It happened again this week. I was working with a young lady with developmental and behavioral challenges and her mother.
This girl, we will call Cecelia, was upset because I did not bring some of my toys into the room. Now I had a good reason for this but she is very ritualistic, so she was having none of it. She started with loud screeching but quickly progressed to hitting me. Ignoring was not working, so as she accelerated, I got onto the floor with her and gave her a big bear hug that put her on her back so that I could control her movements better. I used my left arm to deflect her legs while my arms controlled her arms. I made sure that I kept away from her mouth to avoid bites and her head to avoid collisions with my head.
I then began in a loud whisper to say “I will know when Cecelia is ready to be let go when she says “Please let me go Dr. McGuire”. Her mother attempted to intervene once telling the girl to stop it, but I quickly hushed her, explaining that Cecelia couldn’t understand her in her current state. Mother then sat back and watched. Cecelia was not decelerating, so I added a second suggestion of “I will know Cecelia is ready to be let go when her legs stop moving”. I alternated those two phrases in the loud whisper for about another minute or so. Then, ever so subtly, I noted that her legs were slowing down and staying lower to the ground. I then said in a slightly louder voice, “Oh Cecelia is letting me know with her legs that she is ready to be let go.”
I let go of Cecelia, and we both sat up on the floor. She was staying in what I call a sitting version of the fetal position, with head down and legs crossed under her, hands to the middle of her body. She didn’t say anything, but I commented on how she was calmer, but said nothing else. She then reached for the toy character she had brought to the visit, a unicorn. I slowly moved my hand toward it, asking if I could pet it, but she growled and pulled it away. I said I understood. A little bit later, the unicorn came forward again. I again asked if I could pet it, bringing my hand slowly toward it. She said “no” and pulled it away. A little bit later, the unicorn returned and I repeated my process. This time she said yes, so I gently petted it. I then said to the unicorn, “You really like Cecelia, don’t you?” The unicorn said “Yes” and moved away. Then, one by one, the characters I had brought to the session came out. Each time I asked if I could pet them, got an okay, petted them, and said, “You really like Cecelia, don’t you?” and got an affirmative. By half way through, Cecelia was making eye contact with me and smiling.
In between the pettings, I would talk to Mother about what was going on and why it was important to help her regain her inner calm at her own pace. Mother had been experiencing these outbursts a lot lately, and noted that this was the quickest she had ever seen Cecelia regain her composure.
Cecelia was not being oppositional and defiant, although many would have labeled her as such. She had been overwhelmed by a break in her rituals and that scared her. Her limbic system, which is called the reptilian part of the brain, due to the primitive nature of its responses, had taken over. She couldn’t access her frontal lobe to analyze her feelings, and develop plans of negotiation or acceptance of this change. As an adult, I had to help her contain her fight or flight response until she could work through it, regain her composure, and figure out what she could do instead.
When it was time to go, she still had to be ritualistic in the process, putting one item at a time in the bag, but she was in control of her emotions and could show joy in the process. She also wanted two stickers for the session, which I approved of, but in the end she only chose one, which she put on her unicorn, for helping her find her inner calm.
Let’s take time to help the out of control children. That way they can truly learn and feel good about the process.