[Introduction note]
Welcome to Born to Be Free, a podcast from Learn Play Thrive Continuing Education. On this podcast, we explore how to support the deepest wellbeing of our neurodivergent clients. I’m Meg Ferrell, and our show intro was recorded by my six-year-old daughter. You can find show notes at learnplaythrive.com for all of our episodes, as well as options for in-person and live-streamed continuing education trainings for OTs, SLPs, and mental health providers supporting Autistic kids. If you like the show and want to go even deeper into what it looks like to truly put neurodiversity-affirming practices into action in real life with all of the complexities of our work settings and our clients’ needs, don’t miss our Patreon series at patreon.com/learnplaythrive. Thanks for being part of the Learn Play Thrive community.
 
 Meg:
In today's episode, we're going to continue the conversation about PDA with Stacey Curnow. Stacey is a parent, practice owner, and the author of an upcoming book on PDA that she's writing together with Dr. Ross Greene. So, in today's conversation, Stacey shows us what it truly looks like to lead with curiosity and compassion in our work, especially in our work with PDA-ers. In this episode, Stacey shares with us how Dr. Ross Greene's framework of Collaborative and Proactive Solutions guides her work. We talk about supporting parents, teaching daily living skills, supporting kids with aggressive behaviors, kids in burnout, and so much more. 

About our guest: Stacey Curnow is an AuDHD-er, family therapist, and the founder of Asheville Family Counseling. She specializes in helping parents of complex neurodivergent kids move from power struggles into trust, collaboration, and real problem-solving using Dr. Ross Greene's Collaborative and Proactive Solutions framework. If you're not familiar with Ross Greene, you're gonna love him. Go check out his work at livesinthebalance.org. So, Stacey is currently writing a book called 'The PDA Kid's Solution: Understanding Pathological Demand Avoidance and Finding Out What Works for Your Child', being published in the fall of 2027 by New Harbinger, with Dr. Greene providing oversight and the foreword. 

Her work helps families understand what's actually getting in the way for both kids and parents so conflict can give way to connection. PDA is not a behavior problem, and in this episode, we're going to talk about how we can get so focused on the behaviors when we should instead be looking upstream at what's causing them. Here's the interview with Stacey Curnow. 

Hi, Stacey. Welcome to the podcast.

Stacey:
Hi, Meg. I'm so happy to be here. 

Meg:
It's nice to have you here, and it's always fun to sit down and record with somebody who's local in Asheville. That's a nice treat. I want to start with your personal story. How did you come to do the work that you do? 

Stacey:
Well, I really did come by it personally. I have an ADHD kid, and he started showing, again, what we're now calling PDA, but he's now 21. And so, when he was 4, I didn't have, we didn't have this understanding. But because I've always had a very strong attachment theoretical lens, I centered him. I was curious about him. I wanted him to know that I was there to help and support. And so, we really figured it out together. 

And so, I feel so grateful now that parents have this new lens of PDA to look at their kids through, that we're leaning more and more into attachment theory, and that it's becoming more widespread, this understanding of human beings, and how we're attachment creatures, and how we do better together. And so, again, it really started as a parent. Because I became a counselor, a family counselor, later about when my son was 12-years-old. So, before that, I was a nurse midwife also working with families in their most intimate, vulnerable moments. So, I think I've really seen the lifespan with families and have noticed the same principles apply and really work.

Meg:
Absolutely. I'm really excited as we move through this conversation to hear you talk more about the attachment lens on top of understanding how PDA-ers work and what makes them feel safe. 'Cause as a- parent, that really resonates, right? We come in going, "I want to know you. I want you to feel like you can be your whole self here, and like you're wanted and celebrated as your real self." 

Stacey:
Yes. 

Meg:
And I think it's easy to miss that. Like, as an OT, I was trained to help kids meet developmental goals. And I didn't yet have the perspective of that parent where it's like, oh, my deepest goal is to know and feel connected to this child as they are.

Stacey:
Yes. Yes, exactly. And if we can do that in all of our relationships, in personal and professional, they're all going to thrive. Those relationships are going to thrive. 

Meg:
Yeah. The more experiences of secure attachment that these kids have with all of the adults in their life, yeah. It's so useful to name that. Can you share with us some of your foundational beliefs about PDA, and your values that you bring to your work, and how these shape the ways you support PDA-ers?

Stacey:
Yes, happy to. The key takeaway, I hope, is that PDA is not a behavior problem. We very often get focused on the behaviors, but I like to do what's called, like, the behaviors are downstream, and we wanna look at upstream, at what's causing the behaviors. And from my perspective — and again, this is where I think PDA is really helpful — is that it's a nervous system and autonomy issue. And that for these PDA kids, everyday expectations, again, what looks on the face of it as not a big ask actually do register as threats for these kids. 

And so, those behaviors, again, that we're seeing downstream, I think are best understood as stress responses. And again, not as a choice. They're not making a conscious choice to have these behaviors. They are, in fact, in my opinion — and this is the hill I'm gonna die on — is that they are the downstream results of stress responses.

Meg:
That's useful. We've just had Dr. Bowen Marshall on the podcast who said, "If I could — if you have one takeaway for providers, it's to say what makes this 'behavior' that we're seeing make total sense?" And I put 'behavior' in air quotes a little bit. But, there's something that makes this make sense, and we need to get curious about it.

Stacey:
Absolutely. And we need to get curious about it. So, that's definitely, again, another foundational belief or value is that we need to bring, first and foremost, curiosity and compassion to it. Curiosity that I wonder, again, what's happening? How could this make sense? And then, compassion with kindness, with support, with understanding that we're going to meet with that. And I mentioned earlier that — so we kind of touched on the nervous system, that we're seeing these behaviors because the nervous system is overwhelmed. 

And when the nervous system is overwhelmed, again, it's not a conscious choice, but it's a reaction around fight, flight, freeze, or collapse; or that appease, that sort of people-pleasing behavior. But the other piece really is autonomy. And what we see is autonomy is not a 'nice to have' for PDA kids. It's really a need to have. And this is where, again, you can even have a parent who has two kids, and one of them has PDA and one doesn't. And again, for one, you would notice that not having choice doesn't impact the one kid who doesn't have a PDA. But the PDA-er, that's how you can kind of distinguish it, is that autonomy is really central to that sense of felt safety in the nervous system. 

And so, again, what we have to realize is that, yes, we see this as, you know, if they had the skills, for emotional regulation, for making transitions, for sitting with complicated frustrating tasks, we wouldn't see these behaviors. So, we can definitely develop those skills, but we can't develop those skills if we don't have the nervous system safety, right? That's where we understand that the prefrontal cortex, which is responsible for learning, is actually offline. And so, we want to, again, kind of put all these pieces together and realize that, yes, these kids can develop these skills, but only when they feel safe and they're in an environment where they feel seen, heard, understood, valued for who they are. 

Meg:
Can you talk a little bit more about safety, autonomy, and trust? 'Cause I know a lot of us have this really superficial example of giving toddlers two choices, right? Which may miss the mark for developing a real sense of safety, autonomy, and trust for our PDA-ers. So, can you go a little deeper into that? 

Stacey:
Yes, because it does miss the mark. When a parent or a provider offers two choices, those are still the adult's best attempt to, again, meet the child's needs. But it really highlights the issue that they don't know, and if they're seeing a nervous system response on the kid's side of it not getting the outcome that the parent or provider wanted, right? If the parent or provider is offering two of their best attempts to meet this child's needs and it's not working, then again, we have to be curious, and we have to just default to, "Oh, I guess that didn't actually meet their needs. I wonder," right, "I wonder what could?" 

And that's where we can involve even very young children. We do this a lot better with infants, right? And of course, we've all, if anyone's ever tried to care for an infant before, they know that can be frustrating. And the word that came to mind was 'demoralizing', that there's somehow something wrong with us, that we can't figure it out. And so, again, I think that as kids get older, we're like, "Oh, I'm so glad I don't have to figure this out anymore because I'm really not that good at it. I saw that I had these deficits when I was working with an infant."

But again, if we can just put ourselves back in that mindset that we were willing to try with an infant different things, trying to imagine what they would want, that would serve us really well in our relationship with even these young children that we're seeing in their response that we're not hitting the mark, as you said. And so, then even with young children, I mean, I've used this methodology I'm gonna be sharing with you today with three-year-olds. And so again, it is an aspect of cognitive ability in a sense. But even with non-speaking children, we can use from signs, from flashcards, to symbols, right?

So, again, we wanna be thinking, like, "How can I communicate with this child?" And there's always a way. Again, we do it with babies, we can do it with anyone else. And so, when we start looking for ways, like, one of my favorite ways with this three-year-old was just to do the thumbs up, thumbs down. That I would take guesses, "Oh, is this what's hard for you?" Because we're always thinking, what's making it hard for you to meet this expectation? Because we're really — I mean, if you boil it down, we're only seeing these stress responses around the difficulty that the child is having in meeting our expectation. 

So, first, we wanna be really clear about what our expectation is. And then, we want, again, with these younger kids or these non-speaking kids, we wanna get really clear about, like, "I wonder if there's a way that we can connect around this difficulty that you're having." And then, again, one of my favorite things with this three-year-old was first coming up with playful guesses. So, the issue that we were working on with her was her difficulty washing hands after she used the bathroom, and specifically around peeing, because we really do — this is something so important I wanna communicate to our providers listening, our parents, our therapists who are listening, is that the specificity is extremely important.

So, that's why I said it wasn't just like washing your hands after going to the bathroom, it was washing your hands after peeing. Because for this child, it actually wasn't hard for them to remember with poop, because again, they had more of a sense of, like, "Oh, I don't want any poop on my hands." But when they didn't see any evidence of any, you know, kind of soiled appendages with the peeing, it was harder for them to take the time to wash their hands. So, again, the, mom was saying, "Oh, she's not gonna talk to you. She just tells me —" you know, again, "She just has these meltdowns when I ask her what's hard." 

But then, again, I'm like, okay, so then we're seeing that she's having difficulty answering the question when posed with a direct question, right? So, maybe if we had more of this curious and playful kind of interaction... So, I just started with silly examples. Like, "Oh, is it hard because the soap is too scratchy?" And she was like, "No, soap isn't scratchy!" right? So, that was like, she said 'No' while she was giggling. And then, it was like, "Oh, is it because it's too purple?" And she was like, "No, the soap isn't purple," right? And then, I eventually, like, when I just had her giggling a lot, I asked her, "Is it because it takes too long?" And then, she said, "Thumbs up." Yeah.

But again, when we go into this methodology, this model that I'm gonna share, we're really holding two different aspects. And one is that — well, first, we start with the expectation, and that's really specific. Saying, again, difficulty washing hands after peeing. But then, we wanna hear, first, what's hard for the child, right? For that child, it was that it took too long. And then, we also wanna hold what we call that adult concern. So, again, that could be the provider, the parent, saying — this mom's concern was washing the germs away so we don't get sick, so you don't get sick, so no one else gets sick. 

And if you think about the provider, I think we were talking about this before we even started the podcast, that of course that there are providers who have this idea of, "Oh, I really want to essentially work on this skill with this child." And so, again, we'd wanna think about what is the provider or the parent's concern. And we really do wanna focus it on one of five different areas, because if it's just the adult's personal preference or their value system, yeah, that's gonna be a no for a PDA kid who, again, they're very justice-oriented too, around fairness. That's not fair, essentially, for you to impose your value system on me, right? And that's something that we do learn as therapists, as providers, too. 

But again, these PDA kids from a very young age are very sensitive to that. But again, a totally valid concern that a provider or parent could bring around health, safety, learning, right? So, that provider who's like, "Oh, I really want to help this child learn this skill," right? And then, the other two are fairness, again, and the relationship. Because those are concerns that any human being has. This gets back to attachment theory, that we all wanna feel safe, we all wanna grow and learn, we all wanna be healthy, we all wanna, again, be in a system that supports justice and fairness. We all want to be in relationship. 

And so, again, though, getting back to that learning skill, we wanna get back to that idea that if the child is overwhelmed, again, and the prefrontal cortex is offline, they're not gonna learn in that environment anyway. So, much better to kind of back up and focus on the trust which is built around the empathy, the listening with curiosity, and meeting the child with understanding.

Meg:
Thank you so much for sharing that. I think that 'I wonder' tool is so powerful. I remember, as a new provider, feeling like I was supposed to know a lot of things, and that pressure to make kids do things so that I could document progress, but also prove to myself and the others watching that I knew what I was doing and was an actual OT. And I was explicitly taught to wonder, to be a detective, to be curious, to say, "Wow, that really upset you. That is such good information for me. I wonder what about this activity felt so bad." I wonder. 

Stacey:
Yes. Yes. 

Meg:
Very, very powerful shift out of imposter syndrome and into relationship with the person in front of us.

Stacey:
Yes. That's perfect. I'm so glad you got that because I don't, again, think that we do get that very often in our training. And so, I'm so glad that you got it in yours, and that you're highlighting it here, because that one shift changes everything. 

Meg:
It really does. I'm very curious about the ins-and-outs of how you practice and how you integrate Ross Greene's work. Can you talk to us about how you support your PDA clients? 

Stacey:
Yes, absolutely. And again, I think it just started foundationally with this curiosity and compassion I had for my own kid, and then later as I became a family counselor, realizing how important those principles were. And then, I found a model, and you might have heard me call it 'my model' because I do feel so much loyalty to it. And so, about five years ago, I became a certified provider in the Collaborative and Proactive Solutions Model that was developed, created by Dr. Ross Greene. And many of you may know him from his wonderful book, his seminal book written now over 20 years ago, 'The Explosive Child'. He's also written 'Raising Human Beings', 'Lost at School'. So, again, I'm really following in his footsteps here. And again, you know, as a provider, we could — there are hundreds of theories, models that we could lean into, and I leaned into this one. And I feel so strongly about it because it works with everyone. His key phrase is really, "Kids do well if they can, not when they want to," right?

Like, this idea that 'If they wanted to, if they tried harder, they would' is really wrong because it's not a want, it's a can't. And then, it was so easy to extrapolate from that, that parents do well if they can, providers do well if they can, because doing well is preferable for everyone. And so, when we just go back to this model and use it as this framework for understanding what might be getting in the way of doing well — again, for the kid, for the provider, for the parent — it changes everything. 

And so, first, we wanna get really clear on what our expectation is. Because adults, again, with this wonderful prefrontal cortex, this problem-solving function, we're generating solutions all the time. But the problem is that we often impose them on kids, and Ross Greene calls that a unilateral solution, meaning it's just coming from the adult; as in contrast to the collaborative solution, which means the child and the parent, or the provider, the caregiver, the teacher, are doing it together. 

And I already gave you the two pieces. After we've identified the expectation, we also want to understand the child's concern, and then we wanna present our concern. And again, around the safety, fairness, learning, health, and relationship. And then, the third step, so it's simple but not easy, because again, there's many places where we can get off track, but the third step is simply the invitation to solve the problem with the child. And it really sounds "Hey, given your concern that washing your hand takes too long, and my concern about your health, I wonder if there's a way that we could solve for this that would be realistic," meaning we can both do it, "and that it's mutually satisfactory," meaning it meets each of our concerns. 

So, in that case of that small child, of that three-year-old and the handwashing, she said, "Well, if I could just do it, you know, for like for three seconds?" And the parent was, who was actually a doctor, was like, "Well, nope." Like, the jury's out — I mean, the jury's in. You're not going to get sufficient handwashing from three seconds. And so, then I wondered if there might be a hand sanitizing gel that the child could use, 'cause that would just take a few seconds. 

And then, the parent — so then, we were like, is it realistic? Could she use the hand sanitizing gel? The kid said she could, 'cause she was already familiar with those. And the mom said, "Well, yes, I think she could. But I would have another concern about her health, which is whether there were any toxic elements in the hand sanitizing gel." And so, then the question became could she find, could the parent find a hand sanitizing gel that wasn't toxic. Because again, the child was still sucking on her fingers, and so didn't want her ingesting anything toxic, and she did find it.

So, then, again, we sort of checked the criteria, which is: Was it realistic? Could they both do it? Yes. And was it mutually satisfactory? Did it meet the child's concerns about it taking too long, that it'd be a very short time, and the parent's concern that it sufficiently cleaned the hands? And so, it did. And so, again, this wasn't any longer — I mean, again, the parent's solution to that had been wash your hands for 20-seconds while you sing the Happy Birthday song, right? And that did not work for the child. And so, again, as long as we're continuing to really include the child in the solution, we're gonna get that solution that's gonna work for everyone.

Meg:
Yeah, I really like the way you brought in the relationship with the parent. Because I think, especially again for new providers, I remember just giving a lot of information. And as I became more comfortable and more skilled, I noticed that if a parent said something like, "Yeah, I'm probably not gonna try that," I was like, "Yes, I'm in." Like, we're having a conversation, they're sharing with me, "These are the things that don't work for me about that." We try to tell providers if you give an idea and the parent's like, "No way," good job building that collaborative relationship. But I like the way you bring in that curiosity with the parent, too.

Stacey:
Yeah. Oh, my gosh. I mean, again, it's so important to, again, apply that curiosity and compassion to the parent as well. I had a situation with a parent where I was, again, trying to take them through the model. And the issue that we were working with was the difficulty the child had keeping their glasses, right? 'Cause they were often losing their glasses, or they were sitting on their glasses, or stomping on their glasses. And so, the parent had gotten so frustrated that the parent was like, "I'm not buying any new glasses. You know, whatever, if you've broken the glasses, I'm just gonna repair it with duct tape." And so, this was a six-year-old girl who was going to public school at the time and was feeling bullied by the appearance of her glasses. 

And I had a hot button issue around that where I really said to the dad, I was like, "That's not okay, right? That's punishing the kid for, you know, not having the skill set yet to maintain their glasses." And the parent really pushed back to me. I mean, it almost destroyed the trust in our relationship, but got really upset by my view, again, my value system, that that would be punishing the kid. And he said, "I don't look at it that way at all. I mean, I'm not — again, my intention is not to punish this child, and glasses are expensive, and we don't have the money," and I had missed that. I had missed that there could be another concern that would be driving this parent's behavior, and I hadn't been curious enough. I hadn't been compassionate enough. Luckily, they let me repair that relationship, and we ended up doing really good work together. 

Meg:
That's such a good example. Yeah, that listening with curiosity is part of culturally responsive care as well because we don't know what we don't know about a family's culture, their beliefs, their values. I first heard of Dr. Ross Greene's work when my oldest child was three. And he was — he had a tablet that he got to use for, like, 10-minutes during a certain routine of the day that was otherwise very hard, and that was really working. But when tablet time ended, it was very, very hard. 

And I heard about Ross Greene's work, and people were like, "You'd be surprised the ideas little kids can come up with." And I was skeptical, but I was like, "All right. I'll try it." And I was like, "What can we do? It's not working for me that you're yelling at me. It makes me not wanna let you have this time, but I know you really enjoy it, and it's making this other routine work. What can we do? What ideas do you have?" And he said, "Well, when the timer goes off, you should go ahead and take it, but then give me a big hug."

Stacey:
Oh, that's so sweet.

Meg:
It's so simple, and it totally worked. And it was just so insightful, and I've been a believer ever since 

Stacey:
Yeah, absolutely. And it's such a great opportunity to talk about how it's so wonderful when we get a collaborative solution where the kid is just able to tell you, "I think that this would help," and then it actually helps because it highlights another really important aspect of this model is that the model is skill-building in itself. Because, again, we really are saying that the child is having difficulty because they haven't developed these skills yet of making transitions smoothly, of sitting with frustration, of taking on the perspective of the other person, of being able to not be black-and-white, that it has to be always this way or the other way, right? These are skills. 

When I kind of show parents the skills that the child is probably struggling with and that are probably what are the kind of the root causes of the difficulty they're having, 9-times-out-of-10 the parents will look at the list and say, "I have trouble with those skills. I have trouble with taking the perspective of another. I have trouble sitting with difficulty and in and finding collaborative solutions." And it's really great to realize that, yeah, as human beings, I think our whole lives we're gonna be able to kind of maintain and execute these skills at different levels through our whole life, right? 

Because, again, it becomes a capacity issue. It's much more easy for me to stay with the complexity of a problem if I'm well-rested, if I haven't been sick, if I don't have a lot of stressors competing for my time and attention, right? And the same is true for these kids. So, getting back to the model, when your kid said, "I think it would help if you just took the iPad away and then gave me a hug," and it worked, that's fantastic. What I want to highlight — and again, it's a part of the model — is there may have been a day where you took the iPad and offered a hug, and that didn't work for him. 

And so, we really build in, hey, that's okay. If a solution that we agreed to one day doesn't work or doesn't even work the first time, no problem. We've just got more information, right, that it's actually not enough to just take the iPad and give the hug. Okay, so what else, right? What else might we need to do? And your example was very helpful because in the model, we actually never talk about the concerning behavior or the undesirable behavior. In your example, you said, "Hey, I really don't like the yelling."

Meg:
Yeah, this isn't working for me. Yeah. 

Stacey:
This isn't working for me. But just, it's perfect to highlight that. So, in the model, we would not highlight the behavior that we don't want. We would kind of go back to our expectation and focus on what we do want. So, when I was listening to that story, I think the expectation would be 'Turns off the iPad after 10 minutes', right, or whatever that timer had been. So, that would be the expectation, right? 'Difficulty turning off iPad at 10 minutes'. So, then we would go back to that, right? "Oh, I'm seeing that, the, taking the iPad and the hug isn't really helping anymore with turning off the iPad after 10 minutes. What else do you think might help?" So, we don't say, like, "Hey, you said a hug was gonna help," right? I know I've done that where I just go back to, like, "Hey, you said —?" Yeah. 

Meg:
It's hard as a parent. I think that the expectation should be higher as providers, too. I love that though, that they are getting to practice making a choice, see what happens, because that is a lifelong practice. For folks who are on our Patreon, we have an episode on PDA — well, it's on PDA, but also on sensory regulation with Autistic PDA-er and OT, Sorcha Rice. And she talks about autonomy with choosing what sensory regulation strategy you want and getting it wrong, and noticing that. 

'Cause as providers we're often like, "Ooh, we want to pick the right thing and regulate the child," and she really highlighted similar to what you're saying, that trying something and being like, "Wow, that didn't work. What else should I try?" is part of the process of learning. I think we, as providers, have to increase our distress tolerance to move through that. But the other thing I was thinking as you were talking is how we're modeling the curiosity, and the flexibility, and the perspective-taking. It's unfair the way children are so often asked to take others' perspectives constantly when we aren't modeling taking that child's perspective. 

Stacey:
A hundred percent, a hundred percent. Empathy, I think, compassion — and my personal belief is that compassion is innate. I think human beings, we naturally innately care. Do we innately care about each other? But empathy is a skill, in my opinion. That ability to take the perspective of someone else, that is empathy. That is the 'I understand, I've walked in your shoes'. And we all have, again, that we wanna feel seen and heard and understood. And so, again, by modeling it, that's how kids learn it.

We can't just tell a kid to be more empathetic; we have to show them. They have to have learned it. And it was interesting you said something just a few minutes earlier about how, again, as providers and parents, we're expected to regulate the child. And again, this is where if we lean into attachment theory, the belief is really that regulation happens together. Again, we co-regulate. And so, again, very often when a child is showing a stress response, what's happening in our nervous systems, too, as the adults? We're also very quickly getting activated, right? Anxious, frustrated; and then, our nervous systems are just being in that distress. 

And you can't fake it with a PDA-er. Of all the kids, you can't fake your regulation around them. You can't put on a sing-songy voice and hope they don't notice that you're actually in freeze or fight. 

Stacey:
A hundred percent. Because again, I believe that's a human aspect is that — I call it our nervous systems are always talking to each other, no matter what our facial expressions look like or the sing-songy voice, I love that example. That the kid is, again, I just see these PDA-ers as very sensitive, like, having very sensitive nervous systems. And so, again, they're more likely to pick up on these kind of non-verbal cues. And we have to really, you know, we have to just admit it.

Because I've worked with so many parents and providers where they say, "Oh, no, I was calm." And I was like, "Well..." you know, again, just like that. [Laughs] Like, I know you probably were using a calm voice. You were low and slow, but what was happening inside your nervous system? And they said, "Yeah, I was panicking. I was..." Because again, like, the classic example is I was at the grocery store, we were at the child's birthday party, and I really wanted this kid, my kid to do okay. And I saw them getting dysregulated and that was so hard for me. Totally understandable. Yeah. 

Meg:
Yeah, thank you for sharing that. I've said this before, but my oldest kid has the gift of a lot of language to explain his thoughts and feelings. But I remember him saying to me when he was around four, "I don't like that tone of voice. It's like you're acting like you're calm, but you don't actually feel calm." 

Stacey:
Nice. 

Or like, "The way you're talking doesn't match how you feel to me right now," or something like that. And I had worked in preschools and stuff, and was pretty good at just sort of superficially doing the like, "Hey, guys," you know, kind of just phoning it in. And he was saying, like, "I need you and your nervous system here with me in a congruent way." And it was hard. It was actually a pretty hard shift to learn how to do that. 

Stacey:
Yes. Yes, so hard. I'll never forget, because my kid had those explosive behaviors, and it would automatically send my nervous system into freeze. Like, I would just freeze, a deer in the headlights, and not be able to stay connected to him. And he was about 10 or 12 when — and again, he's 21 now — he was 10 or 12 where he actually said to me, "You didn't go away that time." Or meaning not physically, 'cause I would stay with him, but I would be, you know, again, this isn't a video that people can see, but imagine someone frozen, deer in the headlights, and not being able to act. 

And so, then this one time he had an explosive behavior, and I was just able to stay with him, my nervous system regulated, saying, "That sounds so hard. I see how hard you're working, and that didn't work out. I'm so sorry. What do you need? How can I help?" And, his response was, "Wow, you didn't go away that time."

Meg:
You didn't go away. Yeah. He was noticing all along. That's so powerful. 'Cause when we stay with our kids in those hardest moments, they get to stay with those parts of themselves, too, right? They don't have to cut them off and push them away. 

Stacey:
Yes. 

Meg:
That's a good segue. I want to ask you about aggressive behaviors. What guides your work around supporting kids with aggressive behaviors, and can you share some examples? 

Stacey:
Yes. Again, so to highlight and reiterate again and again that these concerning behaviors are stress responses. Aggression is a stress response. And of course, that does not mean it's okay or that safety doesn't matter, we need to somehow condone this behavior. But it means that we need to understand that this child has been pushed past their capacity. And again, just to kind of imagine what I've been talking about upstream and downstream, I look at it as like something has pushed them into the rapids. And now, that aggressive behavior is them flailing for survival. 

And again, it's not a choice. It is an unconscious nervous system reaction. And so, as parents, again — and this is a foundation of the model, the CPS model too — is that we have to get better at noticing the earliest signs of dysregulation because they're showing them to us. I'll never forget working with a six-year-old child and was working with the parents trying to — and it was our second session, and the first one had gone really well, and this is where it gets back to capacity. 

So, we had done the first session while the child was on a winter break and so hadn't been going to school. The second session happened after school, right? So, we're already like this kid is out of capacity. And the first thing that I noticed was that before we had really good eye contact in that first session. The second session, he was not making eye contact with me at all. And so, that was — and again, I'm just gonna like kind of rush to the end saying I didn't pick up on these signals early enough. But looking back is when I realized, like, oh, my gosh, he gave me all these signals, and I didn't notice them.

But if I had stopped at the noticing that he wasn't making eye contact, we wouldn't have had that aggressive, explosive behavior that we had in that session. So, now — and then, I talked to the parents like, "Have you noticed that first he won't make eye contact?" And then, the second thing that he did was he hid behind a chair, and made himself very small. And still, I just thought, oh, I'll just make myself small with him. So, I just got down on the floor, and I curled myself up and spoke in that low, slow tone. And what I got from that was a growl, right? So, again, I hope this is helpful to people to say even me, even with my background and all of my training, I really messed this up. 

So, the next thing that he did was pushed the chair violently at me, right? Again, just to kind of give you the flavor, right, it was an aggressive push that could have hurt me, but I was able to move out of the way. But this is the behavior that they see with this child, the parents were seeing with this child, and it was leading to a lot of conflict in the home with a younger sibling, right? So, again, it's like, oh, but he's giving us the 'tells', is what I call them. He's giving us the earliest signals. And really, if you think about it, we shouldn't have planned for a session after he had a full day at school, right? We should have anticipated that is not a good time. 

And so, again, I hope you're hearing that aggression is a stress response. We need to really understand what pushes a child past their capacity. And again, these are reliable, these are reproducible. These are not surprises. Again, a child could get in a totally novel situation and show this behavior, and the parents say, "Well, I didn't know because it was a novel situation. How would I have known that they would have responded that way?" And I'm like, "Well, the novel situation is a stressor," you know? We should have been able to say, like, "Oh, what is my child's capacity?" And that's again, there's so much great things that, again, we can either anticipate that they're gonna have decreased capacity, but even very young kids, like the six-year-old, we started talking about Spoons Theory very early.

And I think a lot of providers, OTs now have this idea of Spoons Theory that this idea, that if we're at full capacity, we have 12 spoons, but we may wake up with only 8 spoons, and then we quickly lose spoons. And I would say kids really respond to this. I've even given kids going to a restaurant supply store and buying a bunch of cheap tinfoil spoons, and then giving them a Ziploc baggie of 12 spoons and having them go throughout the day, you know, like, taking the spoons out of the baggie, and then having this kind of understanding that, hey, if you're at 6 spoons or less, we're not gonna — we're gonna start reducing demands quickly, right? Reduce expectations very quickly. And then, when we do that, we're not seeing those explosive, aggressive behaviors.

Meg:
Yeah. I love that you chose an example where you missed it. Because one of the things I hear the most when I interview people about how we support PDA-ers, it's to move through rupture and repair with them. To say, "I missed that. I pushed you when I should have heard what you were telling me, that it wasn't the time. And I'm sorry. And next time," here's what, you know, we're gonna move through a real repair process, which goes back to trust, right? Now that's we're building trust. Yeah. 

Stacey:
Yes. Yeah, and that's so important because, again, these PDA kids, they want to do well. That's one of the things that I've learned from them, is that it's crushing to them. They feel very ashamed that they can't meet expectations, and they see their peers doing it. They see their siblings doing it. And so, they feel, again, a lot of shame. And so, again, to be met with understanding, to be saying, "Hey, I messed up there. I'm so sorry. I should have seen your lack of eye contact as your sign that you were past capacity, that this was too much for you, and I'm gonna try and catch that earlier. And you're good. Like, you're good." Yeah. It's totally understandable. 

Meg:
I think the really cool thing is the way this is foundational for their own self-advocacy. 

Stacey:
Yes. 

Meg:
That we are noticing for them, and we're honoring it for them. But over time we're gonna be noticing and honoring with them. And then, you hear kids turning towards themselves, "Oh, I noticed this. I think I need this." But it has to be scaffolded, right, as 'I'm gonna do it. This is gonna be my job right now'. I tell this story from my own parenting, where I was at a, like, a camping/glamping place that had a pool. And my kid, who was like seven or eight who loves swimming, swam with their friends for 10-minutes, and then said, "I'm done. I'm going back to the tent." 

And I noticed the urge in me to say, "No, we've only been here 10-minutes. You love swimming. Let's keep going." And then, I was like, Meg, that is that self-awareness, that self-advocacy that kids work so hard to find. 'I noticed I feel tired. I need a break back at the tent'. And so, you say, "No, keep going," and then they explode, and you say, "Next time just say, 'I need a break.'" And it's like, "Yeah, but I already did that, and it didn't work."

Stacey:
Yes. 

Meg:
Yes. It's so easy as a provider to be like, "But, I was gonna work on this in this session. And I have to document, and I wanna feel like we're making progress." We have our own agenda. And it can be so easy to miss the magical thing that's happening of this kid showing us what they need, and the trust.

Stacey:
Exactly. 

Meg:
Yeah. 

Stacey:
Yes. And I work with so many, because I am the founder, the owner of Asheville Family Counseling, so I have many counselors in my practice, and we talk about this all the time, especially the child therapists who, again, are like, "What do I tell the parents when the kid says, 'I'm done with the session,' at 20 minutes?" And I say, "You say the kid said they were done with the session at 20 minutes." And then, when they come back and are more regulated, have more capacity, you can look at what was the thing, again, that seemed to push them past capacity. 

"Hey, I noticed when I asked you to transition from, you know, that activity you were enjoying to this activity that I thought would be good for you, that it didn't go well. What was hard about that for you?" And then, "Oh, okay, yeah, if you're enjoying an activity, of course we can keep doing that," right? Or, "If there's something that I think is important, again, for your learning, how could we also include that?" So, again, it would be a collaborative strategy. So, then the piece is that we're talking to the parents about this, too, how we are attachment based, we are nervous system informed, we are leaning into this Collaborative and Proactive Solutions model.

And so, that they really understand and that it's okay with them, too. And again, what we're hearing from the parents is like, "Absolutely, I'm so glad that you're not pushing them past their capacity and that I'm getting this dysregulated kid at the end of the session. Like, that's really helpful." And then, we have these policies in place too that if we can't, you know, say the session ends at 20-minutes, we can't charge the insurance, we don't charge the kid at all, and AFC pays the provider. Because, again, I want it to be completely non-punitive, right? No one is getting punished, not the parent for still having to pay for the session, not the clinician for not getting paid for the session when we're really building this new paradigm of we meet you where you are, we are responsive, we are engaged, we are compassionate, we're curious. Yeah, that's the new paradigm.

Meg:
So interesting. It's interesting to see behind the curtains a little bit of how you run the business in a way that supports that. I think as OTs and SLPs, the kid does have to be present for the session, but we don't have to be one-on-one with them for the whole session. So, you can sometimes get away with letting the kid be done and doing parent consult for the rest of the session. Yeah. 

But it's interesting to think about if you're in a setting where your time with the kid is the billable time, how do we make sure clinicians are still getting paid but we're not making that an excuse to override a kid's needs and autonomy? That's really, really interesting to hear behind the curtains there. I know you do some work around school burnout, and I just wanna ask you briefly before we wrap up, can you talk a little bit about how you support PDA-ers who struggle with school and school burnout?

Stacey:
Yes, I'm so glad that you asked because a lot of people think that if, again, because it's so contrary to the dominant paradigm, which is kind of this power over the adult decides. And again, always with the child's best interest in heart, but again, in this kind of really basically uninformed way because it doesn't include the child's perspective, is that it's permissive, right? So, then the kids don't have to do anything. Like, if they're overwhelmed by, again, what seemingly normal expectations, is the point we don't have any expectations? And the idea really is that we want to be very strategic. So, it's not permissive, it's strategic. And so, if we try to work on all of the problems all at once, we're not gonna solve any of them. 

So, we really do, when I'm first working with a family or teachers or other providers, it's really that idea of let's work on one problem. Let's work on solving one problem using this model, and then we are going to release all other expectations for now. For now. That's not saying always, but again, this is a skills-building approach. But if we focus on everything, it's gonna lead to overwhelm and nothing is gonna be accomplished. 

And so, we, again, we wanna look especially at these PDA-ers because, again, they are highly intelligent, highly sensitive, really do care. So, again, these ideas that they're oppositional, defiant, they don't care, are completely wrong. And so, a lot of these PDA-ers describe what we call masking, right? That they'll act like — and again, very often parents will say, "Oh, they do great in school, but then they come home and explode," right? That's because they've been pushed past their capacity. 

So, again, we wanna choose a problem, and we wanna be very clear about, "Hey, we're gonna put everything else aside for now, but," right, "I see school is hard for you. I'm hearing from the teacher that you're not completing your math worksheet," or, "I'm hearing it's really hard for you to come in from recess," right? And again, the parent and the teacher should really be involved in this too, because again, we have to ask what's actually realistic and mutually satisfactory. 

And in this case, it would be with the teacher or the school administration. So, very often, though, teachers and school administrators, they want this kid to succeed, and they just might need some support and this model to do that. So, again, it basically goes down to being very strategic, identifying the problem that you wanna solve, and then including those major actors in it. So, it would be the kid, it would be the school, the administrator, and the parent, and then just working through the model, and then being willing to revisit the model when or if a solution isn't durable. 

Meg:
Thank you so much. Is there anything you wanna add or bring us back to?

Stacey:
Gosh, I mean, I love — you started it, Meg, by saying how you've learned to be really curious, how you learned to be a detective, and that's really a phrase that I use a lot, too. So, I think it'd be great to bookend this podcast with saying that my little tweak is become a stress detective, right? Like, start being able to see the earliest signs of the stress; and then, stopping that right in the moment. Because again, the more stress escalates, the less likely that there's gonna be any learning. 

But to go back to that and say, "Hey, when you entered the session, I saw it was hard for you to have eye contact with me. Can you tell me what was hard about that coming into the session?" And again, they will tell you. Just like you said, you know, you've heard that kids are pretty creative. They're intuitive, they're smart, they know. But again, if they haven't shared, it's because they haven't felt that safety, that trust that they could share, and those problems would be held with compassion, and curiosity, and a real model for solving them together. 

Meg:
Yeah. Thank you for bringing us back to that. And just in case anyone is likely to misinterpret, I don't think they are, but when you're talking about eye contact, you're talking about a kid who authentically uses eye contact as a way of feeling connected with others and then doesn't. But that would be different if we had an Autistic client who preferred to connect without eye contact. You're not going to that and saying, "I'm noticing it's hard for you to make eye contact." I just didn't want anybody to come at you for that. 

Yes. No, I really appreciate that, because that really goes back to knowing the child, because I was thinking about that example with that child who had made easy eye contact with me in the previous session. So, yes, again, the point is to be curious about the child in front of you and to really accept the child who is in front of you and then work with that. I will just say one other thing that, yeah, I shared with you a mistake that I made, and I held myself in compassion about that. 

I'm totally open to people coming at me if I do something wrong. That's how I learn, even though it can create some nervous system dysregulation in the moment. I built the skill of being able to hold that, and I think one of the ways that I've been able to hold that dissonance when I get something wrong, when someone calls me out, is that I have compassion for myself, and that is a skill. And so, I hope that any provider, any parent listening to this would also take that away, that parents deserve compassion, and curiosity, and support in working through the things that are hard for them, too. 

Meg:
Yeah, I love that, and bringing that to the provider for themselves, too, as a way for us to be able to move through all of these things. And I just wanna add, this deserves its own conversation, but for folks who support non-speakers, a lot of our examples today did use a lot of language but we can still practice attunement, and curiosity, and safety with non-speakers, even if they aren't yet using AAC, right. Like, all of this is still very relevant for folks supporting non-speakers as well. 

Stacey:
So relevant. That's why I talked about the infants, right? Those are our earliest non-speakers, and we do it with them. So, we can definitely do that with non-speakers of any age. So, I'm glad that you also highlighted that point, because it is so important. 

Meg:
Thank you. Stacey, where can we find you and your work? 

Stacey:
Yeah, thank you so much for asking. So, you can find me at ashevillefamilycounseling.com, and I actually have a gift for our listeners, and that would be at ashevillefamilycounseling.com/podcast-gift. And maybe you can include it in your show notes, but it's a PDF called The Defiance Decoder. So, again, very often we're looking at this behavior as defiant, as oppositional, as not caring, but I've written it all down where you can see, oh, that's actually — or it's another lens for looking at the behavior, for sure. And again, I will also mention, even though this will come out way before my book, I am working on a book, writing a book currently for New Harbinger Press that will come out in September of 2027 on parenting PDA kids. So, I think there'll be a lot in there for providers as well. 

Meg:
Wonderful. Thank you so much, Stacey. 

Stacey:
Yeah, thank you, Meg. This was such a pleasure to be here with you. 

[Ending note]
Thanks for listening to the Born to Be Free podcast from Learn Play Thrive Continuing Education. If you enjoyed the episode, please rate our show on your podcast player and share the episode on social media. For more in-depth episodes, visit patreon.com/learnplaythrive.