PDA, Anxiety, and the Avoidance Cycle with Dr Nicoll

What if your child's refusal isn't about being defiant... but about feeling overwhelmed?

In this powerful conversation, Dr. Nicoll explains why many children with a PDA (Pathological Demand Avoidance) profile experience everyday demands as threats to their nervous system—not simple requests. What can look like stubbornness, procrastination, or "noncompliance" is often an anxiety response.

💡 In this episode, we discuss:
• Why anxiety fuels the avoidance cycle.
• How demands can trigger a fight, flight, freeze, or fawn response.
• Why traditional reward-and-consequence approaches can unintentionally make things worse.
• Practical ways parents and educators can lower anxiety while still supporting growth.
• How connection, collaboration, flexibility, and trust create better outcomes than power struggles.

One of the biggest takeaways? When we stop asking, "How do I get my child to comply?" and start asking, "What is making this feel unsafe for them?" everything begins to change.

If you've ever felt exhausted by daily battles over seemingly simple tasks, this conversation will leave you feeling understood and equipped with a fresh perspective.

🎧 Listen now and let us know what resonated most with you.

We want to hear from you! Follow us and leave a comment on our Instagram at ThePolarisConnection or reach us at Info@PolarisAcademy.com

Transcript

SPEAKER_01 0:00

Just pausing and being more present will allow you to first connect and then correct.

SPEAKER_00 0:09

Hello everyone and welcome to the Blairts Connection, connecting parents of autistic children with industry experts. Each week we navigate the world of autism together, bringing you real conversations from specialists who truly get it. The journey is challenging, but you don't have to walk it alone. So settle in, get cozy, and let's connect. I'm your host, Brad Broyles, and I'm here with my undercover sensory hacker co-host, Nathan Palmer.

SPEAKER_03 0:39

Brad, thank you. I don't know how undercover, I mean, we're pretty bold and out there about how we address it.

SPEAKER_00 0:46

I know, but you you you just slip it in from time to time, and so it's amazing.

SPEAKER_03 0:49

So you know, I'm glad to be back too. It feels like that month of July, I miss being here. So I'm glad that we're making a return. And for those who've been listening, thanks for your patience. We're so glad to be back with you.

SPEAKER_00 0:59

Uh and we made some improvements, Nathan. Like what have we done since since the last time we spoke?

SPEAKER_03 1:04

You know, we took our own advice and we actually created a more sound sensory-friendly podcast environment.

SPEAKER_00 1:10

So yeah, so folks, we'd like to, you know, go online, look at our new studio, and to welcome our new studio, our upgrade, we have a fantastic guest. Nathan, who do we have today?

SPEAKER_03 1:24

Uh I'm so excited. We have Dr. Nickel with us. And and uh you so Dr. Nickel, can I just tell them why this is so momentous?

SPEAKER_00 1:31

Please do.

SPEAKER_03 1:32

We had Dr. Nickel on a few months ago, and it was one of the best podcasts we ever did, and our audio got destroyed in the process. And so we have just been, I'm gonna use the word anxiously waiting for his return because what we wanted to talk about with him was anxiety, avoidance, and some cycles that, frankly, whether you have a neurodivergent autistic or you know, special needs child or not, the advice you're gonna hear today applies to everybody.

SPEAKER_00 2:00

Yes. And we were so excited last time to have you, and we're excited for this double take. Dr. Nickel, thank you so much for being here. Welcome to Back to the Polaris Connection.

SPEAKER_01 2:09

So happy to be here. We at I work at the Grove Comprehensive Psychiatry and Wellness, and we just love Polaris. We have so many of our patients who go there, who we refer to you guys, and it's just wonderful having a place to send people where we can trust. So thank you guys for what you do.

SPEAKER_03 2:27

Well no, thank you. Um, Doctor, if I remember right, when we introduced you last time, and I'm gonna do a lot of flashbacks to this episode that nobody's ever heard because it was just that great. One thing that you I remember you talked about was how at Grove you're certified not just for treating adolescents or childhood or pediatric, but also for adults. Um and that I thought was unique because some people will specialize one or the other. Um why why is that rare? In other words, why why is it that you don't find that we just do all ages all the time? What's different about a pediatric approach versus an adult?

SPEAKER_01 3:03

Yeah, I mean, that's that's a great question. And we we love working with all ages and find it very uh freeing and very educational and very necessary because a lot of mental health concerns are genetic. If we've got anxiety with a kid, very often you can look up a little bit and find some genetics of anxiety or OCD or ADHD or mood disorders, depression that go up a little bit. And so very often the parents might need extra support as well. I'll go into that a little bit later as we talk about anxiety because having a kid who is very anxious or demand-avoidant, that's hard enough for a parent without anxiety. You take a parent with anxiety and that becomes this overwhelming issue. And so I love being able to treat the kid at or the adolescent and being able to help support and treat at times the parent as well.

SPEAKER_00 4:08

Wow. And I and I would assume that's an eye-opener, right? So you have a child that you're trying to treat for anxiety, and then all of a sudden the parent, they might not be aware of those same symptoms. So how do you bridge that gap? Like how do you how do you coach them through that?

SPEAKER_01 4:21

Very gently. Very gently. Because it's it's hard. It's hard when we are, as an adult with um, you know, a fully developed uh frontal cortex, you know, it's hard for us to change our patterns of thinking and behaving. So you take a kid with autism still developing extra rigid and inflexible brain, and we're trying to get them to change thinking patterns and behaviors. That's extra hard. And that takes a special parent and uh a Herculean amount of effort and patience from the parents. So bless these wonderful parents out there who have to have to take that extra time and effort in order to get this incremental change to help their kids grow and develop.

SPEAKER_03 5:11

When I so the reason I I went down that road is listen, as a parent with a kid on the spectrum, our instant inclination is what are the supports for my kid? What are the supports for my kid? And blessed to be in Arizona, there's a lot of them. But one area that I think doesn't receive as much attention as it needs to is just general mental health support, right? So, like we look at speech support and occupational therapy and ABA, there's all these things that we're programmed to go after, but the burnout and the stressors behind that are real. And so we have these layered conditions where we're doing that, but we have anxiety, depression at the parent end, like it's mirrored. And so the reason I love that you're holistic that child and adult-centric, and sometimes I think we're all just big kids, but um is you're offering a kind of support that I think is frankly often overlooked. And part of the reason we're so excited about today's episode is that I think the dialogue today will be as helpful for the parents, if not more so, than for the kids, and give us this extra lens to look through of there's other ways I can support my kid that don't require a specialized license and are available where I can just get the this the mental health to make it enjoyable and not so hard. Yeah.

SPEAKER_00 6:30

Well, and I want to uh I'm curious, Doctor, like why is it seems like mental health is more um talked about now than ever before? Is it and and there's so much debate out there of like of why is it why are people dealing with mental health more now than ever before? Why is you know they always talk like autism's on the rise, for example. Like, why is that more discussed? Is it because we are able to identify it better? Is it because our society is changing? Is it you know they always throw it's because of the computers or the or the phones is causing all this? I don't know. Curious to know your answer on that.

SPEAKER_01 7:08

Yeah. Yeah, we we could talk all day on that, but we can do that. We should talk about it. Get lunch, let's relax and talk about this all day. The um the thing I'll focus on is this idea of just kind of this theoretical and this tangible world that we can live in. And I think a lot of people have heard about, you know, if you want to be depressed, live in the past. If you want to be anxious, you know, live in the future. And if you want to be happy, just live in the in the now, in the present moment. So much of our environment is pulling us out of the present moment. It's pulling us from where we are now with our kids or with our friends and pulling us to a different country where we're now thinking about, you know, chaos and and things going on over there. So now we're really anxious and overwhelmed by it. Too often our brains go into the past and we replay past trauma, past hurt, uh, past uh, past struggles that we've had. And so now we feel a little more depressed. Or we're living it in the future, thinking about anxious things. We're on social media. Social media pulls us into this world, this intangible world of comparing and anxiety and what I could and what I should be doing instead of just letting us live in the present moment. So if I could prescribe one thing for everyone of all ages, it would be to be more present and more mindful. Now, I work with the Anasazi Foundation that does wilderness therapy, and one I'm their medical director. And one of the things that's just so powerful about Anasazi and wilderness therapy as a whole is you're just disconnecting from all these things and you're you're just removed from it, and you're in nature and you're you're with yourself, with your thoughts, with your emotions. You're not able to distract, you're not able to avoid, which moves us out of the present moment.

SPEAKER_00 9:10

Yeah. Well, and and with that anastasi, there's that one therapy they do about making the spoon, which I think that's interesting. Can you speak about that real quick? I think that's I think it's awesome how they do it.

SPEAKER_01 9:20

It's a great thing. I mean, just so powerful. When when you're out on the trail as a young walker, if if you want a spoon to cook with, to eat with, you got to find a stick and you got to carve a spoon. And and even more than that, if you want to cook with a fire, you've got to figure out how to make a fire. Now, they train you on it, right? We don't just throw them out there and say, figure this out. Um, but if you're in your soup, they soften with the liquid breath. That's right. But it it's a beautiful thing and it forces you to be in the moment. Screens, screens are hard, aren't they? Yeah, yeah. We we all know what they do to us and they take us out of the present moment.

SPEAKER_03 10:04

They do. And I and I'm processing that idea of be present because you know, one theme that we've had consistently across the podcast from multiple guests uh to parents is just be a parent. Yeah, right? Because we we we try to wear so many hats and we try to prescribe so many things and we try to solve so many problems that we think we're being this provider for our kids, and they don't need us to be a provider, they need us to be mom and dad. Yeah, they need us to connect. And what I'm hearing you saying is stop stop worrying about what you did wrong, stop worrying about what you might get wrong, and just be there with your kids. And that's uh it's funny. Like I'm I'm hearing that, and it just feels lighter. You know, that like I can do that. I you're saying just be here, I can I can be here. And that's that's just uh it's funny. Take that for a moment, audience, and just just experience forget about tomorrow, don't worry about right or wrong, just just be present. I can do that.

SPEAKER_01 11:04

Yeah, yeah. Yeah, it's a beautiful thing. It's a beautiful thing. And um I I like I like that idea of you know, j just be a parent. And being a parent is it's really hard. It's a really hard thing because you do need to correct, you do need to teach, you do need to intervene sometimes when when siblings are going at it um too much, right? Like there's a lot you have to do as a parent, but if ever you find yourself correcting too much or teaching too much or punishing too much and not doing enough connecting, that's where you want to rebalance a little bit. And that is a real skill. And you know, back to that idea of parents who struggle with anxiety. Sometimes, and and I fall into this category as well, I'm sure every parent has, your parent, your your kid is maybe acting up in a way, and that's where the anxiety kicks in, and it's saying, Hey, like I I'm being a par a horrible parent, are people gonna judge me? My my kid's gonna, you know, end up on the street or in jail if if I don't fix this right now. And and that often makes us come in too strong with our correcting and with our our attempts to get control and uh and to fix things immediately. And so uh just the pausing and being more present will allow you to first connect and then correct, which is the best way to do it.

SPEAKER_00 12:35

I like that. First connect and then correct. Because I know in those moments it's hard. So you're a parent, you're in a grocery store, your kid is acting out in public, builds up that anxiety. So, what is what is a nice little um, I guess, a trick or a tip that you would give a parent to say, hey, this is how you would, you know, first regulate yourself, yeah, and then able to connect and help your child.

SPEAKER_01 12:59

Yeah, that's great. If if you're in the store, you gotta do it. You gotta do it quick. You're not sitting down crossing your legs and doing some meditation. Just what we call a soft belly breath. That's where you're breathing deep in through the nose, soft belly, breathing slowly out through the mouth. Even just that single breath, you'll feel it, you'll feel your nervous system go right down a little bit. There's great meditations you can do when you have a little more time. Leaves on a stream is my personal favorite and one we teach the most in our practice. So look that one up, Leaves on a Stream. I love that one. But get really good at just taking that one soft belly breath.

SPEAKER_03 13:41

Love it. Now, Doctor, you you you hinted on a couple of things as you were talking. You know, Brad asked about mental health and its prevalence, and you mentioned the thing, you know, all screens are bad. And and I know you didn't mean it in that context, right? Because it's the it's the junk food of the brain. Yeah. The last time we had you on, we had a fantastic discussion about something you called it was both the anxiety cycle and the avoidance cycle. Um, and it was in the context of you know, avoiding these stressors and why some pressure is good, but too much can be detrimental and how we cope with those things. Um, I wonder if you mind going down that road with us a little bit because as parents, we feel anxiety all the time. I I think we don't like to acknowledge it. We like to see it more in our kids than we do in ourselves. Um, and I think sometimes the way we react to our kids is more a reflection of our own dysregulation than us being able to really, you know, proactively help them with theirs. So if you could talk a little bit about, and I don't know which order you want to start with because they both tie in, but that idea of the avoidance and anxiety and how we actually feed it and knowingly through some of these coping techniques that have been kind of driving the problem.

SPEAKER_01 14:55

Yeah. I I love, love, love that topic. That's uh in in my practice, one of the things we we really focus and specialize on are anxiety disorders, such as OCD, generalized anxiety, social anxiety, separation anxiety. Love that topic. Before we go there, I want to uh preface it with a quick discussion on PDA. Um, what what is PDA? PDA. Uh a lot of people have heard about it. Um now I I hope I don't get attacked on the way out of here because I'm gonna maybe say some things that might feel a little controversial. Um, PDA is uh something called pathological demand avoidance. It is not a diagnosis, it was a concept that was developed in in uh the United Kingdom back in the 80s, and and it's kind of caught on here in the US a little bit more. Another word they use for that is uh uh uh pervasive um demand for autonomy. Demand for autonomy. Yeah, is kind of the more accepted term now. But here's what I just want to bring up about that is um a lot of people latch on to this label as if it's the end-all be-all. It's an interesting concept, and and I want people to look at it. If you come into our office and you're saying, hey, my kid was diagnosed with PDA, we we work with you because it's a really interesting kind of theory and concept to look at. But I just want to point out what it's missing, and a lot of the research on PDA points to this fact as well. The largest study was done in 2021, and they took a bunch of kids with PDA, um, with with kind of this uh designation, this profile. What they found is that the study was not very well designed, and it was because people kind of came in and just slapped on that label and they were not curious about it. They didn't say what else might be going on. And whenever kids come in with kind of this PDA type profile, meaning they shut down whenever a demand is placed on them, they have a lot of avoidant-like behaviors, they they really struggle with transition transitions, um, they shut down with things even that they want to do. Um the this this profile is really interesting, but I want to invite us all to be very curious about it. And especially as parents, you're getting your kids back to school, you're gonna see a lot of avoidant and behaviors. You're gonna see a lot of anxiety, a lot of anger, a lot of digging in your heels. And we want to be very curious about that today. And one tool to look at this through is the lens of the anxiety and avoidance cycle. So we'll we'll dig into that.

SPEAKER_02 17:53

Okay.

SPEAKER_01 17:54

Um anxiety. I like that jumping curious.

SPEAKER_00 17:58

I like that.

SPEAKER_03 17:59

Well, well, you you know, you said something that I think is always good to keep in mind. You said be curious. Um always. And yeah, we we talk about behavior as a form of communication. And sometimes it's easy to see this expressive behavior and just go, I don't want that. How can I make you stop doing that? Yeah. Instead of asking the broader question, why are you doing that? And what are the underlying factors? And and Dr. You know, I don't think we're gonna beat you up on your way out, but I think what you're suggesting is not all what seem like PDA behaviors are PDA-driven motives. Right. Right. And so in in in asking the why, you might discover these other layers that may not by themselves just be this PDA thing.

SPEAKER_01 18:42

Yeah. And and when you're not curious and you don't find those different layers of it, the problem is that you don't look for ways to make it better. You sometimes will just read online, okay, my kid has PDA. Um, and a lot of the guidance is just remove all demand from the kid. That is very, very harmful. Very harmful. Now, um the the main idea is you want to get them to a level level where they can begin to tolerate moving forward and growing and taking on demand, but we don't want to remove everything that just turns into avoidance. So let's go into that avoidance cycle a little bit and the dem uh the the damage it can create. Let's take a kid who wakes up for school and they have anxiety. Uh, what are they gonna see? What what will the parent see with a kid who wakes up for school and they're feeling anxious? What have you noticed?

SPEAKER_03 19:44

Well, they're not compliant. So the frustrating side, they're not compliant. They're not doing what I asked them to do, right?

SPEAKER_00 19:50

They're not getting ready. They're not getting ready. The hair's all a mess, and they and they run from they run from mom and dad to get ready.

SPEAKER_03 19:58

Yeah. Or we call it they're just being difficult.

SPEAKER_01 20:01

Yeah, that's just just they're being difficult, they're being defiant, right? And that's a label we slap on that is very stigmatizing, and it's not very solution focused.

SPEAKER_00 20:12

Which we call a normal day, normal more morning in the Broil's household. Okay, that's what we call it.

SPEAKER_01 20:19

We're you're not alone. We're not alone. Um so we start seeing that behavior, we start seeing headaches, we start seeing stomach aches, we start seeing nausea, right? Um on top of all the kind of avoidance of getting ready. Um now, we want to be very curious and we want to say, what is driving this? And often it is anxiety driving it. When we feel anxiety, we find a way to make that go away. Now, if I'm nervous to come somewhere to go to school, I know how to feel better. And that is avoid it. That is to call up and say, hey, I'm not feeling well, can't come. I get immediate relief when I get that. And that's how a kid feels when they're really anxious about school, and they say, I've got a stomachache, and the parent says, Great, you can stay home. Immediate relief. Okay. Now it feels good in the moment, but what happens long term is that we've now reinforced that anxiety a little bit more. So the next time the kid is faced with one of these issues, they are likely to turn again to that same avoidance strategy again.

SPEAKER_03 21:34

Okay, so this is where you're saying that maybe I'm gonna call it questionable prescription of just remove demands. You're actually, if you're not identifying this sub layer, you're actually feeding a different problem.

SPEAKER_01 21:47

Yep, yep, exactly. And let's take it a little bit deeper. What is the issue? What are they anxious about? That's what we want to be questioning. Okay, so one, especially with autism, there can be a lot of Social anxiety. When they're going to school, are they thinking, I have to talk to people and I don't know how to talk to them? And so now I'm anxious. Very often with OCD can come or uh autism can come OCD traits, such as perfectionism. Are they really afraid of what if I make a mistake? What if my teacher corrects me? And that's their big fear, why they are feeling anxious in the morning. Just those, or let's go one more. Let's go sensory issues with autism, right? When they're thinking, I have to go to school, is their brain thinking, I have to go to school where the lights are going to be too bright, where it's going to be too noisy, where a kid will sit behind me and be tapping a pencil or breathing too loudly, and it's going to make me anxious and mad. Just those three things is why we need to be curious as parents. Why is my kid being so avoidant of school? Why are they having the headache, the stomach ache? Why are they avoiding getting ready? We want to be curious and find that trigger there. Now, the importance of that is if we can identify the problem, the root cause of the anxiety, then we can treat it. We can treat it with therapies such as cognitive behavioral therapy with a big focus on exposure therapy.

SPEAKER_03 23:26

Getting them more used to that thing that's causing the trigger.

SPEAKER_01 23:30

Exactly.

SPEAKER_03 23:31

You know, it's funny, I'm I'm hearing you, Doctor, and um I'm realizing the cost of not being present, right? Because I think as parents, where we go is we have this image of what the day was supposed to be like. Um, my kids not fitting into that image. Yeah. And again, whether I'm honest with myself or not, I'm now just as anxious because the day's not going how I wanted it either. And so we start using these anxious-driven strategies of compliance and forcing, no, fit the fit the picture that I had for today instead of being present in the now. Something's off with my kid. They're hurting or struggling in some way. The only thing I need to worry about is not what the day was supposed to look like, but what's causing this? What is the thing that's triggering? And I love this idea of I like how you called it layers, you know, you're you're driving down, okay, there's anxiety, but anxiety about what? What specifically is it? And we don't find that unless we're going to be there present and connected with them. And there is a lot to that general parent intuition. Yeah. I I I parents, if I can say anything, trust your gut. It's right more often than it's wrong. But to get to that, you have to remove your own anxiety and be present with your kid. Be present. Um, and and I love the idea that that that will expose new avenues we can go, not just to treat, but to support our kids through it. And I'm just now replaying, I I it's funny because I'm now thinking in the past and getting a little depressed. So thank you for that preface in the beginning of all the ways I did that wrong before. And I'm like fighting not to do every parent feels that way, you know. Yeah, but but but still the awareness. If I'm feeling depressed, am I in the past? If I'm feeling the ang anxiety, is it because something's not to expectation? Being present is such a wonderful prescription because it drives the curiosity. Yeah.

SPEAKER_00 25:26

Well, and my question is like, okay, I'm curious. I kind of I think I found the root cause and I'm experimenting that that is the root cause. What do you do with it? So, like, okay, now that I know, what do I do?

SPEAKER_01 25:39

Yeah, really good question. And I would say, as uh as you're looking for help and support from a psychiatrist, from a primary care doctor, from a therapist, make sure they've got more than one tool. Okay, right. If you go somewhere and they offer, we we do neurofeedback, right? If that's what they do, that's what they're gonna prescribe. Yeah, if you go to a psychiatrist who we do meds and that's it. You're gonna walk out with a medication. Whenever you go somewhere, look for options. At the Grove Psychiatry, we have the medications, all the evidence-based meds, we have alternative medicine approaches, we have dietary interventions, we have every therapy that you could you could want, we do there. TMS. There, there's a lot of different treatments there. And and you need that for these complex things. Um, so Brad, to answer the question, what what do you do with that? Sometimes meds are the right answer for these kids, right? Sometimes their nervous systems are so dysregulated that they can't even begin to move forward with exposure or facing the thing that they're so afraid of. I'll I'll use an example example when we're talking exposure. Let's say someone has an extreme fear of spiders. Anyone in this room? Oh, no phobia as a kid. It took a while to move past that one. Yeah.

SPEAKER_00 27:13

That's that's how I get under the skin of our producer, Jess, just throw spiders at him. There we go. There we go.

SPEAKER_01 27:18

So with him, we could do a little bit of exposure therapy. Now, what's the right way to do exposure therapy? It is not to walk in and say, boo, here's a spider, and we throw it at him and hope that he will learn to be okay with a spider. The same thing with our kids. We're not taking the thing that they're afraid of, whether it's school or demands or making a mistake. And we're not just surprising them with this overwhelming flood of exposure. We are helping them understand what we're trying to do, which is we're trying to help them build up a tolerance and a resiliency to the thing that they're afraid of. And kind of back to your idea, Nathan, of the being present with them. We are trying to teach them and model for them that it is okay to sit with an uncomfortable emotion. And that's why it is so important as a parent to just be there and be present and to not try to control it too much, which is just a way for us to avoid rid of the feeling.

SPEAKER_03 28:26

And that's where I keep going because we're talking about the kids struggling, but doctor, I think this is a parent issue as much as anything. Because um, and and I don't want to gloss over it, you you preface this with calling it an avoidance cycle. Um, and I I think we went through that quickly, but really what I'm hearing you say is avoidance for us is a reward. Right? For the kids, it's a reward because they they they get to turn off the stress, and that avoidance I'm sure comes in a number of ways. It's not just not going somewhere, but it's escaping, right? So screens can be an avoidance strategy or social media or or video games or whatever the thing is, right? Avoiding is is a reward. But as a parent, what what I'm what I'm seeing is sometimes our response, our prescriptive behavior for our kids is also an avoidance strategy. I don't want to deal with this right now. I know what they like. I'm just gonna give it to them to avoid the drama. And our motive is still avoidance. And you're you're kind of raising this idea, you say you know, saying it's good for our kids to sit in this discomfort. Well, as parents, it's good for us to sit in it. It's okay to feel like we don't have the answer, but to throw away, I don't like that I'm feeling uncomfortable, and more ask, why? Well, it's because my kids are not doing what I want. Okay, is what I want the most important thing, or do I need to ask what's their struggle first? And that uh I think that idea of avoidance is one that that deserves its time in the spotlight because a lot of our strategies are avoidance driven.

SPEAKER_00 30:01

Well, and what is it that makes us want to avoid that? You know, like you know, like again, not being present, you know, just kind of hey, I'm just gonna throw this and just get out of here. Like, what is it in our minds that or what motivates us more now to avoid these um these behaviors rather than just you know, let's just take it on?

SPEAKER_01 30:22

Yeah, just just human nature. We're we're logical, intelligent beings. And when something is uncomfortable, we get away from it. That's that's the logical thing to do. This is not fun, this is hard, this is uncomfortable, this hurts. Stop doing it, is what the brain will be screaming at you. But you need to have a bigger why of why we want to sit and endure that discomfort in order to grow through it. And that's hard to teach a kid. And so, what's one of the best ways to teach it is modeling it as a parent. Now, the I that that idea of avoidance for a parent, right? We have a trigger, our kid is not obeying. We have uh an uncomfortable emotion, anxiety, anger, frustration, uh, judgment, right? And so then we do a behavior to make that go away, which at two extremes might be either we're going to control, we're gonna yell, we're gonna punish, we're gonna threaten, we're gonna put hands on and say, do this right now, so we can either control, or you swing the other way to just pure avoidance or distraction. I'm gonna hop on my phone. I don't want to deal with this. I'm just gonna hop on my phone or give my kid a phone and say, just go, just go away.

SPEAKER_00 31:46

Can we speak to that? Last time we spoke, this really changed my pers my whole perspective of the demand and the dopamine that you get from like a cell phone avoidance. Yeah. Can you speak to that again? Like kind of go through that process. So I have this demand, I want to avoid it, and then how the how cell phones negatively could could play into that.

SPEAKER_01 32:09

Yeah, yeah. And that that's where the avoidance cycle gets gets kind of scary because it's already very reinforcing, right? A trigger, uncomfortable emotion. We do something, we feel better, and we're more likely to do it next time. Now, if the phone is the behavior that we are using in order to get away from that uncomfortable emotion, we all know it. No surprise, phones are very, very addicting, right? Every app we use on there, people are sitting up in their in their buildings designing apps to be more and more addictive. Um, and so when we feel uncomfortable and we go to our phone, not only are we being reinforced by the fact that the negative emotion went away, but we're also getting a little bit of a dopamine hit, which is then addicting us further to that avoidance strategy that we are in.

SPEAKER_03 33:04

Almost like we're craving the avoidance and it's almost inducing the anxiety to begin with, because we want to get back to our coping strategy.

SPEAKER_01 33:10

We are rewarded by avoiding discomfort.

SPEAKER_00 33:14

That's like that's crazy. It's scary. Think about it. You're like, okay, I'm gonna avoid this behavior, and at the same time, I'm gonna get like this dopamine hit, like this drug hit. And now I'm so that gives me another positive. I'm gonna feel good about that. So I'm feeling good about avoiding a behavior. Yeah. And then how does that build with anxiety? Complete that circle.

SPEAKER_01 33:38

Yep, exactly, exactly. As you're as you are reinforced with a behavior and especially an addictive behavior, it then pushes you to even feel more anxious.

SPEAKER_02 33:51

That's crazy.

SPEAKER_01 33:52

Because not only, not only are you getting withdrawal from it, right? That's that's part of it, is whenever, whenever you do do an avoidance strategy, like I'm calling off sick, I'm I'm not going in, and I'm just gonna be on my phone all day. Well, whenever you remove that and you put someone back into a stressful situation and remove the phone from them, their brain is feeling this big drop from high dopamine state to a low dopamine state, which our brain interprets as discomfort, pain, and anxiety, which then drives us right back to that same behavior again. And so as adults, we feel that you can feel when you're coming off of that dopamine high. Can you just imagine for a moment what our kids are experiencing with the screens that they're on? Now, nobody panic, like don't go home, don't throw your TVs out, you don't have to go break your iPads, but we we need to just be aware of the cycle.

SPEAKER_00 34:54

Well, and and that's what I liked about that. It's not so much that screens are bad or phones are bad, it's how and when you use it. Exactly. That's when it that's when it becomes bad. If you're using that to avoid demand, yeah, then that's when you have to say, oh, why am I doing this? Okay, it's because I don't want to be uncomfortable. Okay, let me put down the screen, let me feel uncomfortable, let me let me kind of go through this emotion, let me meet the demand head on. Um, that's that's that was the eye-opener. Yeah. Because a lot of people I hear in society all the time, hey, phones are bad, they're ruining your brains, whatever, but they're also really, really, really good, obviously. But it's not, it's not so much the screen or the phone, it's just when and how you use it. Yeah, yeah, yeah.

SPEAKER_03 35:34

And and listen, we we have enough stresses as parents. And so what I don't want is for this discussion to add a oh no, I've been doing it wrong dynamic, where now you're gonna feel even worse.

SPEAKER_00 35:45

We're gonna give you more anxiety.

SPEAKER_03 35:47

But there's a there's a parallel here, I think, that that helps to make this make a lot more sense. Like, you know, Brad, you're a fitness guy, you've been in the sports world a long time. The process of building muscle and working out physical health is one that we all kind of innately understand. We know that to build strength and endurance, we have to cause discomfort and pain in our bodies. And as we endure and push through that, our bodies become more resilient, more healthy, and stronger. You know, eating good food builds good things, eating too much bad food makes us fat and unhealthy. But every so often it's okay to have a little dessert indulgence because that's that's a good thing to reward, so long as we're not eating too many Oreos, you know. I'm paralleling that now with this concept of mental health, which if you had asked me six months ago what's mental health, oh well, that's for all the people that are struggling with anxiety and depression. But I think the discussion here is mental health needs to be as prevalent as physical health. And it works much in the same way. If I'm avoiding those hard areas, it's like giving up in the middle of my second rep. Yeah, right. Yeah, or if I'm just eating too much ice cream, it's like spending too much time on social media. And I think if we're thinking of mental health the way we do physical health, then really it's, you know, we're used to modeling what's my workout routine for the day. But let's ask ourselves the other question: what's our mental health routine? Yep. And am I getting too many carbs in my mental health diet? Or am I getting enough protein? Am I putting enough stress to keep building resiliency versus taking away the demands like you were talking about? So um I think there's a and maybe it's just me because I need to dumb it down. If I ask, do I have a mental health routine for myself and my kids? That changes the way I look at their own mental response when they're feeling discomfort. Now it's it's okay to sit in that and I'm gonna ask myself, what's the healthy mental exercise for this workout that we're dealing with? Whether it's cardio or strength, which is gonna be, you know, PDA or anxiety, like there's there's a lot of parallels there that I think can help us intentionally plan out. It's okay to have some mental stressors because there's an aspect of resiliency with that. Yeah. Um, just so long as I'm not avoiding it, which is just gonna make me mentally fat, unhealthy, and decrepit. Yeah.

SPEAKER_00 38:08

Well, and as you're speaking, like you think about good health, you know, we talk about counting your calories, so don't have your calories go over so many, you know, per day. Same thing you can do with screen time. That's why you put limits on screen time so you're not overindulging on screen time so that you are more present. Right. You know, and I and I and I I think that's one of the coolest attributes. The more I've been studying PDA, ABA, and and and you know, how the nervous system works, being present is a struggle and it's hard. Yeah. And you really have to focus on that, which I never thought of before because we want to, in a way, daydream. We want to relive the past, or you want, or we're worried about tomorrow. Yeah, you know, and so that's it's a it's a great concept.

SPEAKER_01 38:57

Yeah, and it's a good framework. It's a really, it's a really practical framework to look at things through. Now, before you know, you go out there and you feel like we need to go all in on this, you know, I gotta get my kid doing this, this, and this, and remove all screen and all avoidance, slow down because right, like if we've got if we've got like PDA, let's say, let's let's take a kid with more of that PDA type profile or symptoms. Um, they that's the equivalent of someone who they get winded going up a couple of stairs. Yeah. Right. The the first step is not go do a marathon, right? The first step is just try getting up those stairs over and over and over until we just introduce you to the middle day. Exactly. Exactly. It is it is walking down the street, two houses and back and beginning to grow from there. So don't feel a huge sense of urgency, which will just lead to overcontrolling and and anxiety-driven behaviors of pushing the kids too much or going too all or nothing with uh with the approach. So just start really, really slow and meet them where they're at, be present with them, and and begin to help them develop that growth mindset, which is that idea and that attitude that discomfort is a helpful and healthy thing for us. And and I think the best way to do it is show it as a parent. Like, hey, I'm I'm feeling really anxious right now, and and I'm just gonna sit here. I'm gonna sit with that anxiety for a moment. And uh, and I'm I'm worried about a lot, and uh, and I just want to go eat some ice cream and I just want to go hop on my phone and social media, but I'm I'm gonna sit here. Well, will you just gonna sit here with me? And and can I don't know, can we can we hold hands? Can can you just sit close to me? Maybe you sit there if you don't like uh physical contact, but let's just let's just sit here and breathe just for 30 seconds. Can we do that? And then begin to grow from there. What a great way to model just sitting in discomfort for a while, which will then give them that idea that hey, there's something to this, um, I can do it too, and I can begin to grow and feel discomfort.

SPEAKER_03 41:23

See, and I I hear that, and again, Doctor, the reason I love this episode and why we were so excited to come back to it, this is not just advice for my my kid. Yeah, this is advice for me. Um, frankly, this is advice for a marriage. You know, when there's discomfort, what do we do? I don't want to talk about it, we don't want to shine a light on it, give me my space, I'll give you yours. We avoid and and introducing the idea that avoidance is a cycle and a reward. Because we think about I don't want to reward the wrong behavior in our kids, but here we are using that strategy for ourselves to avoid discomfort.

SPEAKER_02 41:58

Yeah.

SPEAKER_03 41:59

Um, and if there's a message I'm hearing resoundingly loud in this episode, it's that discomfort is not a bad thing. It's a sign that there's a stressor and it invites the opportunity to be curious. Yeah. And if we're curious about the stressor, then now we can be open to understanding and connecting. And that is as powerful for our kid as it is for our spouse, anybody that we're gonna have a relationship with. And so your approach is don't run from discomfort. It's be okay sitting with it, and more importantly, be curious about it. And in that curiosity, it forces you to be present and it drives that connection that is so crucial. You know, we call this the player's connection. Um that's probably one of the single most powerful bits of advice we've had on this in how to be present and connect. It's okay to sit in this discomfort, don't run from it. It's gonna be okay.

SPEAKER_01 42:55

And step by step, yeah. We don't we're not looking for 10 minutes of discomfort. We're we're beginning with just a couple of seconds of it. Um I think when we talk in these terms, it can feel like we're oversimplifying things, and in a way, we are. This is a great foundation, but I just want to kind of validate what a lot of people go through. There are some very complex brains and behavior patterns and behavior cycles going on out there, and and and sometimes you need some specialized and intensive care. So I don't want to minimize that. No, like no one feels bad if your kid really benefits from a medication or from a certain supplement. You're you're not weak, you're not necessarily doing the wrong thing. Sometimes kids need extra help to help regulate their brain, their nervous system, their anxiety, their OCD. Back to that spider example I was talking about before. For some people, if we're trying to get them comfortable around a spider, um, and they can't even tolerate seeing a picture of a cartoon spider, they go into a panic attack. They're gonna have a really hard time doing any kind of exposure. And those are the times where I say, hey, let's look at a medication or a supplement that might bring the anxiety down a little bit, that will allow them to look at a picture of a spider, and instead of feeling a nine or a 10 out of 10 anxiety, they're feeling just the discomfort of a five out of 10 anxiety, which is tolerable. They can learn and they can grow from that. If they're feeling a 10 out of 10, they aren't going to respond to that exposure. It'll traumatize them further. And so that's why working with a capable therapist or a capable doctor who can help prescribe options to be able to help make this tolerable so the kid can grow.

SPEAKER_00 45:02

Well, that's why I like what you're saying, that you want to work with somebody that has options, right? That can look at from multiple points of views and really try to customize the uh uh, you know, the uh I guess the procedure or whatnot to the child or the individual. So if we do the medication route, uh, I know some people like I'm curious, like, is that something that, hey, if we do medication, is that a long-term approach? Is it a short-term approach? Is it, you know, well, how do how do we progress from medication to begin off of medication? How do you manage that?

SPEAKER_01 45:33

Yeah, that's a great question. Um, meds do not have to be forever. Now, I wish I could promise that for every kid, you know, you give them a med, you give them propranolol or guanfosine or a little bit of zoloft, and their anxiety goes down, they engage in therapy, they they change the pattern in their brain, and they're often going able to face any spider out there in the world. I wish that was the case. In in a lot of cases, you do the meds, you do the therapy, we see the benefit, and then we can slowly come off of the meds and see how things are going. A lot of kids are able to come off of them. A lot of kids, even though they do the best therapy on earth, you come down on the meds and they're like, I'm doing better, but I'm still having extreme anxiety and I'm seeing spiders everywhere and I'm anxious about them. And they say, you know what? I function better. My brain just works better on a medication. In some cases, they stay on meds and they they benefit from them.

SPEAKER_03 46:34

You know, and the the reassurance here, Doctor, is that listen, anybody that's been listening for the past 45 minutes or so, I think can see the value in having a professional on these topics. I mean, I mean, the things we've talked about and gotten relatable aspects that any parent can do right away, but also the way you've just coached through some of these topics. And listen, you didn't really come hyper-prepared today. This is just a conversation we're having. You're highlighting the importance of a professional in your field. And I think to circle way back to when we started, this is an area of support for our kids that I think is most frequently overlooked. Yeah. When we get that diagnosis, what whatever it is, we immediately go to the resource therapies that are out there that are more behavior and and you know, the ABA and service-based. And I just frankly think the mental health side of it is often overlooked. And if we've done anything today, it's highlighted the important that no, this is a, as you put it, a layer. We might still have those speech needs and those ABA needs, but there's that layer of behavioral and mental support, whether it's depression, anxiety, or OCD perfectionism, there's there's a a ton of them that there's an added benefit we can get. And I just, if nothing else, I am hoping we're shining a light on that on Grove and what you guys do so well, that there is this other resource that frankly is as helpful for your child as it is for you. Yeah.

SPEAKER_00 48:02

Well, and you know, you live here in Mesa, Arizona, your office is here in Mesa. Um, but we have a lot of people outside of the state of Arizona that listen to the connection. For those who are outside the state of Arizona, if they're looking for those so-called options, how's the best way for them to find it? Uh, we're gonna put your stuff out on our social media and and and uh on our podcast, or everybody can find you. Yeah, but outside the state, how's the best way? Because we hear that all the time. It's like we have questions to ask. Yeah, what should I be asking? What am I looking for? You know, and and you know, you're gonna get one doctor that says no, you know, medication is the only way to do it. Oh, hey, you have PDA is the only way to do it. And it's kind of like with Polaris Academy, how we kind of fell into PDA, like there's a loud voice that PDA is the only way that you can work with these autistic uh kiddos, and then there's a loud voice of only ABA works, and there's a loud voice that no, only OT really works, and there's a loud voice that says none of that works. Yeah. So, how do our parents find those option doctors and give good advice and good resources to them?

SPEAKER_01 49:03

Yeah, spend a little bit of time uh researching where you're gonna go. Try interviewing the therapist or the doctor who you're gonna work with and just use that word. What options are there? And if if it's only one thing, I would say, do you know anyone else nearby who has other options? I'm not I'm not opposed to medication, I'm not opposed to therapy only, but I'm looking for someone who can integrate all of it together because kind of like you what you were pointing to, Brad, this is very, it's a very complicated thing. There's no just PDA or just autism that is is very simple and that there's one approach. We need we need a multi-layered approach to it. Interview and just use that word. What options, what tools do you have to offer me? Now, in a lot of cases, you're not gonna be able to find that unicorn who has all of the tools. Uh, our our goal at at the Grove is we say, what would I want for myself, for my family, for my kid? If I brought them in, what would I want to see? What would I want to hear? What kind of care would I want to get? And in our minds, we want we want options. We want someone to meet us where we're at. So I wish that could be everywhere and I wish I had a connection everywhere, but it can be hard to find. Yeah.

SPEAKER_03 50:30

So I think you've given enough tools and references that if all they do is benchmark who they talk to against what they've listened to today, it's a good starting point. It is, it is. Um, and and thank you, Doctor, really, for introducing. It's funny because we have this autism podcast, like we're going to talk about PDA and anxiety, and you come and go, no, no, no, there's this thing called avoidance. And we weren't initially prepared to even have that discussion. And it's like this, it's like, you know, I almost want to call it the avoidance monster, the thing, you know, the monster behind anxiety and PDA. You know, it's and it's a strategy, really, it's a it's a strategy we've all learned to use in different ways. Yeah. And I'm glad we've pointed out the big elephant in the room. The avoidance cycle, like is is this thing that I think can shape us to be better parents. Um, it can help us to understand when we're running versus when we're being present. Yeah. Uh, and it just drives the idea that it's okay for us to feel discomfort too. Yeah. I I love love the focus. Yeah.

SPEAKER_00 51:30

And this and that reminded me when you were talking, Nate, last time we spoke, you said a term of, and I'm not, and I can't remember if it was like a clinical term or just a term maybe you use about how to address avoidance. And if I remember correctly, the phrase that keeps coming back in my mind is the word of move forward. You know, and is that is that correct? I'm not sure if that is a clinical term or whatever, but I just I like that, you know, think about like if you're lifting weights, how do you how do you get from one rep to another rep? You gotta move forward. Yeah, you know, if you're if you're avoiding, like, hey, you know what, I know I need to do this, I gotta mow the lawn, yeah, the best way to do it is move forward. Yeah, yeah. I just I kind of like that cord.

SPEAKER_01 52:15

I love it. I love it. And yeah, and that that calls a lot on a therapy called acceptance and commitment therapy, which is moving forward in a value-driven way.

SPEAKER_02 52:26

There you go.

SPEAKER_01 52:26

And the the issue with this whole avoidance cycle is that it it stops us. We get stuck in avoidance, and then we stop moving forward. And so, what I'd what I'd recommend to all parents is wherever you are, wherever you're at, wherever your kid is at, find a way to start moving forward. And a framework to start with that is going to be that curiosity. You need that curiosity because there is no one pill for autism. There is no one pill for PDA. It's really getting curious and looking at the layers and saying, okay, what is driving the PDA? Is it anxiety? Is it anxiety caused from perfectionism, from noise, from social anxiety? And you get to that layer, and then you can cure be curious and then move forward with a treatment that is targeting that exact layer. Don't don't take simplistic approaches to things. If you walk in and and you say, My kid is defiant, and someone says, Oh, defiance, that must equal ADHD, that must equal, let's get you on a stimulant. I can't tell you how many times we have kids coming in who have seen someone who was not curious and looking at layers and said, defiance equals stimulant, and now the kid is through the roof, they're not sleeping, they're angry, they're irritable, they're scratching at their skin because someone wasn't careful, someone wasn't curious, and looking at the real root of what's going on. And so just make sure whoever you go to is curious, that they are digging, that they aren't oversimplifying, because these kids are not a simple diagnosis. Each one of them is very unique, they have layers, and we can get to them. It can be extra hard when your kid doesn't want to talk. When you bring something up and they say, uh, you say, How was your day? And they say, Fine. And they they shut down every conversation. It can be hard to get to those layers. I get it. But as time goes on, as we're moving forward, being present and connecting, you'll begin to see those layers.

SPEAKER_00 54:41

Awesome. Well, thank you, Doctor. This is awesome. I really appreciate that you're here. Um, we'd love to have you back again and keep doing more of a deeper dive on this wonderful conversation of anxiety, um, you know, depression avoidance.

SPEAKER_03 54:55

We're just with the trends of mental health. You know, I I go on my fitness app and there's yoga and there's strength training and there's you know plometrics, and so he needs an app. You need to do this we need to do that. Today today in our mental health exercise, we learned one aspect, one exercise. But I think, Brad, I think there are multiple routines we can dive into. And frankly, I'm excited to do it. Doctor, I'm excited that you're there as a resource. I'm excited our parents now know about it, and if nothing else, their challenge to be present. Being present will drive that curiosity. So thank you.

SPEAKER_00 55:25

Awesome. Thank you. Thanks, guys. Hey, well, thanks for uh letting us be part of your day. If you enjoyed the show, please hit the subscribe button so you're always in the loop for more inspiring conversations. A huge shout out to our amazing team, Justin Palmer, our producer, our marketing director, Dallin Davis, for making this happen. Until next time, let's do some good.