an adaptation to your body's need. So, we want to look at the difference between

19:43  
a purposeful misbehavior and a protective adaptation that our children's bodies do because of those invisible differences.

19:56  
And I'm so glad you talked about the word purposeful, because one of our

20:00  
Goals are creating a family is to help parents and teachers and quite frankly, other adults who interact with these kids move past and we call it move past won't towards can't. And let me mention that this was we are not unique at coming up with this as actually we were, we were not original to us, I should credit Diane mobbin. With fetal alcohol spectrum consultation, education training service, I think she was the first one who I heard talk about moving from one to can't, because it changes how we parent if we believe our kids are purposely not doing something, then we parent in a way to eradicate that. But if we think our kids can't do something, then it shifts everything. It shifts how we approach it. And that's, I think it's the purposeful nature and understanding that prenatal exposures can cause brain damage and our kids brains are different.

20:57  
Absolutely. And we are obsessed as a culture.

21:02  
As you know, in our systems are obsessed with intentionality, we believe in intentionality. And we believe that if you just try harder, you can do it, Honey, do it. Do it for me, please you'll earn a sticker you'll earn your you'll earn a trip to the yogurt shop, or you'll get your phone back that I've taken away or you'll get your phone back get out of timeout or what That's right. And again, I'm my my position is always a no blame no shame zone. So if as a parent or teacher, or caregiver, you just had like a cog in you, please No, of course we pair up that way. That's how I parented my children. They're older now. But we were we're basically informed by compliance and wanting to give our children incentives. So don't beat yourself up.

21:57  
Right, right. So don't beat yourself up. But But here's the deal.

22:02  
As as psychologist Ross Greene says, you probably know Ross Greene from collaborative problem solving. He says children do well if they can love and I really believe that children do well if they can. So understanding the difference between won't and can't, is essential. And again, it's very, this is why I think it's important to understand the invisible nature of brain trauma.

22:33  
Yeah, you're right. Look, you can't it the child doesn't necessarily wear it on their face. Right. You may have facial dysmorphia, you may have dysmorphic features. I mean, and and but for the mass, vast majority of our of our children with differences, there are invisible, and we need to appreciate that. And I don't blame parents to be quite honest with you, I lay the blame for this problem.

23:04  
Frankly, one of the places I lay the blame is at my own field of psychology. And that is based on a deficiency model, a deficit model, if you if you will, a medical model. And it is based on the DSM the Diagnostic and Statistical Manual, which is the labeling system that the fields use to label children with disorders such as Oppositional Defiant Disorder, and conduct disorder, rad reactive reactive attachment disorder, may omnibox. So many of our kids have been diagnosed with reactive attachment disorders. So many of our kids are given labels very early on. And okay, labels are useful for getting insurance coverage, for example, or possibly getting support for a child. But other than that they are harmful. And one of the areas of harm is that it implies that there are fixed problems in our children that lead us down the wrong path of how to help the child. For example, if we look at something like Oppositional Defiant Disorder, conduct disorder, calling behavioral challenges where the child can't comply with the task demands of a situation, calling that a disorder, is really not respecting the nervous system. Because if we believe that children do well, if they can, which I completely believe,

24:44  
then we will stop blaming them and saying, oh, you're not compliant enough. I have to teach you how to be more compliant. 1000s and millions and millions of dollars are spent on behavioral plans to try to help children become more compliant.

25:00  
When we are completely ignoring what's causing the child's difficulty, to engage in the task we're asking them to Hmm, and sometimes our children are going into states of the nervous system, that one, one state that we all may be familiar with is the fight or flight state, right? This is a physiological pathway. This is not a choice. This is something the nervous system chooses, where the child needs to move, sometimes they yell, scream, they may try to run away. This is, this is a pathway that is adaptive and protective because the brain is sensing, threat or danger, even if the child's objectively safe.

25:48  
And we have to understand that certain insults to the brain, including trauma, but also including certain types of exposure, will make the child more reactive to the sensory contours, the sensory input of the environment.

26:07  
And you can have the most amazing parents in the world. And I've worked with so many incredible Foster and adopt parents and their circle around them, the teachers, the school district, their their providers, are telling them that they need to clamp down more or be more be more consistent with their discipline. And, frankly, Dawn, that is what I'm calling out in my in my work. That is an outdated model that did not consider something called physiological state, the state of the nervous system. That is a model that only looks at behaviors at the surface. And as the signal, we don't want to punish the signal, and I believe that's one of the reasons so many of our foster and adopt kids have a very poor image of themselves because they also are starting to feel Yeah, something's wrong with me, I'm damaged. Why can't I do just do this? Yeah. Okay, let me get down to some of the nitty gritty one of the most frustrating things parents face when parenting a child with FASD, or other prenatal exposure issues, is that they don't seem to understand cause and effect. And this makes it so difficult to punish or give consequences, or in any other way discipline these children, it also leaves parents and adults to assume that the behaviors are intentional. So what's a parent to do? Because it is, it is, it's just crazy making to have somebody do the same thing. And and you have talked about it, you have gone over it you have done, and yet they're still making the mistake or doing the misbehavior or whatever, however, you want to say yes. And let's just acknowledge how frustrating that is for caregivers,

28:01  
and how much patience it takes to

28:07  
have that happen over and over again, and feel like oh, my gosh, is there like no learning curve here. So let's just, let's just pause. And and that leads me to first saying something that's not even about the child, it's about us, it's about the caregivers, and that is, self care is the prerequisite for you. Because you do have to go into your deep well of self control, patience, self compassion, in order to have compassion for the child. So having said that, let me address your question.

28:45  
The ability to understand cause and effect is a neuro developmental process. And what we need to do for children who don't yet understand cause and effect or aren't making it or aren't having the ability to make that real, and essentially, we're talking about the beginnings of executive function difficulties, right, right, is we have to go to the neuro development. And we have to go to the more basic levels first. And I talk about social emotional development as the stages of building a house. So oftentimes, and there's six main stages, and I'll just briefly run through the first thing I'll run through the first four right now. And then we will talk about why this is important because the building blocks of cause and effect and social and problem solving essentially

29:48  
are the same for all children, but for our exposed children. It's harder to get the foundation of the house built for some of them.

30:00  
And again, I'm not going to make any blanket statements because I have worked with so many children over 1000s of children now over 30 years, and they you cannot predict what's going to happen. So I'm just this is not a blanket, but let's just say that you have a child who is older, who is seven or eight, or even, you know, early teens who's having difficulty with executive function with cause effect with planning with the ability to see that what I do right now is going to impact me in the next five minutes or the next year, right?

30:34  
So So let's think about the how does that how is that built? Okay, the first layer of the house is the foundation of the house. And the foundation of the house is called regulation and attention. It basically, and this is a big word. But physiological state regulation is where the nervous system is calm enough to take in the environment, to be able to feel calm and steady in the physical body.

31:04  
Many of our children are not born with a ready ability to feel calm and stable in their physical ability. What does this look like in infancy, it might look like difficulties with the sleep wake cycle, it might look like difficulties settling the body down, from, you know, going from one thing to the next. It might be difficulties with just playing and being in the body, and I have all of a sudden big reactions. And you're you're looking the baby's crying or distressing and you're not sure why. So physiology is the straight state regulation is the ground zero. What that does, is that allows us to relate with other human beings. And in babies, that means going back and forth with cooing and babbling and, and facial expressions and giggles. And then it moves to reaching out to be picked up and wanting to engage with their caregiver in a back and forth way, which is the second part of the house, which is really this, this framing of the house is relationships. So you have the calm body on the bottom, you have relationships of back and forth communication, and we really look very carefully, as early as possible as to how that baby and toddler is communicating without words, we have to look at this, what we call gestural nonverbal communication, it is essential to the next step, which is the ability to communicate with another person

32:44  
to communicate your needs without having to use words. So you're pointing you're gesturing, you're using your body, you're walking towards things, you're crawling towards things, you're pointing to them. And you're saying, you know, with those words, with those with your point, you're saying, Mommy, I'm interested in that, Daddy, I need this, or you are indicating that you want to be picked up because you're scared or you don't feel good, you're just reaching out

33:14  
that ability to have nonverbal communication, I look at these three milestones so carefully in every single little person, and family I consult with and see how strong they are. Because these three are the foundation that cause and effect sits on

33:37  
that we get to the fourth. And these milestones are fluid, by the way, where they're at, we're always working on them back and forth. It's not like you, you get it, and then you have it forever. No, these are always in progress. But the fourth is social problem solving where that is where the child puts together, their gestures, their words, their stability in their physical body, meaning their, their their level of calmness or agitation in their body. You put this all together for social problem solving. And typically this is all happening in the first three or so years. And it moves up to what we call symbolic reasoning, and then building bridges between my ideas and someone else's ideas. And that ability to plan forward to hold back your impulses to use words instead of your body to get something or to just tell yourself in your head. Oh, I really want to watch TV right now. But I'm going to do my homework, put it in my backpack. And then I'm going to ask mom if I can watch it a show or play a video game.

34:46  
Hmm. So this developmental process, people aren't talking about it very much in education. They're basically talking about

34:56  
learning and teaching a child how to be a social

35:00  
Problem Solver rather than how we use relationships,

35:06  
build the blocks for social problem solving. And that was the topic of my first book, social emotional development and in early intervention, because again, many of our of our children who have early behavioral challenges like they are having difficulties, doing the basics, brushing their teeth, putting their clothes on, going, getting ready to go to school, sitting in a car seat, playing appropriately, all of these issues are stemming from difficulties in this control center. That is way more basic. And it's also why things like as you said, sticker charts, incentives, please, if you do this, you'll get this don't work with many of our children.

35:55  
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36:27  
Alright, so what if I understand you, we've got to go back to a more fundamental level with with our kids. So what would that look like you're parenting a child. And you you believe that they may have been prenatally exposed. But what you definitely know is that they don't seem to be learning the cause and effect cause and effect, therefore they keep doing the same wrong thing in your mind. Yep, over and over again. So what should a parent do? In that situation? How do you go back to the basics, and make it simpler? Going back to what Dr. Ross Greene says a child children do well when they can. So when they're not doing well? How do we help them? What are the skills that they may be lacking that we need to identify? That's right. So the first skill is our own skill, and that is of observation. So we look through a new lens, we see a child who is repeatedly not able to do what we're asking them to do, right? And we say, okay, there's a reason why this isn't happening. And most as most good parents do, they've tried to teach the child how to do it better. And that's not working either. Because if the teaching worked, the child would be doing better, right, so we observe the child. Now here is the model. Here's the, here's what you do in this physical model that incorporates the brain development. First of all, you look at the child, and you figure out what state the child's nervous system is in. Now, I could do a whole podcast on on that, but for now, I'll just say that, basically, we can look at if the child's nervous system is calm, the child's body is able to, to to be in a state where they're actually looking at you listening by kind of paying attention, and that they're not poised to run or move or, or they're not checked out. So look at the physical body, is the cut child calm enough? In this moment, or are they agitated? In which case you don't? You You stop everything? And, or if they're checked out, you stop everything, and you go to settling that body doubt? How do we do that? Through our relationship through our, the way we look at a child, and instead of saying something like, okay, I've told you 10 times, we got to get out the door. You know, this is like, you're you're messing everything up again.

39:07  
And again, with all due respect, cuz it's so frustrating, but they do our child.

39:12  
Ah, sweetheart, this looks like this is tough right now. Let me sit by you for a second. Let's slow this down a little bit.

39:21  
And so you slow the process down, and you give the child the solid rocket fuel for organizing their self, which is acceptance, warmth, and pacing of their nervous system. We share our nervous system we share our calmness with the child, we regulate. Before we request we help and what this is called is emotional co regulation. So we go to the basics. Now for many of our children. This involves going away from the behavior plan away from this from the sticker charts.

40:00  
away from the if you do this, then you'll get that down to a fundamental fundamental level of play. Because play is the building block for self control, and self control, self regulation leads to executive function down the line. So we use a highly developmental approach, many of the children that I work with, have not had enough play with their caregivers. And I'm talking about depending on the child's age, and stage, what they're interested, I'm talking about the neural exercise. And there is data on this, there's lithic data on this from the American Academy of Pediatrics, most recently in 2020, or 2019. That is actually prescribing play to children. And if you have a child who has developmental delays, the best thing you and your team can do with the child is play with them, because that's the birthplace of cause and effect. We do it in pretend play. Or if the child is not into pretend play, we do it with back and forth play, the child is into sensory play, we do it with balls in water, and sand and, you know, back and forth like a tennis match back and forth communication builds the neural pathways of social problem solving. And I probably talking a different language, you know, because I know you're asking about the specifics, what does this look like? One of the things I would recommend parents do is have a developmental team rather than a behavioral team. Because you want a developmental pediatrician, if you can, through your state or local resources or your insurance, have a developmental pediatrician, please have a developmental therapist or occupational therapist or speech therapist who has this framework and understands neuro development as a separate piece of getting the system organized, rather than just simply focusing on the end product, which is the behavior. Hmm, I think one of the things that we as parents can do is, as you say, hone our observation skills, pay attention to what is specific, usually we can predict when our kids are going to be struggling, if they have been continuing to make the same mistake. That's one indicator that the next time they face the same situation, they may not be there, they're probably going to repeat it. So at that point, we can create some scaffolding around that specific situation or, or group of situations transitions or, or getting out when things get hurried. When you're trying to get out the door, or separation, things like that. We suspect that our kids are going to struggle. So what type of scaffolding is the word that I we use it or I use? What type of scaffolding Can we put in place that can prevent this even though in our minds, we're thinking, Good heavens, a 10 year old ought to be able to get their selves out of bed, get their teeth brush, get downstairs and eat breakfast, that they ought to be able to do that in 30 minutes. I mean, they ought to be able to This is driving me nuts. They're gonna make me like, yes.

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Yes, that is that's that that's what we think. And that's what we see.

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Therefore, we try to parent to that by saying, if you don't get your butt downstairs and didn't know, at this time, every day, you will be going to bed 10 minutes earlier, every night, you know, we're going to figure this out, you know that? And I get it. Trust me, I've those words have left my mouth. So trust me same. Yeah. And, and and we are but but we are flying without a roadmap, we are trained that the best way to get a child to comply is to ask them over and over again. And then we get we get upset and the child gets upset because they want to please us but they can't. Right. Understand that your example what you just gave, why can't a 10 year old just get out of bed, brush their teeth, put their darn close on it come down and have breakfast. That sequencing involves something called praxis, which is actually a very sophisticated set of neural meaning brain sequences that are often interrupted when you have an invisible set of brain wiring differences because when we're talking about differences, we're talking about different parts of the brain that are not talking to each other.

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yet. So I want parents to know that something as simple as getting up getting dressed and brushing your teeth, for many of our children is extraordinarily complex. And I urge you to work with incredible occupational therapists who understand something called praxis, the ability to do what's required in the moment to get my body from point A to point B, working on a child sequencing and practice, they're ideation. They're planning, they're sequencing, they're executing of actions, which occupational therapists know more about, I think, than anyone, any AI professional, I agree with you, right? That is the birthplace of executive function. So we want to go deeply developmental, and again, understand with so much self compassion, that what you have signed up for what you have, is a child who is going to require a lot more time to do simple things, and a lot more compassion. And one thing that I really think we should start doing, because this is going to boost, we can't, we can't guarantee our child is going to catch up in their brain development, there may be differences throughout the lifespan, right brain damage in real life, we do say that there are differences, we don't know what those differences are going to be. And they're going to be different for each person. And brains can rewire they can go make connections that are new connections to go around the old ones. So there's always hope. But let's just say, I believe the biggest insult to our children's development is the messages they are getting that they are not purposely going with the flow. And that and what we can do to build up their mental health is to have compassion for them and say, my darling, I know, this is this seems really hard, and work together, give them the benefit of the doubt. I know you're trying to do to help us get out the door in the morning. And this is hard, and work with your team to find success, so that the child feels like they are whole, they are whole, but they have differences that we need to respect. It's called neuro divergent brains. And if you want to look at the neuro diversity movement, those adults who are showing us meaning us as younger parents, and providers, that the old fashioned way of pick yourself up on the boots from the bootstraps, and try harder, was damaging to their self concept, and can cause anxiety and depression later on. So go gentler on yourself. Start with self compassion, move that compassion to the child, and then use accommodations that are individually tailored to the child. And I have to say that the reason I wrote the on behaviors, it's not to plug my book here or anything. But the reason I wrote the book beyond behaviors is that I couldn't find a roadmap book out there. So you can use that or use other resources. Like once they have at the perfect and foundation or icdl.com. We can put those in the show notes, where you can find in our my my website Mona della hook calm, where you have free resources on how to make these adjustments for your child that are that are respectful of their neurobiology. Huh, exactly. And that's what we mean when we say, create scaffolding. And I will give an example.

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In the example that we had used a 10 year old with the expectation that after you wake them up, they will brush their teeth, get dressed and come down and eat breakfast within a 30 minute period. If you observe the child and try to figure out or even talk to the child and see what the problem might be, sometimes children can identify their own problems, sometimes they can't pass. But let's say that the child's problem is the skill that they are lacking is that they get distracted. And all of a sudden, 15 minutes have gone by and they're still you know, playing with this toy that's sitting on the ground. That was beside the shoe that they were getting ready to put on and they got distracted because they saw the toy and then they lay down and started playing with the toy, you know, an idea of scaffolding around that and I agree with you that working to help the child not need the scaffolding is a great idea. But in the interim, the scaffolding that might just be an example of scaffolding would be

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Having the child's clothes downstairs having their toothbrush downstairs having them in your bathroom. So when you're getting dressed, the child is getting dressed with you. And then when you're brushing your teeth, the child is brushing their teeth. And you can see when the child starts going off off the off the plantation and is now you know, chasing a fly in the room, you can bring back the task and say, Hey, teeth now teeth, now let's get our teeth. And so the child then, and so you're providing some of the external structure that that child simply doesn't have at this point, and then taking them to the table. And honestly, then you may say, okay, even doing all that 30 minutes is, shouldn't be enough, it's been enough for all the advocates, but by golly, this kid is is a special snowflake. And we're going to have to say that this one needs about 45 minutes. So we're going to get him up, bring him downstairs where his clothes are. And we're also going to focus on breakfast that can be portable. So this trial may still not have because my son diverted at the table to looking at the grains and the wood and drawing pictures of the grains. And therefore we will have his food that he can pack up and eat in the car, as opposed to yelling and he may not finish it even though the car but nonetheless, a couple of bites will have gotten into his stomach. So that's the type of scaffolding as opposed to saying, Why can't you ever get downstairs You're making me late again, and and then this kid starts thinking I am a problem, versus the kid who has been brought down and had all this, he's not even aware that he is the problem. And that's good, because he doesn't start thinking it once he starts identifying that I am the problem, those are the secondary issues that that caused low self esteem, those are the secondary issues, which be can become primary, when you are given the message that you are damaged that you are that you are not a good person because you are making us late again, again, write

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about this every day. And please, again, parents, please know those words came out of my mouth on a regular basis, especially before before I studied neuroscience. When we hear Oh, yes, my Oh, so give yourself give yourself so much grace. Yeah, and, and but what you just gave us a beautiful example of appreciating individual differences, and really giving that nervous system the benefit of the doubt. It's not the child's fault, that they get distracted by a visual or a thought, or an idea. It's because that brain is working really hard. And guess what that brain might invent something one day or code something one day that would never have come from more from a more neuro typical brain. Very good. So we must celebrate neuro diversity. And let's get away from from this this DSM disability model where these children are given the message subconsciously, of course, because I know all educators and and people who work with children have excellent intentions. But let's come to grips with the fact that Why are only 4% of foster children graduating from college and in four years. It's just not right. And because they have been given the message over and over again, maybe that no you don't you don't live up to expectations. How does that feel year after year after year being told that you're you're falling short of our expectations, no matter how many incentives we give you. So this is a mind shift on and I just applaud your your work in getting the information out there that there is another way to conceptualize and to support and to scaffold for as long as that brain needs it. Right and and it'll you know, it's it's a great time. It's an exciting time because we are fighting brain science is a new field and we're learning more

54:16  
and and the elasticity of brains and we're learning that as well. But you had mentioned before.

54:22  
I want to take a moment to thank children's connection they have been a longtime partner and believer in our mission of providing expert based trauma informed resources they have they have really stood by us and have believed in us all from the almost from the very beginning, which is a long time ago. Children's connection is an adoption agency providing services for domestic infant adoption and embryo donation and adoption throughout the US. They also perform home studies and to post adoption support to families in Texas. In the time we have left let's let's leave parents with some tips and

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Let me also mention that when when I went through at the beginning about the studies and what we know about the impact of children, the impact on children of prenatal exposure, I do want, especially adoptive and foster families to keep in mind that these studies most often do not separate children who were exposed prenatally and then raised in a home with drug or alcohol abuse from those children who were prenatally exposed and were raised or adopted, or fostered in homes without substance abuse. So that is something again, to keep in mind. But that's an important point. And, and it really shows the drawbacks of the study. So we have to take them very, we have to contextualize them. Thank you. Yeah, that's a very good point that the, the healing power of a stable home is is is reflected. So if you had some tips that you could leave our parents with those be okay, first tip, prioritize sleep, be militant about your babies, your toddlers, your child Sleep, sleep, is the most Ground Zero piece we need for healthy brain development, that sleep wake cycle. So I really ask parents to be militant about the sleep make it make it a relational, playful, beautiful, wonderful thing for children. It's, you know, so that they feel like sleep is is cozy. But sleep is your life support system for yourself and for your child.

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Of course, at Yeah, it's it's you, I'm sure you know, Don, the studies on this are just off the charts. The this the first thing I do when I meet with a family of child with behavior issues is to find out about the family's sleep. So that's the big one. Of course, nutrition is important too. But I'd say become an observer to your own nervous nervous system into your child, become an observer as to your heart rate yours, are your hand sweaty, are you feeling calm, because we can actually have something called emotional contagion, the way we feel is transmitted to our children. And that's not meant as something to freak you out. But just to say it's you matter. So I would say that Another tip is understand the power of something called co regulation. And that means that when we provide a struggling child with our own calm, and engaging and more self, we actually change their physiology. And there is a new theory, not a new theory, but theory that's been around for 20 years that I think is going to be the primary theory that's going to guide providers is called the theory of constructed emotions. And you could at least have Dr. Lisa Feldman. Barrett tells us that you can change a child's physiology by a look, by a smile, or by looking away or a timeout or a spank. So go for engagement, go for co regulation before teaching. And understand that the foundation of executive functions have the ability to be a successful independent person on your own one day, which we hope that our children will be is the amount of CO regulation they get when their physiology goes offline. And our foster children and our drug exposed children have their physiology go offline. Oftentimes, more than kids without that exposure. So we want your team you want to educate your teachers, everyone on your child's team and your and your family members to remember that this child is not. We can look at her being neurodivergent through a compassionate lens. So go for the scaffolding, let the child know that you know that they are trying their best. And it's a powerful message that we can give them. And yeah, I think it's a the last tip I'll say is, is stay stay hopeful. Because the more that comes out in this burgeoning area of relational neuroscience, it's a very young field, as I said, but the more that comes out, the more hope we see in the power of relationships to change the firing of the brain as the brain goes forward. And since the brain is a prediction machine, everything that happens in the in the present is going to impact the future. So stay hopeful and stay tuned to the research.

59:47  
Yeah, it is an exciting time. It absolutely is. Well, thank you so much, Dr. Mona della hook for talking with us today about parenting a child with prenatal exposures. We really appreciate

1:00:00  
Your wisdom and for all of the rest of you in the audience. Thanks for joining us and I will see you next week.

Transcribed by https://otter.ai