By: Laura Petix, MS OTR/LEPISODE 27

Dr. Tina Bryson is going to share some strategies to help you with night time routine struggles. We’ll also talk about how this might look different or be a little harder with a neurodivergent child, and when you might benefit from seeking support from an Occupational Therapist.


*Please note: these are the transcript notes, please ignore any typos or grammatical errors as this was captured via a speech to text application that may have resulted in some errors.


Click here to skip to Dr. Bryson’s 5 tips for making bedtime routines easier.

Click here to skip to Laura’s tips of when it’s time to seek support from an OT.

Click here to see links to connect with Tina and Laura.

 


Introduction: Dr. Tina Payne Bryson is the author of the Bottom Line for Baby and co-author (with Dan Siegel) of two New York Times Best Sellers—The Whole-Brain Child and No-Drama Discipline—each of which has been translated into over fifty languages, as well as The Yes Brain and The Power of Showing Up. She is the Founder and Executive Director of The Center for Connection, a multidisciplinary clinical practice in Southern California. Dr. Bryson keynotes conferences and conducts workshops for parents, educators, and clinicians all over the world, and she frequently consults with schools, businesses, and other organizations.  An LCSW, Tina is a graduate of Baylor University with a Ph.D. from USC.  The most important part of her bio, she says, is that she’s a mom to her three boys. You can learn more about Dr. Bryson at TinaBryson.com. 

Occupational therapy has been around since 1917, quite some time. But it’s still such a hidden field! No one really knows about it, no one knows what it is. So the goal is to get as many people to learn about OT to hear about all the fabulous things that it does. I’m here recruiting other professionals, like Tina here, so that I’m not the only one praising OT. I love hearing how other professionals work with OT and how they are impacted by OT. 

I truly love being an OT and I feel like OT is one of those things, like therapy and seeing a psycholgists that EVERYONE could benefit from. But, there are children who might benefit from OT a little more than others, and in today’s episode, Dr. Tina Bryson is going to share some strategies to help you with night time routine struggles. We’ll also talk about how this might look different or be a little harder with a neurodivergent child, and when you might benefit from seeking support from an Occupational Therapist.

Before we jump into the topic of bedtime routine, I want to chat with you a bit about your center, I know you have Occupational Therapy services there, can you talk about some of your common cases that you end up referring to OT for? 

Tina: I’m a huge OT fan! In fact, I sort of felt like if I could get another doctoral degree, I would probably get it in OT. I love it so much, and I try to learn about it as much as I can. For about 10-15 years now, anytime I’ve spoken at a conference or educators or parents, I always talk about OT. Here’s why.

Back in the day when I was a green therapist when I was working with kids, I was taught about the brain and the nervous system. I think very differently about how I think about mental health than how I was trained. So here I am this young, green therapist. I’ve got a handful of kids on my caseload, 3rd and 4th grade kids with debilitating anxiety.

So I worked through my lens, and I started asking all these questions to try to understand: what is happening here? The way that I think about anxiety, is that the nervous system is really detecting some sort of threat or overwhelm where they can’t regulate their states of arousal because they’re in a heightened state of arousal because there’s something that’s giving them the signal of threat.

So as a mental health person, I started asking all kinds of questions around that. Then it turns out that a lot of my kids on my caseload had really safe, protective parents and cozy, warm teachers, they weren’t bullied at school, and no trauma history. So why were these kids having a trauma response if they are safe on the outside? So I needed to peel the layers back.

I could have just treated their anxiety symptoms, but I just wanted to peel the layers back to see what’s causing it. For example, if I have a cough, and I just keep taking cough suppressant, I might continue to cough. But maybe I go to my doctor and they say I have pneumonia or allergies, then they can help treat the source instead of the symptoms.

So as I started to peel the layers back, I came across the field of Occupational Therapy.

What it turned out was that about 85% of the kids who I was seeing for mood disorder that looked like mood disorder, turned out to be kids who either had sensory processing challenges, OR they had some sort of underlying learning challenge that hadn’t yet been discovered. They were neurodiverse kiddos.

Yes, I could have done some top down mental health strategies and some bottom up breathing and movement, but what they needed as OT, or a neuropsych assessment and educational therapist.

So all of that inspired me to say, that “if we’re going to chase the why, which is really the whole approach in No Drama Discipline”, I need professional arounds me that know things that I don’t who can ask better questions.

So much of the time it’s not simple, the brain is complex and the nervous system is complex.

So I created the Center for Connection that is multi-disciplinary. So it’s mental health and neuropsychological assessment across the lifespan. We also hae OT, educational therapy and Speech Therapy. I also wish we had psychiatry and developmental pediatrician, but we are 6 years old and are still learning and growing. 

We have about 50 people who work for us with a long waitlist. It’s a model that people are really excited about. We have specific carved out time for our teams to interact with eachother so we can ask better questions. We want to be interdisciplinary practitioners, and the longer we work with people, the better we can do that. 

Laura: Yes that’s what I was looking for! I love collaborating with OTs, but there are times where I’m like OH man I wish I could consult with a play therapist or a psychologist, and then I send parents on this goose chase. How great would it be to go down the hall and just ask someone’s perspective. How amazing to have it all in one place!

Tina:  I remember when we first started, we had a kid who had educational trauma. He had significant learning challenges. His repeated experiences in school were terrible and his nervous system got jacked up when it was time to sit and learn. So he had a full Neuropsychological evaluation and we were able to see his strengths and challenges. Then we had our OT do a full assessment as well. What was amazing was the parent was paying for an hour session, but what we did was this kid (who usually wouldn’t get a lot of learning done in an hour of educational therapy) instad spent about 20-25 minutes in OT to get regulated, then would spend 20-25 minutes in educational therapy and he would learn so much in educational therapy. 

He was then having the experience of learning and being a student and creating a new self concept of himself in a state of his body that was positive. It was starting to rewire who he was or how he felt about himself as a learner. 

Our speech and language pathologists and OTs do a lot of work together as well. A lot of kids who have social communication challenges also have emotional regulation and attentional regulation challenges, which OTs are really skilled and savvy at helping through sensory experiences. 

I just love it. It’s such a rich environment! Parents feel really held because they don’t have to run around from different places and we all use the same lens and celebrate parents. We’re not the kind of therapists who do stuff to your kid and you take them home. You’re the parent and you’re just as important for the team. 

Laura: So can you be like evaluating a child were all the professionals can the kind of see at once and overlap rather than like one by one evaluation and then from there be like okay I could I’m going to assess this as the OT and the speech therapist is like Oh I’m going to look at that?

Tina: That kind of like of depends on what a family is time and resources and desires and openness are.

One of the ways we think about this is what say the first point person is like the neuropsychologist who’s doing like a full evaluation and our people are trying to do some sensory screenings. Think about this person is like your general practitioner but just like when you go to your practitioner and they say hey I think you also should see the cardiologist for you or you should also see the endocrinologist…

So thats kind of starting point. All the family knows is that their kids getting kicked out of school, they’re out of control at home they’re desperate they don’t know what’s going on and so we often start with OT.

Laura: But their first point of entry is typically like a behavior at school or at home that it kind of gotten out of hand

Tina: And where parents are feeling really overwhelmed or not sure. Or they’re really afraid that something is really wrong with their kid. And one of the ways that I like to reframe that is like, look what are the demands of a particular situation? What is your child’s capacity? When the demands of the situation and our capacity have a huge gap that’s where we’re going to see anxiety, depression, acting-out Behavior, internalizing behaviors things that look like what some people label Oppositional Defiant Disorder (which I never will give that diagnosis and I will always UN-give that diagnosis) because oppositional behavior is communication that something is not working. 

We can peel back and figure out what that is and then treat that. We don’t ever want to do more than a family needs because that’s that’s wasteful of their resources and time but when it’s clear the problems have been going on a long time to get information from the family to get information from the school and it looks like there’s a lot happening then yes we can have all of those professionals working together and do a full comprehensive evaluation otherwise we can do it step wise where that information is shared along the way so that parents aren’t having to say tell their story over and over and over again.

Laura: So if a child came to you first or to an educational Specialist or a neuropsychologist what is some of the most common cases that you find out if like OH OT would be a perfect first stop for you. 

Tina: I work in a school as well so I do a lot of consulting in lots of different schools and you know some of the cases are really obvious he know kids who are removing clothing articles you know past the age we would expect that you know lots of sensory seeking kinds of behaviors which some people might think of as like ADHD hyperactivity and as you know there is like a 50% comorbidity around attentional regulation challenges and sensory challenges but  sometimes they’re really obvious kids covering their ears.

One felt really obvious to me I don’t know that it would be to everyone but this one little girl she was she was seen as ODD, Oppositional Defiant Disorder and she was she was not cooperative she would stomp everywhere she went she would climb under her desk and curl up in a ball and refused to participate and the way that we create meaning around those behaviors makes every bit of difference about what happens next right and we have to remember that as parents as professionals as Educators we are meaning makers for our children and how we perceive those behaviors so for me you know this looks like she was she was over responsive in terms of stimuli and now I feel like I’m I’m talking about your profession now

Laura: I love it! 

Tina: So she was overwhelmed by sound by smell and she was obvious about it or would cover her ears or nose and she would run away from other kids and then she was also under responsive about other kinds of things, she was stomping on the ground and like needing to like push up against the wall so to me that’s really obvious that OT was the starting place but a lot of times it’s not that obvious and what people don’t understand and why I love OT so much is you know all of the things that we do that lead us to the place of being able to regulate our attention and to regulate our bodies and to regulate our emotions and to direct our behavior and to communicate with other people like all of these things seem like mental health kinds of things and they are but they are also foundationally built upon how our sensory systems process information 

So for me if someone comes to me and the behaviors are really big I’m going to start peeling back the layers and I’m going to ask questions about daily activities you know, like what is getting dressed like, what what is eating like ,what are the battles you have? The questions I kind of loved asking parents are like what do you fight the most with your kids about what are the most frequent battle.

So I ask a lot of questions about daily routines and that often gives us a lot of information about kids trying to make sense of the world.

OK let me give you a really specific example, this is actually a really funny story. I had this family come to me the little boy was five and his older brother was already in school so he had been on the campus of the school multiple times taking his older brother and it was time for him to start kindergarten and before kindergarten started they had like a pre-K like a summer kind of get ready for kindergarten program and the parents started taking him and thinking he’s going to love it and  he started just freaking out every time the mom would try to drop them off.

Like he got so highly distressed that he would like bite her and rip her clothes and cling like he wouldn’t let her leave and so I always ask parents you know I start with, “what’s your theory about that behavior like what do you think of that?” and mom’t theory and her husband agreed that he was manipulating. She was like “He’s just manipulating us” 

So I was like what’s he manipulating you to do what do you think he’s trying to get? Mom said,  “he just wants to stay home with me” and I said tell me more about that and as we begin to explore the parents theory around this is that he was you know he was just manipulating them and so I began to ask more questions. This looks like something we call separation anxiety and that when you’re with him, you are his best strategy to regulate him and so when you’re there he feels safe and he like he can tolerate whatever is happening around him but when you are going to leave, he panics because you’re his best tool and he doesn’t feel like he can regulate so I think there’s a a big response there have you ever seen this before?

 Mom said, “No”, they had never seen separation anxiety before he had been in to previous preschool and never have seen this he had babysitters and not really that much that they might cry but it wasn’t this kind of a response. 

And so I began to be curious this is the most important thing any of us can do when we see behaviors in our kids. We need to be be curious so I said “Hmmm,  I wonder why?” So I started asking questions and it turns out that the last preschool was like 10 to 12 kids, 2 teachers tiny little environment little playground the new program he had to make like five transitions there were a hundred kids he was eating lunch with and so I was like wow I wonder if that’s too much input for his little system right and it turned out this kid had all kinds of sensory things I sent them to get an OT evaluation but what ended up happening, like here’s an everyday example, the dad and the son would get into these massive arguments and  be like I want the blue cup and he’s like, the blue cup’s in the dishwasher you can’t have it and he would just freak out to where he became violent and then his dad would get really angry and you know and might try to grab him so that you couldn’t hit him. And then he’d say you got to go to your room and then the kid’s like destroying his room and this was multiple times a day and so when they came to me you know they thought he was spoiled and that he needed stricter discipline and as we begin to explore this I was like “well what have you tried have you tried strict discipline?”

They were like yeah I guess that’s what we’ve been doing and I’m like okay well let’s let’s be a little more curious. Once we finally figured out that he did have some sensory things you know him demanding that blue cup was about him trying to make his world work for him there was something about that blue cup that felt better on his mouth or whatever so I think of her kids have confusing behaviors to us that seemed much more dramatic than what we would expect to develop mentally like it’s normal for a 3-year old to throw a tantrum when we cut their muffin and half and they and we can’t put it back together like they ask right but one thing that I think is a really important clue. 

Something that might to you into saying you know what I’m going to call and OT and just ask some questions see is this right for me if your child has multiple Tantrums throughout the day the last more than about 20 minutes or so and that’s a frequent thing they go on longer than 20 minutes multiple times a day day after day. To me is a cue that the nervous system is having something that is taxing it in a way that I would want to be curious about.

Laura: Yeah that’s 20 minute marker is what I use and I haven’t found like literature that like defines like this is a point but just like from my experience as a mom with a neurodivergent kid and the client that I see, that seems to be the time. 

But also like you said, I ask how does this impact you daily, and if they say like “Oh we’ve been late to school every day this week, we had to cancel this appointment we can’t hang out with friends we can’t go to the restaurant” like that is extremely impactful on your daily life.

I want to go back to what you mentioned about OT too that I love is that OT’s are really good at examining the environment and like the most subtle things that could be setting off a child out of here like I didn’t even think of that and I might get sounds like every time in that corner there’s something going on over there oh well it’s because the reflection of the light and there’s something there or There’s like so many little things that a lot of OT take into consideration end also so we help find out the underlying reasons for the behavior based on environment but that means that we can also adapt to the environment to help decrease that gap like you’re talking about between the demands in the capacity so we’re not always just trying to fix or change or do something to the child.

Yes we want to support them and give them the skills but if we can adapt to the environment and the tasks so that that comes down and then it’s already easier for the child and that’s you know that’s one of the best ways that you can help in the moment right then and then build those skills in therapy alongside that.

Tina: That’s how I think about Psychotherapy that I do you know that I do but you know or educational therapy or speech and language is really we sort of get really clear about what that gap is and then we get curious. 

The magic sauce is to being able to bring down the demand as we build the skill so that it’s a match and then when that then as that happens their capacity expands the demands can also expand. 

So this is not about like bending the whole world to our child and keeping it that way forever because I know parents get really afraid that the world won’t be like that but we need to tell parents trust development no matter what your child is like we all have individual differences,,,if if there’s neurodiversity present if there’s not neurodiversity present none of those things matter around this point it’s really is the idea that even if we don’t do anything as the brain develops and as development unfolds, our child capacity to tolerate things or their window of tolerance gets wider anyway but if while their brain is plastic we can provide these kind of inputs it can be incredibly powerful to expand that window now which gives them more opportunities earlier then they can learn more and they can be in a more regulated stating their body which then allows them to be curious and to explore as opposed to being in a defensive survive mode.

 I think the other thing too is when you said like if there’s little things sometimes we missed it would never occur to us. I think back to this idea of curiosity we make assumptions about children far to often, like we do about everything.

We’re usually  wrong. So like for example I had a mom who came to me it was also separation anxiety preschool situation and she said he’s never has separation anxiety before and I don’t I don’t really know what this is but he’s he’s just having a really hard time with the good-byes in the morning and I said “have you ever asked him?” he was like four have you ever asked him what’s the hardest part about the goodbye and what was funny was it was she was wrong it wasn’t separation anxiety at all.

He said “My teacher squeezes me too hard and her voice is too loud when she says hello in the mornings” Okay this is a sensory preference that was super easy to fix right so she gave him the option she said do you want a really gentle hug or do you want to fist bump, high 5 or bump elbows like what would you like to do she just she and she turned her volume down. And when she did those two things that they’re by was easy it wasn’t at all about separation anxiety with Mom.

So I think we have to ask our kids and we also have keep in mind though that sometimes they don’t know you know.

Laura: Or they’re non speaking, right? 

Tina:  Right, or they’re not verbal right yeah so. So in this way is also connected to our attachment with them which is really about tuning in reading cues, coming with curiosity instead of making assumptions and really tracking what our kids are communicating whether it’s through words or not.

Laura:  That’s one of the first things I tell parents too when they’re just like, “I can’t figure out” I’m ike,  “have you asked?” and they’re ike, “No I don’t think he would know” and I’m like, maybe? You might as well ask.

My daughter does the same thing where she was starting to get really stuck on having her hair  the same way every single day and it’s one of her triggers and her things I’ve been tracking is like kind of like OCD type, so I was like there’s another thing she’s obsessed with being the same and I finally asked her, like “How come you don’t like doing pigtails anymore, you used to do pigtail braids and do this now you only want it in this half up half down very specific”  And she goes, “After nap time it always messes up my pigtails and then my teachers won’t help me tighten it I don’t like the way that it feels” and I was like, oh my gosh!

Tina: She had it all figured out!

Laura: She had it all figured out. So, let’s keep this conversation with what we’re going to talk about today with the bedtime battle which is such a specific one so I want to focus I’m I’m sure there are still older kids maybe even teenagers who still push back at bedtime but let’s focus today on that like maybe toddler preschool-aged the under five crew who are having daily bedtime battles maybe leading up to bedtime maybe during bath, after bath, but that whole stretch. It’s so stressful in households everywhere I want to hear from you what are some of the most common struggles that you hear often and then I also want to talk about some of your best strategies that you suggest to help bedtime routines go a little bit smoother. After that just to give people a heads up of what we talked about that at the end will will narrow it down to how that looks different for neurodivergent children

Tina: I have three cildren and I will say that I have have lots and lots and lots of practice doing it badly and doing it well. I think probably I would say the number one least pleasant part of parenting when my children were young was the sibling conflict that was number one and bedtime battles was number two so I I really feel your pain. You’re tired, they’re tired, you just want them to get to bed so you can have 1 minute to pee by yourself once during the day, you know it’s really a lot I understand.

Here’s one thing that’s super important. You can apply this to anything, you can apply this to eating challenges, getting dressed or anything but keep in mind the brain is an association machine so if we make bedtime unpleasant and stressful and were yelling at them and we’re rushing them, consistently, like for sure we’ll have nights like everything I just said like I’ve done it done it then but in general what is bed time like? If it’s stressful is it’s rushed if parent’s yelling and unhappy with them if there’s a lot of conflict of course they’re going to say no, they’re going to push against it and and have dreaded feelings of dread leading up to it and the opposition around it and uncooperative because you know like I don’t want to go to an unpleasant dental appointment right? So they’ve come i into bedtime with all kinds of negativity bias if it’s typically an unpleasant experience. 

Now rest assured history is not destiny no matter what your bedtimes have looked like up until this moment the brain and the associations we make in our memory systems are based on repeated experiences o you can start creating positive associations with bedtime right now and your child will adapt to that quickly.

So we want to make it pleasant and safe and cozy and delightful and something your child even though they may not want to stop what they’re doing because the day is amazing and their programmed to learn and grow and explore that they still want to do it So a couple of things that I actually learned this tip from a from the lead OT on my team a number of years ago, in particular for neurodiverse kids who might have specific sensory aversions around certain things like putting on pajamas or brushing teeth, or things like that… to do the most unpleasant, or most offensive one first, when your child is more regulated, less tired, so then you have all the good things.

So some kids might not want to be snuggled, or they might not want touch in a way that’s pleasant… but any chance of connection and coziness and cuddling. 

For my most recent son at bed time, I used to ask him “okay what’s your job”, and he would say pajamas, brush your teeth. And then I’d say “Ok as soon as those are done, we can play Uno”. And he was super excited, and the uno game would last 5 minutes. But there was a game, or something fun we were doing. So he would do the other stuff, with the anticipation of something fun about to happen. So that helped with a lot of cooperation.

But keep in mind, if we’re like “Go to sleep!” and we’re screaming at them then it’s really hard for them to do that. 

Laura: So if you are having one of those nights where even if you have something fun for them to expect but they still don’t get things done in time, or they’re still refusing, is it a fair thing to say, “well now we don’t have time to play uno” and then it becomes more of a punishment? How would you react to that?

Tina: We have to keep in mind our goal is to help them sleep. I’ll tell you about a bedtime battle I had with my son who was about 8 and his older brothers…I’m really militant about sleep in my house,  I’m like really rigid about bedtime or getting enough sleep.

So the older brothers were having friends over it’s a Friday night they’re preteen and teen and he’s like eight or nine and it’s time to read and he is so mad that the brothers get to stay up and he doesn’t so he is like walking around like a floppy fish out of water out of his anger is just like Furious Furious. Now I want in that moment to say okay if you’re going to do that then I’m not going to read or okay now you’ve you’ve had this all the time so now we only have time to read one book or now we can’t

Laura: Oh my God I’ve said that before 

Tina: Me too! The problem with that, ok and first of all this is a whole other thing, but behavior is communication about what skills need to be built. So he was communicating that he wasn’t yet in a place of development to handle when things feel unfair and he’s not getting what he wants to happen when he’s dysregulated.

If I threaten him and remove something when he’s in a reactive state, he’s not going to learn. The brain is either in a receptive state where it can learn or it’s in a reactive state where it cannot learn. The whole point and purpose of discipline is for our children to become self-disciplined people and the way we get them there is through learning. He cannot learn in this moment, so if I say okay now you know this is what this is what happens you lose it next time maybe we’ll do better it doesn’t really work that way that cleanly because our kids are regulated, they typically are fairly cooperative. 

So he’s in this dysregulated state. If i just threaten to remove all this stuff, he’s not going to learn anything number one. People are really confused about that, people think, “no you have to do it so they learn”. That’s not how people learn, that’s based on old animal research from the 50s. 

The other thing is it’s going to be a lose-lose because he’s going to get more upset and his job is to down regulate to fall asleep and if I threaten him and leave the room and take things away it’s counterproductive it’s so much better for me to say…it’s fine if you hold it like I can say if that’s true and it’s getting really late it’s fine for me to say “oh sweetie we really don’t have time to do uno tonight tomorrow we’re going to play 2 games, one you know earlier in the day and if And if he cries and he’s upset about not going to play uno..that’s okay and then my job is to walk with him through and be like I know that’s so disappointing and I’m right here with you while you’re disappointed 

Laura: versus just being like “well now we can’t play UNO” but just the way you deliver it can still be a moment of connection and still helping them downregulate even with those big emotions before bed. 

Tina: Absolutely. And this goes with my second tip which is like using playfulness, silliness, and this helps with cooperation. So let’s say I’m really worried about the time, it’s getting really late. I might I might give a choice I might say we can either play UNO and I can only read two books instead of 4 or we can read four books and play a game of Uno tomorrow so I might do that but I also might say Okay instead of a regular Uno game tonight so I’m not even be like I’m taking away that you know whatever instead of a regular game of UNO tonight I’m going to give you half the deck and I’m going to and I’m going to take the other half and we’re going to flip the cards over as fast as we can and see who’s going to win ready and that’s going to happen that’s going to take less than one minute and then we’re going to do this instead of our regular game, but it’s going to be called UNO Flash style. 

So we bring in that playfulness and silliness. I think, yes we have to be careful about not amplifying what’s happening because we have to downregulate them, but if I’m not creative there, he’s going to get upregulated anyway because he’s not going to get to play and he’s going to get really upset. So, if we bring up this silliness and this play, it can elicit a cooperation. 

Like around tooth-brushing, maybe my kid doesn’t want to brush their teeth. 

I can say okay I’m so glad you’re not going to brush your teeth tonight because I’m going to use your toothbrush and I might clean out all the cobwebs but I’m saying it in a funny joking way, obviously if that’s going to upset your kid don’t do that this is if your kid is at the age and development where they can handle it. Or you say okay here’s what we’re going to do tonight you’re going to brush your teeth and I have to make up a rhyming song about brushing dog’s teeth, I don’t know you just come up with anything. Or I talked about in the whole brain child the getting dressed game where you have your get dressed you say put your pajama top on and then I’m going to tell you what we’re going to do we’re going to go hug your teddy bear as hard as we can so go grab it so they can reach out and we’re going to try and tickle the ceiling for a count of 5.

We can do different things that that make it fun again we’re creating these positive associations through play and playfulness and those kinds of things 

Laura: Yeah I love that cuz then you’re even you’re getting them some movement stretching but more down regular I like I want to insert myself here a little bit the OT is coming out because I hear a lot of I like hear a lot of parent coaches talk about things to do before bedtimes for kids who are resistant to bedtime may be more active around bedtime and so they like oh-oh jump on the trampoline or do spins or do like wrestling before bed because they’re thinking of getting like sensory input but the OT brain in me is like screaming, but not all kids will respond well to this especially even if you have a sensory seeker. Sometimes, kind of like high-energy sensory input right before bed is just going to completely backfire. So how Tina says that the down-regulating you need if you still want to provide them like heavy work in deep input, but through more isolated like massage and squeezes squeezing a bear like she said rather than like really high intensity you want to do those kind of activities earlier way earlier like before bath time or however long you’re not right in the last hour before bed that would ramp up a lot of kids I love that you talked about that. 

I have to remind myself as well because there are some nights where I don’t want to perform like I feel like I’m performing for her I don’t have the energy I don’t I’m not in the mood but I have to remember and sometimes I don’t but when I do I remember I can either spend my energy doing this connecting with her building a positive association doing this game that I really don’t want to do right now because I’ve done this all day as an OT or I’m just not in the mood or I could spend the energy fighting with her about getting her in bed and then being pissed off for the hour that she’s already in bed and like not like then I’m ruminating in my brain so either way I’m spending extra energy tonight that I don’t want to but this energy that will be spending is much more beneficial to our relationship but that’s something that I have to remind myself.

Tina: I had a Mom one day as I was telling her about using playfulness and silliness to elicit cooperation she was like I don’t want to do an effing puppet show to get her shoes on and I said I know but think about the energy you’re going to put in in the battle otherwise you know?

Laura: it’s not it’s not a snap of a finger and that’s that’s sometimes there’s there’s some a lot of work that needs to be done internally for parents to really get that mindset shift to understand that maybe your child does need a lot of extra support around bedtime and that’s just the way it is maybe in this stage in this phase and I know it sucks and so parents also need that validation that you’re right this does suck that you have to do it and your neighbor next door can just snap a finger and their kid is  in bed. 

Tina: You just it kids are so different and so you know if if you’re one of your kids is really easy to sleep in another one isn’t like it doesn’t mean there’s something wrong with your kid or that you’re doing something wrong every to end and please don’t compare your kids to other people’s kids either I think you know some more like think about what is so pleasant to you like you know think about like when you’re in love when you’re totally like a dopamine poisoning in love and you just want to be with that person every second and it feels so good to be with that person that’s all you want to do that’s also kind of how I feel about us when when they’re really little and we’re reading stories to them and they want us to stay in their rooms as they fall asleep because it feels so good to them and so you know I think I think there’s also a lot of messaging in our society like you know you shouldn’t let kids sleep with you or you shouldn’t stay in their rooms if they’re falling asleep and they have to learn to self-soothe and all the stuff honestly like I’ve never once in all my years have seen a kid who slept in their parents bed or where the parents help them stay in the room while they fell asleep that as teenagers they couldn’t fall asleep on their own and had to sleep with her parents like I’ve never once seen that we really don’t have to worry about that I think that’s another big discipline concept and there’s decades and decades and decades of literature to support what I’m going to say here and that is that we cannot spoil our children with too much love or affection or attention so ignoring bad behavior that’s old news old old old news by giving them attention we cannot spoil them by coregulating them and giving them a that connection and soothing we absolutely cannot spoil them and in fact when we do those things it gives their brain practice going from dysregulated States back into regulated States and that’s how they learn to self-soothe is by us doing that for them. We’re spoiling and I don’t even like that word I’m using air quotes, you can’t see me, where spoiling comes in is where parents don’t set boundaries and limits and have expectations and structure so so we really want to be really high on expectations, limits, boundaries but also be as high as we can on all that other stuff and and we’re not going to spoil them. If your child feels safer as they fall asleep and it takes a few minutes longer for you to stay in the room scrolling through Instagram in the chair in the corner while they fall asleep like fine it’s like great because what you’re doing is you’re creating kind of an association with I feel safe bedtime is safe, falling asleep is pleasant so really good investment of time.

Laura: So would you consider then when a parent has a boundary like okay it’s time to get in the bath and then that’s there boundary, 5 minutes… a parent who extends the time okay fine 5 more minutes does that count as spoiling or fall in that area of having no boundary if you can’t follow through with it or because you’re just like ugh whatever 5 more minutes and you just have like loosey goosey boundaries?

Tina: it’s a great question. So 2 things… one is it’s totally fine to give our kids 5 more minutes or one more story or whatever from time to time like right I mean I’m like I told myself I’m going to eat two cookies and I end up eating 4. We can be flexible we don’t have to be rigid but the way we do it matters. 

So I think it’s totally fine to change our minds like that let’s say I told my kid 5 more minutes or you know we’re going to bed and then he says can I have 5 more minutes in that moment if I if I’m like okay fine have 5 more minutes that is not what I want to do instead I can say yeah I’ve got time, hold on let me look at that time 5 more minutes is perfectly fine.

And then the other thing I would say and my kids learn this is I think negotiating and you know making compromises that is phenomenal prefrontal practice for our kids because they have to think about what’s going to appeal to us and how they should ask and that’s really good brain work but as soon as I say I’m not changing my mind so if I say you can have five more minutes and then they ask for 5 more minutes I say no we’ve already done 5 more minutes we’re not doing 5 more minutes and then they start crying please please please I say we’re not having 5 more minutes we’re going up right now and I’m not changing my mind then I don’t change my mind and they know then that when I say that phrase it’s not worth continuing to go so it’s totally fine to do that.

I think the other thing to keep in mind though remember my kid fish out of water flopping on the bed when it was time to go to sleep and I was trying to read to him what had happened there was he asked for 15 more minutes to stay up with the brothers, and what happened

was he was 15 minutes more tired for the battle that was going to happen anyway. So in that moment I probably should have just held the boundary and  then it’s okay again for him to be upset. We just we don’t set the boundary early enough so sometimes like we’re really just setting ourselves up to not handle it well.

5 tips for making bedtime easier


Laura: Okay so I want to summarize the strategies that you mentioned and then do a quick little talk about how the nuerodivergent piece fits in with this.

Tina: Let me just hit that like five strategies to like let me just punch it here quickly yeah

  1. Pleasant, association machine 
  2. Use playfulness, silliness not too amplified to create more that pleasantness but also to help them you know cooperate.
  3. Start early enough. When our children get tired when we all get tired in order to stay awake and continue to engage our body has to release adrenaline, epinephrine, and cortisol to keep us awake so if we wait too long to start the bedtime routine they’re actually going to be amped up even higher so start early enough. I know that’s hard with family schedules but as best you can start early enough.
  4. Don’t rush it and I know sometimes you are going to have rushed bedtimes, that’s just the reality of family life but one of the ways we can think about falling asleep as it’s actually one of the hardest things are young children have to do to down regulate their nervous system so you can think of that almost like they’re volume dial is up and to fall asleep their volume dial has to get turned all the way down so that time it takes time to transition and to down regulate you know just like I talked about tantrums that last more than like 20 minutes there’s a reason behind that and that is that when there is an initial reactivity that happens you get mad you get scared it takes about 20 minutes for your HPA access to release all that adrenaline and cortisol and all of that. It takes time to move through your body that takes you know 15 to 20 minutes so if the tantrums are going longer and you’re not ready able to return to baseline there’s a whole thing behind that and I think that’s the same thing with down-regulating is it takes time for us to turn that volume dial down and the more we can emphasize safety and the sense of safety a lot of kids have night time fears and then when parents are like you have to stay in your room if you come out you’re going to get in trouble that is that leaves the child in an unresolvable biological paradox which is either I go to my parent and I’m going to I’m going to get in trouble and that feels terrible or I have to stay in my room terrified, and that feels terrible, like don’t leave our kids in that kind of state. If your child is truly afraid this is not a behavior problem this becomes for us a prompt how do I cultivate a sense of safety and that might mean me staying in the room until they get that until they have that it might mean having a light on it might mean having music on it might mean having a pet or sibling in the room it might mean all kinds of things but what can cultivate your child’s sense of safet. If you think about falling asleep it’s the most vulnerable time we have as a sort of mammals like if you think about people who lived out in the wild before we had houses and stuff when you fell asleep that was in your most vulnerable state. Falling asleep is really an exercise and  we really have to feel safe to do that.
  5. The fifth one in the last one is come up with something with your kid that can be really fun especially if they’re like 4 or 5 or older have them come up with a lullaby playlist are you create one for them if they’re too young to do that, and you might want to switch it out every now and then or you can listen to some sort of mindfulness kind of thing my son loved this one on YouTube it was free and it was like a mindfulness falling asleep and this guy was like it was like a guided visualization where they were like in a hot air balloon and they were crossing the Plains and what do you see and I would like totally fall asleep listening to it with him. When you create playlists and you listen to some sort of mindfulness thing it gives your child something to focus on so they’re not thinking about the fears so much or not thinking about worries thoughts or whatever they’re focusing on it as their body is falling asleep to it several times their brain has also made an association between that and going to sleep. 


When and how OT can help with bedtime

Laura: What I want to then segue into in this last bit is talk about how you mentioned earlier and we’ve been talking about this whole time that you know the brain is an association machine right the neurons that fire together, wire together. The more experiences you have that are similar within the same context will create like this pathway your brain that’s like OH, I’ve done this before and this is my stress pathway I’m just going to go straight to triggered mode because it create a shortcut to melt down or tantrum or this fight or flight mode so what I always tell parents is that when you have a child with sensory processing challenges particularly sensory sensitivity, which is usually a bigger player for bedtime routine because of bath time, sounds, in the bath and like grooming, brushing hair, lotion all of the things, PJs all of that is sensory sensitive. What I tell parents is sometimes these things start out as a sensory trigger like this is painful on my body that is painful for my ears I can’t focus it’s too much of a over-stimulation. What once may have started like that when they were really young and the more often they have that kind of association because you have to do it everyday may then morph into this like anxiety and like learned fear and we need to start there.

I call it like decreasing the scare factor or undoing the scare factor of bedtime routine but so, my question then is:

If these aren’t working that might be sign that an OT might come in and help and really look at the context, the environment and try to pinpoint maybe it’s the bath time the sound of the running water or echo is triggering them and now they’re brain has associated that so they used to only cry in the bathroom but now their brain has become so efficient that it’s going to start crying and avoiding the bath time right after dinner and it just extends and so we need to create those positive associations which OTs often talk about the just right challenge so I always talk about playing in the bathroom outside of bath time to create fun positive experiences so the brain can start un-learning the scare factor and building new Pathways to regulation around that time so so OTs can really help pinpoint which part of bedtime routine is it, is it the separation anxiety about bedtime or is it the PJs or is it the tipping your head back when you have to rinse off the shampoo because your vestibular system is over response if there’s so many subtly things that that you can start with that we pinpoint that and then work on that in OT while also giving parents education on why it’s hard and that Insight goes a long way for just the compassion and like oh my gosh that makes so much sense I had no idea I thought it was he didn’t like water on his face but it was tipping his head back that was really hard for him so so that stuff happens a lot.

So I want to ask you that if at that point when you work with parents for bedtime routine and then you they work with OT on those longer-term skills how do you or are there any other extra tips that you give parents of neurodivergent kids in the moment for like while they’re still going through therapy but they haven’t quite built those skills yet are there any extra things that you suggest to them or is it kind of just like a trust the process you’ll get there one day type of thing?

Tina: Yeah I mean one of my favorite phrases that applies to all of us no matter where our kids are is to trust development and to trust the process I think that’s a really important part I think you know for me anytime I’m really worried about something that’s like about one of my boys or whatever if I pause and ask myself like is it better now than it was six months ago or is he better at being able to do this anymore than he was a year-ago? If the answer is yes then I can trust development. If the answer is no, I know that’s a really good indicator I need some support you know we need to figure out what’s going on.

The other the thing I would say is I think applicable to everybody but even more so with neurodiverse kids and that is this and this is this is kind of the the main point of my book “The Power of Showing Up” that I wrote Dan Siegel is that one of the best predictors for how we turn out on everything we measure a kid’s on is that they have secure attachment with at least one person and by the way that’s not at all attachment parenting, that’s different. So how do we cultivate that how do we cultivate secure attachment if it’s one of the most important things we can do for our children no matter if they’re neurodiverse or neurotypical and really Dan and I talked about the four S’s and for me this is my Northstar so no matter what’s happening with my kid or with any kid in the moment if I’m the therapist or I’m coaching another parent for their Neurodiverse kid  If I can give the four s’s as my response it’s always the best response and here are the four s’s 

One, I help them feel safe right so that’s that one things like I’ve got you you’re safe number two is seen. That’s why I’m like I know buddy it’s so hard when it feels unfair and the brothers get to stay up and you have to go to bed and when you don’t get what you want it’s really hard I know so we really like let our kids know and it doesn’t even have to be verbal it can really just like be pulling them to us and taking a breath and rubbing their back to let them know like I see you’re having a hard time right now so it’s really that idea of them feeling felt and really like someone gets me so that’s the second, so safe and seen.

The third one is soothed this is where we provide comfort and nurture and help and when our kids are physically hurt this is easy to do but if it looks like behavior or it looks like disrespect or you know they’re coming at us or it looks like a tantrum it’s much harder to do but the part of the brain that registers physical pain is the same part of the brain that gets activated when there is an emotional and physiological distress from a stress response or from a big feeling so in that moment our whole job is to say so you know when when my kid was thrashing in the bed and I end I was holding the boundary I could say I know it’s so hard and I’m right here with you while you’re feeling it and I just I don’t have to spend so much time to figure out what do I do and do I give a consequence I don’t have to worry about that my job is to show up in that moment with my presence and communicate to him I can handle his big feelings, and you can handle big feelings, and when we get on the other side of this you’re going to have so much more resilience knowing I can handle big feelings like this so we soothe them and then that’s the answer, safe seen and soothed because when our kids have repeated, not perfect experiences of feeling safe, seen and soothed, then they develop  that 4th S,  security and that is where their brain wires to know that if they have a need we’re going to see it and show up for them and then over time they learn how to show up for themselves how to keep themselves safe how to see and understand themselves how to soothe themselves and then how to show up for other people. So to me when we’re talking about neurodiverse kids,They may need more keys of safety they may need more feeling seen and understood they might need more soothing and they might need more reps of feeling like my parents got me going to keep showing up for me when the world overwhelms me so to me that’s my Northstar not only as a mom but as a as a professional and as a wife and at the best friend and is a daughter and a sister all of the things we all need to 4 s’s but I think it’s especially true for neurodiverse kids. So they may need more of the 4 S’s.

Laura: I love that. I like how you say that it can apply to not only all children but even ourselves in all the different roles that we have in life so that’s great what a great way to end the episode. I love all the stuff that you gave us today with discipline and with bedtime battles but before we sign off I want you to share with us how can we find your center how can parents work with you if they want to work with you and then any other exciting projects and books and all of the stuff that might be coming out soon so you share with us.

Tina: I’m easy to find my website is www.TinaBryson.com I’ve been on lots and lots of podcast so if you just Google me you can find me. My favorite place I’m on all kinds of social media but Instagram is my favorite place right now and I’m posting a lot of stuff there @TinaPayneBryson is my handle there. My center is thecenterforconnection.org and they’re also on Instagram. We also have in the last year we opened a place called the center for connection neurodiversity so we actually have it OT based in Duarte California it’s 2 of our Occupational Therapists did this branch out project and it’s part of the center for connection but it’s really on focusing on supporting kids and parents who are neurodiverse as part of their family so I’m really proud of that as well so you can find that that’s @at_the_center on Instagram and a couple of really fun things in fact speaking of bedtime this is a good one to tell you that I was on Netflix has a podcast called Bedtime Stories and it’s actually kids’ favorite Netflix characters telling Bedtime Stories and I got to consult on all the scripts and they are adorable and lovely and they really are I worked with them to make there be episodes where kids learn some interesting things but it’s really about helping down regulate toward falling asleep so it’s a really great tool that you can listen to it after you said goodnight as they’re falling asleep on her own but you can also listen to it with them as your snuggling it doesn’t replace bedtime routine and it’s not screen, it’s an audio podcast but that’s a that’s a really fun thing that I’m working on, it just launched about a month ago but it’s just it’s it’s called bedtime stories it’s adorable but little characters are so cute. I just I just think it turned out really great. Yes and lots of projects in the works not ones I can say are for sure going to happen but maybe a children’s book maybe yeah and I’m doing a lot of business consulting right now which is super fun bringing some of these ideas into corporate culture and I’m trying to work a little less. I’ve got one guy at home still, the other 2 are in college and I’m really trying to savor these last few years.

 


Transcript/show notes at www.theotbutterfly.com/27

instagram: @TheOTButterfly www.instagram.com/theotbutterfly

email: LauraPetix@TheOTButterfly.com

work with me: www.theotbutterfly.com/parentconsult

Connect with Dr. Bryson: 

https://www.instagram.com/tinapaynebryson

https://www.facebook.com/TinaPayneBrysonPhD

https://twitter.com/tinabryson

www.TinaBryson.com

Links for Dr. Bryson’s Center
 
https://www.thecenterforconnection.org/ot-home

https://www.instagram.com/at_the_Center/

https://www.facebook.com/thecfcn

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Laura Petix, MS OTR/L

I’m an enneagram 6, so my brain is constantly moving. My OT lenses never turn off and I can’t “un-see” the sensory and other developmental skills that go in to literally every activity. I love taking what I see and breaking it down into simple terms so parents can understand what goes into their child’s behavior and skills.

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