Supporting Children in the Preschool Years

On the Season 11 premiere of The LowDOWN: A Down Syndrome Podcast, Rachel Okazaki gives us the lowdown on supporting children with Down syndrome in the preschool years.

Transcript

Before we begin today's episode, we want to take a moment to acknowledge that this podcast is recorded in Burnaby, British Columbia, Canada, on the traditional, ancestral and unceded territories of the hən̓ q ̓əmin̓ əm and the Sḵwx̱wú7mes speaking peoples, including the Musqueam and Tsleil-Waututh nations, at the Down Syndrome Resource Foundation. We recognize the work we do to support individuals with down syndrome takes place on land that has been cared for by indigenous peoples for generations. We honor their enduring connection to this land and acknowledge the impacts of colonialism that continue to affect indigenous communities today. As an organization rooted in inclusion and empowerment, we recognize our responsibility to not only acknowledge this history, but to actively learn from it. We are committed to fostering respectful relationships with indigenous peoples and integrating principles of reconciliation, equity, and justice into all aspects of our work. In advocating for the rights and potential of individuals with down syndrome, we strive to build a more inclusive world, one that recognizes and respects all identities, histories, and cultures. Today, on the LowDOWN: a Down Syndrome podcast, Rachel Okazaki gives us a lowdown on supporting children with down syndrome in the preschool years. Over to you, Hina and Marla. Thanks, Danielle. Today, we're talking about a topic that shows up in nearly every preschool, classroom and home at some point behavior support for young children. Those early years are full of big feelings, fast changes, and growing independence. And sometimes that all shows up as behaviors that might feel challenging or confusing. In this episode, we'll explore what effective, compassionate behavior support looks like in early childhood. We'll talk about why behavior is communication, how to build positive relationships and routines, and what families and educators can do to help children feel safe, understood, and supported. And we are very, very happy to welcome our very own BCBA Rachel Okazaki. You got it. Rachel is a board certified behavior analyst. She completed her undergraduate studies at Western University and has a master's degree in special education, with a focus on autism and other developmental disabilities from the University of British Columbia. With over four years of experience in the field of behavior analysis, Rachel is deeply committed to neurodiversity affirming and family centered practices and aims to foster inclusion and implement inclusive practices that honour the unique needs of every individual. Welcome, Rachel, we are so excited to have you with us. Thank you guys so much for having me. I'm very excited to be here. Likewise. Likewise, we are gonna start off with our secret questions that we do every time. Um, just so that people know you as, like a whole person, that's very important, um, for us. So let's get into it. First question. What is a habit that you yourself are trying to break or build? Oh, that's a great question. Um, we're on theme here. Yeah. I was gonna say, um, for me, I'm really trying to, um, smooth out my nighttime routine. My bedtime routine. Um, I am trying to get away from being on my screen. Any sort of screen for my goal right now was one hour. I know a lot of research indicates two hours, which is a hefty goal. That's a lot of time. Yeah, it's a big ask. Yeah. Um, so, yeah, for me, I'm starting with one hour. Um, I'm trying to read books. I'm trying to listen to podcasts and, um. And. Yeah. So I'm getting there slowly but surely. Yeah, a little bit at a time. Yeah. I have always felt like two hours is basically my world. It's like dinner, and then that's two hours and then I'm going to bed. So, yeah, it's like all night. I know, and I support a lot of students with their evening routines and it's hard. I'm very honest with parents. Hey, I am telling you, this is what the research shows, but I'm not necessarily following it myself. It's tricky. It is hard. Tricky. It is hard. All right. Second question for you here. What's one thing that you've always wanted to try but you haven't yet? Ooh, one thing I've always wanted to try. Hmm. Mhm. I know it's such a big like. Yeah. Like um. Well I don't know why this is the first thing that pops into my mind. I always wanted uh, this is, I could easily do this if I wanted to, but my parents never got me those wheelie shoes. Oh, yeah. Pop into my head. And I always thought, like, it looks so easy. So fun. What a convenient way to get around. Um, but, alas, I've. I've never tried it so I could go out and purchase them if I wanted to. So I love that. Maybe. Maybe you will. Maybe I will after today. Yeah. That's true. Those were really a thing. I think they're still a thing. Yeah. The odd time I see a kid with one and I'm like, I see you. Yeah, that'll be me. One day. One day. Uh, last question here is, what's your go to coffee shop order? Oh, that's a great question. Um, I have been really into flat white lately. Um, I like that it's smaller, a little bit more concentrated with coffee or espresso. Um, I usually go for oat milk because. Got a sensitive tummy. Yeah. Um, but yeah, that's been my go to lately. Oh, yeah. Can I ask you what? You guys are probably a latte. You know, I feel like our loyal listeners know my answer. And it's always a hot chocolate. Yeah, I'm a hot chocolate girl. Yeah, that I knew. Yeah. But, yeah, yeah, if I'm ordering a latte, it's because I've already had two in a day, so that'd be the third. And, you know, it's a long day. Yeah. Yes. All right. Well, let's let's dive in here. So we're talking about little kids today. Um, we're thinking toddlers. We're thinking preschoolers. And these ages are called the foundational years for many reasons. This is when a child can learn the daily flow of routines all the way from like getting up in the morning, getting out the door, getting back home, going back to bed. It just keeps going. Parents know this, um, These daily routines are often challenging with young kids, and the challenge level is often even higher for families when a child has down syndrome or another developmental disability. Um, and in addition, the routine building stage can last for many more years. Um, and I'm wondering to hear from you, I guess, what kind of role can a bcba play in supporting a family, to set up routines that will work smoothly for them? Um, so routines are kind of, you know, our bread and butter. A lot of what we work on is, you know, we can start with some of those smaller behaviors. But, um, with positive behavior support, a lot of times we have, um, we create a behavior plan that is routine focused. Um, so there's lots of different areas we can focus on. Um, we kind of like to think of the antecedents, the things that we could do before the actual behavior itself. So what kind of skills can we teach in regard to maybe a replacement behavior? Um, that accesses the same sort of function, um, consequence strategy. So what can we maybe do after. And then those setting event strategies. So, um, you know, things that might change depending on the day. You know, if a student's really tired, can we decrease demands if they're sick, if something else is going on in their life? Um, so I think there's a lot of different areas within a routine that we can kind of come in, um, and provide some support. I think we can think of routines as like, there's big routines that are made up of several small routines in the big routine. So we might say like morning routine. And what we mean is like a two hour period with many other routines. You got to get dressed, you got to brush your teeth, you got to probably eat something. Yeah. So you're talking about the small routine within the bigger routine or sometimes several of those. Yeah, that's an interesting question because I think a lot of times families will say, yeah, I need help with the morning routine or the evening routine or the lunchtime routine. Um, and oftentimes we do. Well, we always need to kind of break it down. I think that's a lot of, um, what a bcbas role is, is we take kind of these big, um, scary, maybe sometimes scary routines and break them into sort of smaller, um, chunks like, uh, and for some families, maybe just brushing the teeth is the hard part of the morning routine or, you know, getting onto the toilet and, um, washing hands or just getting out of bed. Um, so I think, yeah, I kind of work on, um, I work on the smaller things, but, um, yeah, they definitely. Yeah, they impact the bigger things too. Right? So, like, if brushing your teeth is the hard part of your morning routine, it can affect the rest of your routine, too. If that one little routine is the tricky part. Right. So yeah. Yeah, yeah for sure. I think a lot of the way that I think when I'm working on, um, these different routines is, yeah, always breaking things apart, whether it's, um, you know, a routine or even skills. Um, you know, we're talking about this a little bit later, but, um. Yeah, skills like flexibility. Um, I'm always kind of trying to break things down into what are like the micro skills or the micro components of the routine. Um, because, yeah, sometimes when you look at like the whole big picture, it's it's overwhelming. It's a lot. Um, and there might be one piece of it that's like the crux of the whole morning, right? Like it could be tooth brushing. And if we really, really, really struggle with tooth brushing and the kid knows that this is coming, they might throw the brakes on like, yeah, the way before that, just in an effort to have that not happen. Um, so do you when you are breaking things down with the family and you see like, oh, it's this routine in the middle of our morning that's like wrecking everything else. You just go right in there and start there as a place to, like, bring up skills. Yeah. For sure. Um, sometimes, um, we do something called a task analysis, which is like, you know, really breaking things down and breaking things apart and identifying like what the tricky part is. So sometimes I kind of do an informal task analysis of like, okay, what is the really tricky part of this routine? And sometimes it could be, um, you know, right in the middle or towards the end. And it can be helpful to figure out, like what little skills are missing throughout that, um, that whole equation. Um, but sometimes all, all a student needs is like, okay, let's kind of target this one specific thing. And sometimes the whole routine improves, but sometimes it doesn't. So yeah. Yeah. And then it might uncover something else to to work on next. I think I want to add to that sometimes this stage which is often associated with preschoolers, um, might start later for people with down syndrome, and that's not uncommon in this group. We actually see a lot of, let's say, two and a half to five year olds who are very, very chill. Um, and what I mean by that is passive. So it's not a problem to get them dressed, to get them out the door. They are happy to just tag along with parent. Um, but it could happen later. Um, and we see that there's sometimes a really marked shift in like, whoa, this person suddenly has this time concept, and they suddenly understand that, like, there are things happening when I'm not here and this passivity disappears, and then we have challenges. Um, and then we suddenly might see a lot of resistance to daily routines that happens later, like in elementary school, where it wasn't an issue before. I don't know if you have thoughts you want to share on that one too. Yeah. I think, um, one thing that I found is, um, in preschool age or, um, you know, that might mean being in preschool or, um, you know, staying at home with the family. Um, sometimes those, um, boundaries or limits are not really pushed as much. So, um, you know, there's a there's a routine with the family and it's kind of the same every day, and maybe there's a lot of predictability. And then you get to elementary school and it's like, you know, we can't always, you know, do it Jimmy's way and start with ice cream in the morning and then transition to that other really fun activity that we like. There's a little bit more structure that is out of the individual's control. Um, so I think, yeah, sometimes getting to school, and particularly for an individual who has not experienced that level of structure before, um, it can be a really tricky time. Um, yeah. Really disorienting. I imagine I have a lot of compassion for families and kids in that situation, because it's kind of having the rug pulled out from under you being like, wait, am I not in charge right now? Like, hold on, I was in charge before. Um, and that that's disorienting for all kids who start group anything. Yeah. Right. And I think, like, developmentally, also, at that age, kids are starting to come into their own. They're starting to assert their own independence, their own ways. They're wanting more control over their daily routines. So that's why you do tend to kind of see the switch that Marlo was talking about, how like, everything seems to be pretty cool. They're following along and all of a sudden sometimes an overnight over the course of a week, or you literally were doing this routine last week. Now there's issues, right? So this is why we're such big proponents of like that preventative piece to like, okay, like let's start with building some of those healthy routine strategies so that when we do get to that point where that assertiveness happens, we can kind of work through it and help support it, right. So and to be really clear, the assertiveness is a really great thing. Absolutely. This means we're seeing some cognitive development. We're seeing some language development. We're seeing understanding of our world. And then big autonomy here and now. So those are all really good things. And we want to have a space or a way for the child to be able to assert themselves and their independence in a way that will be successful for them. It's not nice to try and assert yourself and then get run into a brick wall every time, because you're asking for things that aren't possible. So being able to know what is possible and provide outlets for all that autonomy seeking very important and very much part of, I think what you do in terms of pointing out like, oh, is there an opportunity for a child to have choices in this section, like, can we, you know, give some autonomy here? Do you want to talk a little bit about what choice can do for little kids? Okay. So yeah, I that kind of makes me think of, um, you know, this whole idea of the ham effect, where we see some of our learners as very cute, and there might be some tricky behaviors that, um, you know, we're like, oh, that's, that's so sweet that they're doing that. Um, when we know down the line it can be a little bit tricky. And I think advocacy skills are so important. Um, but, you know, as we know, working with adults ourselves, um, down the line, it can be tricky when those advocacy skills look like, you know, hitting or screaming, um, or, you know, things that, um, other people might, um, not take as well, um, you know, if they're living in a group home or, um, you know, engaging with other members of the community. So I think, um, it's important when a child is young, um, to start thinking about how are we going to teach a more appropriate, um, behavior instead of, you know, maybe it's just like a silly little push or tap to their brother. Um, but, you know, in the future, um, it could get a little bit more tricky into adulthood. Um, I can definitely paint a cuteness picture. Real scenes from my real office with all names removed. Um, let's say I'm asking somebody to work on something that's hard or different or not what they wanted to do that moment. And sometimes I will most adorably like, let's not deny this is extremely cute. Um, a kid will, like, climb onto my table, climb under my table, or otherwise put on some kind of awesome show. And like with my whole heart, I want to laugh really, really hard because it's very funny. It's very cute. Yeah. And I can't do that because what I should be doing as a responsible SLP in that moment is being like, oh, we need a better way for you to be able to say, I don't want to do that. And then I'm happy to honor what you're trying to say, which is like, I'm going to take the attention off of whatever game or task or whatever we're doing and put on a show. And that doesn't work well when someone's a teenager or an adult that doesn't go well, that looks like running away when you're older. Um, but, you know, recognizing the five and 710 year progression of what this is later and making sure that I teach skills when they're teeny weeny, um, even though I really, really want to laugh because it's very, really, really want you to laugh. Yeah. Oh, yes. Yeah. And I think, um, you know, with behavior, we're kind of often thinking about that function. And sometimes at first, um, I might see a behavior like that and be like, oh, that's very funny. Like, they for sure just want my attention. They just want to make me laugh. But, um, something that we work on is really identifying, like, what is the consequence that follows that? Are they getting a reaction? Are they escaping a A task. Do they like the feeling of going under the desk? So, yeah, I think, um, it's helpful to kind of, um, yeah, to think about the whole picture of like, what? Was there an instruction before? Were they not getting attention before? Um, because, yeah, sometimes it's not always what you think it is. Sometimes, like a silly laugh or a silly scream might seem like one thing. Um, but maybe something entirely different. Yeah, it's good to. It's good to look into it. Um, another one that I hear from parents a lot. The the cuteness thing is really tough because, my goodness, kids with down syndrome are, like, probably the cutest of the children overall. Just like extremely adorable and sometimes like part of their personality. And it's them having fun. But the fun can turn into a bit of a challenge later on. Yeah, sometimes people's expectations aren't correct, essentially because they just see that this child is adorable and they are not being. You know, I hear this a lot from parents that, you know, the school isn't trying to teach my child enough because they're just so distracted, because my child's real cute and they're letting my child just, like, spend all day dancing in the hallway because they got the good moves. But like, I really wanted them to learn to read this year, you know? Yeah. And we missed that because my kids cuteness was the focus of things. And I think parents see cuteness on like, they of course, they want people to know that their kid's cute and acknowledge the extreme adorableness. Um, and yeah. And yeah, it kind of does a disservice to our kids, too, because for some of the ones that go from preschool to kindergarten, they're doing some of those silly, cute off task behaviors. And again, there's a time and place for those. There's time and place to to to react to. It depends. Right. But the thing is like it's doing them a disservice because then they're seen as only that and not capable of learning or capable of or having the potential to, you know, be able to be part of a classroom. Like, I feel like it can do them a disservice because our students are just as equally capable of learning and contributing to a classroom environment. But those little things get in the way, and then sometimes that serves as an excuse for not helping them learn. And so we just kind of want to set them up for success as much as possible. And this is kind of where, you know, your support would come in. Yeah. And I think like for me, I think having that philosophy of presuming competence is a really important thing to just like, keep in my mind, anytime I walk into a space or into a classroom or I'm meeting a student for the first time, um, because, yeah, I think they are, you know, very adorable and very sweet. And I see a lot of times in a classroom environment where, um, you know, I can see those sort of assumptions coming into play from the teachers or the IAS. And, you know, having worked with some of these students in a more one on one environment, I know what they're capable of, and I think their parents know what they're capable of. Um, but yeah, I think there's so many other factors that make it tricky sometimes, maybe for a teacher or, um, yeah, someone in the school team to really see what they're capable of. It really does put parents in a difficult position because no parent wants to say, like, look at don't see my kid as cute. Obviously that's not happening. No, no. Yeah, exactly. And on some level, everyone's happy that their child's being recognized and included, even if it's only kind of this, like, token inclusion, it's better than, like, no inclusion. We have we have a big sliding scale here of, like, what's good enough. Um, but our roles as therapists are always to push that bar higher and expect more. Yeah. Um, yeah. We want the best for our people. Yeah. Um, so let's talk a little bit about long term outcomes. And what from your perspective, are the benefits from of kind of intervening a bit early. So when they're like, you know, I think some of your clients are like even age two at this point. They're like nowhere near preschool age. But a lot of families are just like, oh, like some families do recognize, hey, I would like to get some good habits started early. So early intervention versus perhaps seeing somebody who is kindergarten, grade one, grade two and have maybe some challenging behaviors that are now like permanently entrenched, and now you're trying to undo some of that. So could you speak to a little bit about the the benefit of early intervention and how that can prevent the routine from getting to that entrenched point? Yeah, absolutely. Um, so in, you know, kind of doing my own research and, um, you know, learning about, um, the research in school. Um, I will say a bulk of the research that I have explored has been specific for autism, especially with behavior support. Um, you know, that's where a lot of that early intervention research is. Um, but in general, when we're thinking about, um, early intervention and, you know, just learning in general at an early age, um, we do know that between birth and three years of age, the number of synapses per neuron increases exponentially. Um, and neuroplasticity is at its peak. So, um, we know that teaching and learning, um, is best when it happens at a really early age. And, you know, that applies for things like learning a new language and learning all sorts of skills. Um, so, you know, that applies to children who don't have disabilities and children who do have disabilities. So I think another piece to that is, um, we talk about, you know, the idea of reinforcement. And, um, for anyone unfamiliar with the idea of reinforcement, um, it's essentially when, um, you know, there's a behavior that occurs and there's some sort of consequence that increases the future likelihood of that behavior happening. So, um, you know, some of these patterns of reinforcement happen, and we have absolutely no idea that they've even occurred. And they've been happening for such a long time that they're just so ingrained in your daily routines. And so, um, early intervention can make a huge difference in kind of catching those early patterns, um, before they've been reinforced for a very, very long time. Um, and, um, challenging behavior often, you know, it serves a purpose, so there's usually a reason why it's happening. Um, and early on, sometimes it might be something small, like, um, maybe they're whining because they really want access to candy. And then, you know, over time, you learn, okay, I'm going to keep whining and I'm going to get access to that candy and and those sorts of patterns, really, um, can continue right into adulthood. Um, so yeah. Yeah. And it's and that's the thing, I think it's that that entrenched piece is so tricky because like any habit that many of us that are listening have, when you do something all the time, it's very, very difficult to undo it. Right? It doesn't mean that it's impossible, but it takes time. It takes patience, and it takes considerable support to be like, okay, you know, and again, you know, again, it just depends on the person, what behavior, what routine that's entrenched, how it's affecting their daily life. Does it need to be undone or not? That's a conversation for another episode. You know, that's a big topic, but I think I'm glad that you brought up with respect to the research because, you know, current politics notwithstanding, historically, some countries, you know, have devoted enormous resources to early intervention, including behavior support, with the intention of building skills so that a person does not have such a tough time as they get older. And, you know, this approach is supported, as you said, Rachel, in the scientific literature, because, again, behavior is ultimately a science based, um, theory. Science based. Yeah. Um, but, you know, so it is supported in the literature and in this, um, and we can provide some of the references to the research that you were talking about, some of the other things that we have on hand on the episode page, just so that people that are listening out there can do some of the, the work and kind of look at some of the research out there as well. Um, but I can imagine that, you know, families that are listening to this, maybe thinking about their person and their lives and wondering whether now is a good time to get help, or whether it is, does it? Do they even need it? We have those questions all the time from families here. Do you, as a bcba, have any guidelines or kind of mental checklists that you can share with families when they reflect on their kids behaviors and how they're getting through a routine? Um, to kind of help guide them in making that decision of whether a bcba is required or not. Yeah. Um, I think, you know, maybe from my slightly biased perspective, I think, um, you know, a wide variety of people could really benefit from behavior support. I mean, it exists in a ton of different fields. Um, you know, in like, a professional sense. You know, people use behavior principles in therapy and, um, yeah, in lots of different ways. so I feel like there's never a bad time. But, um, you know, if, if we're thinking of a time where it would be especially helpful to start, um, you know, I think a lot of parents, um, I will say I am not personally a parent, but I work with a lot of amazing parents, and I have a lot of friends who are parents, so I know how tricky um, days can be, whether you have a child with a disability or not. So I think it's very normal to wonder, like, hey, um, you know, is this normal? Uh, is everyone else feeling what I'm feeling or experiencing what I'm experiencing? Um, and obviously all kids have tough moments. Um, but something that I often see, um, is parents getting stuck in a process called the coercive process or the coercive cycle. Um, so this is when a child learns that certain behaviors. So it could be tantrums, it could be refusal, um, or even physical aggression. Um, they learn that it can successfully get them out of a demand or just an uncomfortable situation. Um, and the adult, understandably, they, you know, try to keep the peace. They try to avoid the escalation and they back off. And so over time, this reinforces this tricky behavior. And that makes the routine really hard for the child and for the adult. Um, and I think a lot of families that I work with, uh, don't even realize that this process is happening. Um, so, you know, they just know, okay, everyday tasks feel really tricky. You know, um, the evening routine is really hard. Maybe I, I can't go out for dinner with friends in the evening. Um, or the grocery store starts to become like this big beast. I won't even think about going to the grocery store. Um, I have a student who, um, their family was like, we don't go out of the house at all to see friends. Like, friends can come over to my house. Um, and that's our safe space. And we feel comfortable, and the environment's very controlled, but we will never go over to another family member's house. And, you know, they were like, can we work with this? And at the time I was doing, um, this was part of a project for school, actually. So I consulted my, um, my professor and I was like, hey, you know, can we figure out, um, some things maybe for them to do at home so that they don't feel like they're missing out? And he's like, let's, like, take a step back here. Um, is this normal? Like, should they be feeling like they can't leave the house, that they can't go to the grocery store, that they can't, um, go to friends houses? Like, he's like, let's target that. Let's make them feel comfortable and safe. Being able to, um, to do the things that we all deserve to do in our daily lives. Um, so yeah, that was really like an eye opening moment that, um, yeah, really helped me understand that coercive process. And I felt like even I was starting to think, yeah, we can work within this, but no, I don't think, yeah, things shouldn't have to be so hard. Yeah, I feel like there's a good litmus test, too, sometimes. And as a parent, I also recognize sometimes you can't see in yourself all of the things that you're doing to co-regulate your child to make their make your day manageable, to be able to go through from wake up to sleeping again. And you might not even be aware of all of the kind of like backbends and little twisties that you throw in there to, like, make the day go. And a good litmus test for that is can anybody else do it? Can can anybody else do what you do in a day? Can your child get through any day, anywhere with anyone else? Because it can't be just you in the long term. We know that's very bad for family dynamics. It's very bad for parent mental health to have only one person who can do the routines of the day danger. Um, and if you're finding that that is you, then help would be a great option. Yeah, yeah, yeah. Because sometimes we can't see it and you're like, oh, this seems like fine. It's like the frog in water boiling slowly, boiling water like a survival thing. Sometimes you're just like, you know what? I'll just. Yeah, I'll just I can make it work. So I'll take it. And it's. And I agree. I'm glad that you brought this up too, Mala, because it's, it's one of those things where the families have to kind of think about their own ability to endure this routine over and over again, like you are going to burn out at some point. So let's look at some of those skills, some of those foundational pieces and see, like, how can we make this a bit more of a typical experience for you? Um, and we have many clients and many families here that are are okay with just leaving it the way it is, and that's fine too. Let us know when you're ready to kind of change. Switch things up. Right? Because sometimes families do like to just have their little safe space. And I'm okay for now. And we just kind of, you know, follow their lead for when they're ready to go. Um, totally. So yeah. Yeah. Um, I think what we in our, you know, past experience as therapists always worry about for families is when a crisis does happen eventually or later, like help. There is also not as fast as we would want it to be. Yeah. Um, and we don't ever want anybody to get to a crisis. And we certainly don't want anyone to stay in a crisis. Um, but we know that that can happen. Um, so certainly always there to be helpful when people are ready for it. Yeah. And certain patterns emerge. Right. Having worked here for this long now, we do see kids of all ages. And we see a lot of them from their two to finishing high school. And so a lot of our at least our non bcba suggestions and and thoughts are also based off of like seeing those patterns and seeing that, you know, in development that does happen and like how can we support that. So yeah. Yeah I think like is this the way that I'm doing this routine? Sustainable? How long am I going to be able to do this or. Yeah. In a in a crisis situation, um, is someone else going to be able to support. And I think like when, you know, when you think about, um, dysregulation I'm Hannah can talk much more about dysregulation than I can, I think. But, um, when we're thinking about being in a dysregulated state, which we often are if we're in crisis mode, um, that's not really a time that learning is going to happen or where someone's going to be able to process the lesson or the teaching that I'm trying to provide. So crisis mode isn't necessarily the the best time to get started with behavior support. I think, um, when you do see those, those little signs of, oh, this routine is getting a little bit tricky. Um, yeah, I think that's that's a great time when you're seeing those early signs, um, to to consider behavior your support. Yeah, that's a great point. Yeah. And yeah, I, I make many analogies in my mind for these kinds of things. Um, one of them, for some reason, is digging a hole. Um, and like, if you, if you're really deep in the hole, first you have to fill up the hole before you can put the nice sandcastle on top, which would be that, like successful and happy routine, um, where everybody's needs are met and we feel like we could do this every day and it would be great. Um, but filling in the hole takes a long time. Um, and it's even harder if everyone is maximally stressed out. Yeah. And that's where prevention comes in and. Yeah. Yeah, exactly. There's that early intervention prevention piece that we keep saying, because so many times with a lot of our students, we might notice a couple of things in sessions because we're placing different kind of demands and we're, you know, encouraging them to learn. And then and we're like, oh, have you, you know, have had many conversations with families. I'm like, oh, like, have you ever thought about, you know, do you notice this kind of behavior at home? And so just exploring with families, asking them questions like, I'm sure they're, you know, the your process, Rachel, is that you do do a lot of exploring and ask families questions to help them maybe come to that realization on their own, like, oh, maybe there are some things that maybe I didn't notice. Yeah, yeah. Yeah, absolutely. Um, I think on kind of both ends sometimes. Um, when I ask, well, I like to start with a sort of strengths based questions when I do my initial sort of parent interview. Um, so I start with, you know, what are your, like, family strengths? What is your family really good at? Um, like, I like to give some examples. And sometimes families have a really hard time, um, you know, identifying what are positive things about their family dynamic. Um, but conversely, yeah, sometimes, um, they don't realize those little tricky things that are also happening, which again, goes back to that coercive process where, um, yeah, sometimes you're not even aware that something is trickier than maybe it has to be. So, um, yeah, kind of have to probe and, um. Yeah, go through all of, um, yeah. The different the different routines and the different environments and, um. Yeah, yeah. Um, what would you say for a family who's like, okay, we know we're in it. We don't even know where to start with it. Like, everything is hard. We certainly. And and I both support families who have this feeling of, like, everything is really hard, and it might not even be related directly to the child who has down syndrome. There are many life circumstances that contribute to things being difficult. Certainly when there are siblings, there's extra layers. Today's politics, I mean, there's just a lot there's a lot of things and there's a lot of reasons for things to be really, really difficult. How do you help families in figuring out where to begin, or if it's even the right time to begin. And things like that. Priorities. Yeah. Um, so I think the, um, another thing that, um, my professor really emphasized when thinking about especially routine based positive behavior support is you can kind of, you know, go down a couple different routes. But the two main things to consider are, do you have the capacity to do something really hard, or should we just start with the routine that we know is going to be easiest? So, um, you know, a big kind of, um, universal, uh, strategy that, that we think about is using visuals and we can start implementing visuals in a routine that's just not super tricky right now. So maybe like, the meal time is an easy place to start and we can get some visuals in there. We can use timers. We can, um, you know, maybe make a token border or whatever it may be, and then when you have the capacity to kind of work on the trickier stuff than, than we can do that or, um, thinking about what is your biggest family goal or like what is an activity that you really care about that you want to prioritize or focus on? So sometimes I have started with a really tricky routine and it's like, no, I love like family grocery store outings. So let's start with that family grocery store outing because that's what I want to be smooth. So it kind of, I think depends what the family's, um, capacity level is. Yeah. And that's really similar to something we use a lot in SLP and OT, which is taking the new skill. Let's say it's using visuals at home and putting it onto something that's very simple and very successful, so that we're only adding one thing at a time instead of when we're already going to be stressed out. Then we'll add another layer and we'll have to learn skills on top of, you know, something that's already very complicated. Yeah, yeah, yeah. And sometimes, you know, I, um, I well, I always have a behavior support plan as kind of the product after I've done all of my assessment and observation. And sometimes families will be like, oh, can you, you know, send it to me first and then we can debrief about it after. And I'm like, if you look at that thing, you're going to be super overwhelmed. There's so many strategies and so many different ideas and potential routines that we can work on. Um, but, you know, we can just pick and choose the things that will fit best in your family right now. That might be easiest, that you think might be the most successful at this moment. And those can be the things we start with. So maybe it's just visuals or we just work on, um, you know, providing praise after your child, um, appropriately asks for help. Um, so yeah, it doesn't have to be, um, work on everything all at once. It can be very broken down. And often those little things make such a big impact to because and like you said earlier, that oftentimes I find this with schools quite a bit, but that some of these these strategies may seem simple to us because we live with them day in and day out. But for a lot of people, they're like, oh, I never even thought about, you know, implementing this particular strategy. And it can make a big, a big difference that can hold you until the next thing that you have to work on. Right. So yeah, absolutely. I think a lot of the students that, um, that I have supported, the Dzf, I think, um, yeah, visuals are just like such a big one, which I yeah, we all use them. And as adults, we, we use visuals and, um, in a variety of different ways, but it's sometimes still surprising to me how, you know, I'll, I went in and for one of my students, we just made a little visual schedule. We had a little treasure box that we could get a toy before we transition to school. And the routine got so much simpler. So it's, you know, I'm not going to say it's always like that. Yeah, it's oftentimes a lot more complex. Um, but yeah, things like that can really, like, get the ball rolling. Yeah. And it helps parents, I think, to feel empowered. Yeah, exactly. I have a really wonderful family that I support who really tries really everything that they can think of to help themselves and their child and on their own. They were having some tough times, and they brought out the old visual schedule from like days of yore, and they were like, Marla. It still worked. We did not think this would be relevant at her age and her stage, but wow. Like, it was like magic. It just like she understood the routine that was coming up. She knew what was going to be happening, all the transitions and our day was smooth and we were shocked. And I was like, good for you guys. Like, that's very resourceful. And I think what I'm the point I'm trying to make is like some of those things, they work for a long, very long time. Yeah. Like which is why comfortable? Yeah. Which is why it's so great to do it early on. Because you're setting this expectation and this thing for your kids being like, okay, I do have tools that I can go back to as myself and for the families to go back to. Right. So it just makes so much more sense. And then you're just learning with that as you get older. One thing I think Bcbas are so good at is making it work for the family. I think when we say the word visuals, many people imagine like Velcro, things are stuck to them. They've lost 45 pictures. They have to cut up pieces of paper and like, let's be real honest, I tried that with my kids because I wanted to experience. What is it like when I say do this? What does that mean in a day to day routine with a bunch of toddlers? Oof, she's difficult, but there are way like it is. It's really hard. You don't have enough arms for some of this stuff. It's just one more thing on top of one more thing. You got to sift through the bag like it's really hard. But there are other ways to do visuals, um, where they can be in the place where you need them, when you need them. You don't have to have Velcro stuck on the back of your shirt. Like, you know, there's Bcbas are experts in making it work well for you. So and providing that rationale to right like this is the thing where I find that just saying like, oh, we need visuals. But if you sit down and you talk to the families and like, this is the reason why we're suggesting this, this is how it would work. And then my favorite thing is to be like, oh, like, how do you use visuals in your day? Like, I think that piece of like, you know, how does how do you use reinforcements in your day? Right? You go to work, you get paid or you do a really hard workout and you get a treat after whatever. Right? So I think that perspective shift piece is very important because families will see like, okay, so a lot of the reasons why I do my things and how my routines are easy for me to do, apply to my kids too. So how do I just and this is where you guys would come in, like, how do I make it work for my kid? Right. And it's a really a thing. Like when I say using visuals is hard. You know what else is hard? Two flailing toddlers who don't know what's going to happen next and who don't want to leave the house. Yeah, you also don't have enough arms for that. Yeah. And one of them has you kind of getting kicked in the eye. So, like, I'll take the Velcro even though it's really difficult. Um, but being able to honestly weigh those two alternatives like it is a new skill to have to add some of these things, but the alternative has you getting kicked in the eye. It's just not cute. Yeah. And I think, you know, I like what you said about how, you know, it can be intensely overwhelming to have this giant bag of visuals and Velcro. And yeah, I've definitely I've had a family that said, um, I will start behavior support, but I will not be touching Velcro. I will not be doing any like at least they told me, at least for them. Okay. Good for them. Got it. Yeah. Yeah. Um, but I think, um, that kind of brings up an important point that is really important for me is contextual fit, which I think, um, you know, is a big piece of that family centered model that we have, um, where I'm not just thinking about. And we're not just thinking about as bcbas. Um, how is this going to impact that one individual? We are looking at, um, you know, how is it going to affect mom and dad and how is it going to fit into the siblings soccer schedule? And will grandparents be able to use these strategies easily? And, you know, will the teacher be okay with it? Will they be, you know, will it help them be an active member in their community? So, you know, we're not just looking at, um, the really small picture. It really is. How is this going to work on a daily basis? And you know, I always say like the goal is that you don't need me anymore. I want you to walk away and feel confident that, you know, these things are going to be able to, um, carry over to different routines and in the future. And. Yeah, yeah, I want you to put me out of a job. That's the goal. And at the end of the day, it all takes practice, right? Like, like parents need to take the pressure off of themselves and be like, it's going to, like you said earlier in the episode that it's in small chunks, but it takes practice like any skill. Yeah, yeah. And absolutely. And you know, we have our off days and we have grace and compassion for ourselves and our off days when we forgot the thing or didn't do the thing. And. Yeah, and that's fine. Try again the next day. Yeah. It is what it is. Yeah, yeah, yeah. Well, Rachel, is there anything else that you wanted to add in terms of building skills or looking at routines or thinking about these families with the youngsters? Um, I think maybe we, we chatted a bit about this, but I did really just want to emphasize, you know, the importance of thinking about adulthood, which I think is probably like a scary thought when you have a really little, um, it's like, you know, you don't want to think about them when they're 18 or 25 or 30 or 50. Um, but, you know, aging is something that happens to us all. So I think it's it's just important to think about, um, you know, the long term and what adulthood might look like. So, um, most of my work has been with early intervention and, um, you know, with individuals who are under six years old. Um, but I also have supported a lot of adults. And, you know, I've supported adults who have been really, um, well supported and, um, you know, have have developed really good self-care strategies and self-monitoring strategies. But I've also supported adults who, um, you know, haven't been taught some of those fundamental skills at a young age. So, um, I think it's important to think about, um, you know, in the future, what is independence going to look like? Um, what what is communication going to look like? How are how are these life skills going to translate when, um, you know, maybe I'm not living with parents anymore. So Yeah. I think, um, it's it's important to think about, um. Yeah. Just what what that future might look like when. Yeah, when the parents maybe aren't in the picture as much. Yeah. Mhm. Mhm. And how we know it takes a while to build skills for all people. Um, and how there are maybe like itty bitty things that you can do in early pediatrics or with toddlers, preschoolers, early elementary that really have these knock on effects for later later skills. Um. Yeah. And if you're not sure if you're doing the thing, um, to get yourself there, you can ask. Definitely you can ask and be like, am I are we? Yeah. Are we heading in the right direction? And like, it is not your fault if you're not sure. Definitely not. I think we have such an advantageous position as therapists and we see, you know, more many hundreds of people. So we have this like little population that we draw from. And we've seen these paths and these trajectories a lot of times. So we have a different sense of it than parents do because we have the zoom out picture. Yeah, yeah, yeah. And I think also just that behavior is really everything. So it's you know, it's communication, it's raising your hand. It's um, you know, making a meal. Um, so yeah, behavior support doesn't have to always look like, um, decreasing distress responses. It's also teaching skills. I mean, a plug for my mighty micro chefs. But, um, you know, we are learning about kitchen safety, and we're learning how to make microwave meals. And yeah, behavior doesn't have to be, um, you know, kind of always this really intense stuff. Sometimes it's about teaching, you know, the fun, functional, cool stuff too. Yeah, yeah, just the act of doing. Right. Yeah, exactly. Yeah, yeah, yeah, that's a really good point to end it on I love it. Thank you so much, Rachel. It's been a pleasure to chat with you today. Yeah. Thank you guys so much. Thank you so much. So much fun.