My Child Doesn't Fit In

Podcast Transcript

Speaker 4: Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time.

In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now here's today's host.

Dr. Ethan Benore: Welcome back to Little Health. I'm your host, Dr. Ethan Benore, chair of Cleveland Clinic, Children's Division of Pediatric Behavioral Health.

Today we want to talk about the struggle of fitting in. When a child has a mental health condition, they may think differently than other children. They may behave differently than other children. They may feel and express emotions differently than other children. If a child feels like they don't fit in, this can affect their self-esteem and overall mental health as well.

For parents, there's a unique heartache in watching your child struggle. Today as we finish our season on pediatric behavioral health and psychiatry, we're discussing ways parents can support their children and foster a sense of belonging. Our guests today are Dr. Vanessa Jensen and Dr. Hallie Fetterman my colleagues and staff psychologists at Cleveland Clinic Children's, welcome to Little Health.

Dr. Hallie Fetterman: Thank you.

Dr. Vanessa Jensen: Thank you very much for having us both.

Dr. Ethan Benore: Dr. Fetterman, let's start with you first. Can you just tell the audience what it is that you specialize in working with children, your, your passion and psychology?

Dr. Hallie Fetterman: Sure. I primarily work with kids with ADHD or developmental differences, um, behavior difficulties, um, autism, intellectual disability. Um, so these are kids who historically struggle in a lot of areas, uh, related to social or academic concerns.

Dr. Ethan Benore: Excellent. Dr. Jensen, where's your passion lie?

Dr. Vanessa Jensen: Um, similar to Dr. Fetterman, I tend to see kids who have developmental differences. You notice we said differences, not disabilities. Our focus is on kids who are and often know they are different.

You know, again, kids with autism spectrum disorder or autism. Kids who may be as I lovingly say, kind of quirky. Uh, I've been here a long time. I've been at the Clinic, this is my 35th year, so I've seen a range of things.

The other thing I see, um, other kind of population, I see a lot of our kids who have gender differences. Kids who are transgender, gender questioning, uh, don't fit the standard male female stereotyped norms. And those kids often struggle with where do I fit and how do I fit in the world.

Dr. Ethan Benore: Excellent. Thank you. Thank you both. So, so let's talk about what makes our children unique, and what is it about that uniqueness that, that makes them struggle.

So I, I wanted to begin with ADHD as a condition and, and, and see if you can, um, Dr. Fetterman walk us through where children with ADHD struggle in in social groups?

Dr. Hallie Fetterman: Sure. So the primary difficulties of a child with ADHD can be summarized as hyperactivity, impulsivity, and inattention. Um, so some kids have a mix of all of these. Some have primarily one or the other. Um, but either way they can influence the way they interact with peers.

Um, so a child with primarily inattentive symptoms might seem a little withdrawn or daydreamy. Um, their peers might think they're not listening to them or don't care about what they're saying when really they, they truly do they just forget.

Um, whereas a kid with more hyperactive or impulsive type symptoms may present as someone who's very excited to, to be around peers and maybe kind of suffocating or overbearing. Uh, so maybe a lot of interruption or a lot of talk about their interests, which are, you know, sometimes very unique, um, or difficulty with turn taking either in, you know, physical settings with tangible items or in conversations.

Um, so in those instances, peers may find that to be frustrating, um, and then distance themselves because of that. And then sometimes there's a little bit of both. So those are primary areas or ways that kids with ADHD might struggle with peer relationships. Yeah.

Dr. Ethan Benore: Um, Dr. Jensen, with the, with the patients that you treat, uh, whether they're on the spectrum or have some gender differences, what, what are the areas of their presentation that causes them to struggle when they enter a... I'm, I'm thinking about we all love our children and then we send them to school, and then there's this desire to, um, have your child fit in but, but everybody's unique.

And so in, in this situation, what are the, the things that the children you work with tend to struggle with when they're in those social groups?

Dr. Vanessa Jensen: You know, it varies a lot, and I think we have to recognize that all kids are unique. Similar to what we've heard, I think in other talks that you've done with other professionals, each child's unique.

Each child knows something about themselves. Some of the kids I work with on the autism spectrum may not know themselves as well as some other kids do. Some know things about themselves, very astutely.

Parents also know their kids well. So oftentimes for a parent, it's trying to get a parent to say to themselves, okay, I know little Johnny, little Juanita, whatever the name is, and when I see them with other kids on the playground, this is what I see. So when they go to school, I can kind of expect A, B, and C.

So when you know, little Jason comes home and says, nobody would play with me as a parent you wanna be realistic, listen. Was Jason telling you the whole story or part of the story? But knowing what your child brings into a situation can help you then think through what are the challenges gonna be, because they do vary.

Is it knowing my child is too forward, as Dr. Fetterman said, is too in your face, or is too cautious behind the scenes or too aloof. You know, knowing what they bring, that is a problem, but also knowing what they bring, that's a good thing and then focusing on that.

Dr. Ethan Benore: Excellent. So thinking about this, I was hoping we could try to take this in in ages because thinking as parents, how do I support my child?

We, we relate to our younger children somewhat differently than we relate to older children. And, and the social world is different for younger children than for older children. And so if, if the goal is being an active participant and feeling like I belong in my class, my boy scout troop, my cheerleading team or lacrosse team.

With young children what do we do to try to ease that for young children who are struggling fitting in? I'm just thinking if I'm talking to a parent who's like, you know Alex, Alex just is not getting on with his, with his friends at school. And I just wanna like yell at the teacher, or, or, or those other boys, those other, those other girls. I just wanna just like scream at them, um, because he's not being success, what I think should, is successful in this social world.

Dr. Hallie Fetterman: Yeah. I think it depends on an assessment of where their difficulties lie first and foremost to know how to proceed. Um, so some kids may have trouble with emotional regulation, which is getting in the, you know way with peers, um, perhaps a kid is a little bit more withdrawn or anxious about social interactions and that type of approach might be different, you know, again than if your child was facilitating or initiating a lot of social interactions in an inappropriate manner.

So my first approach or discussion with families or caregivers is typically to encourage them to first reflect on what their child's needs are, or is their child potentially happy with having one very close friend versus a lot of friends and I, I often find a lot of families are concerned because they feel like their child doesn't have a lot of friends, but for some kids, their, you know, their cup is filled by one or two close friendships. And we know that research says at least one good friendship is, is a good protective factor for, for the future.

So it doesn't need to be a large quantity. And reflecting that your experience growing up with friendships can be different from how your kid, uh, kinda experiences the social world.

Dr. Ethan Benore: I, I do like the idea, yes. Thinking about my own kids growing up, it is a different world than when I was growing up. I, I like the idea of trying to be mindful of what their goals are or what their idea of, of success is. That's helpful.

Dr. Vanessa Jensen: You said something really important though. Dr. Beno is in this current world and there is a lot of pressure, you know, with social media. You know, the world is not just your neighborhood or even your neighborhood school.

The world is the world and kids begin at a pretty young age. You know, if they're kind of socially aware to compare themselves and parents can't help but compare their kids to not just the three neighbors they're close to, but to everybody and can judge their child unintentionally. But again, if they don't have 10 kids calling for play dates, so.

I often would say start with asking questions and when your little one comes home and says, everybody's mean to me or nobody will play with me. Use a curious mind, a phrase that I think I have heard you use many times over the years, but use a curious mind and say, wow, what happened? You don't wanna say What happened, what'd you do?

What'd you do is really like, avoid at all costs, but what happened? Wow. Really? Tell me a little more than what those really general things. And what was that like, and did anybody else say anything? You know, and just get lay of the land in a very neutral, supportive way and even support your child. Huh?

How did that feel? It sounds like, it sounds like maybe you were sad about that, but just make it this neutral, emotional connecting with kiddo because that connection there that will fuel you to be able to say. Huh? Let me think about it. You don't have to give the answers. You don't have to fix it.

We all wanna fix it. That's just what we do as moms and dads or grandparents. We wanna fix things. But then later on to go back and say and I was thinking about that. I have an idea. Do you wanna try one thing? But then give them just one thing, like of all those boys who was not being nice to you, who was the nicest?

And maybe, maybe just making a point of saying hi to Alex for the next couple days. But just a little, it's back to the idea of giving a little strategy, a little action plan that feels like you're just putting a drop in the bucket and you are, but at least it's one drop in the bucket. Right.

Dr. Ethan Benore: I love that. I, I, I love the sense of curiosity.

I, I love playing the long game, um, that this is, this is not about, you need to fully fit in today. This is about you, there may be some skill development that we need to work on together to try to manage this. And as a parent trying to hold back on judgment on you either are or are not fitting in. But it's just like this social interaction didn't go well, so let's learn from it and see what we can modify to move forward.

So as kids get older, they do tend to pull away from, um, the family to some extent and start to socialize more in and sometimes in different groups or pods, and that affects their identity, how they see themselves. I am uh, no longer a child that plays soccer. I am a, a soccer player. I am, I am hanging out with the team.

And we all remember those groups when we were going to school as well. But a, as you get older, how you see yourself and how you see yourself fitting into groups can, can change. And so what thoughts do you have about how we might approach this with the, the, the middle school, ninth, 10th graders?

Dr. Vanessa Jensen: I think one thing I would say upfront is again, keeping that curious mind, encouraging that in your children so that they don't have to be just one thing.

Like if I start playing soccer and I'm really good and I'm on a travel team now and forever more that's my thing. That's a thing. Um, and yes, you are a soccer player, but you're also a great trombone player. Or even if you aren't great, you love it. Um, you also attend this organization or you go to our family functions or to the Ukrainian Dance Club.

Whatever it happens to be is encourage kids to not get locked in because if that social group turns sour, we've both, we've all seen that go downhill really, really quickly. So to encourage, you know, yeah, it's great that you have this close group of friends, but try other things too, so you don't feel locked in.

We've all had situations where we see kids, um, who get really caught up in trying to be in the in group, in some group, whatever it is, whether it's band, music, dance, art, sports, and then some popular kid decides they don't like that child, and then everyone's in tears. So encouraging some diversity across those identities is really helpful.

Dr. Hallie Fetterman: In addition, something that I've coached parents a lot on is fostering a growth mindset in their children. So the way you praise them, um, is not necessarily product oriented, but the process of learning and being okay, you know, really fostering resilience. Um, and it speaks, I think, to what you were talking about in terms of, you know, not being one thing or the other.

And a lot of our kids, especially with ADHD, autism have difficulty with flexible thinking. So they're more prone to think, I am one thing and not the other. And as you develop, you know, your sense of identity does become a little more rigid before it becomes a little more flexible when you're in your later teenage years.

So, um parents can, you know, continue to notice when kids do fail, but get back up and try again. And that's something you can certainly point out in peer interactions, but across the board is really a protective factor for developing a healthy sense of self-esteem.

Um, so again, whether that be because of negative social interactions or any other mental health differences they're dealing with, um, ultimately it is not always in our nature to praise the, the process. So, uh, keeping that front of mind as as a caregiver can be really important.

Um, and it's something to probably praise yourself as a caregiver too, because you will also have times where you may have wished you did something differently and that's okay.

Dr. Ethan Benore: That's wonderful. I love you hit several things there. So growth mindset is a, is a wonderful concept in psychology. I think that you did a very nice job walking it through. I, I think parents, if you're not familiar with growth mindset, look it up. You hit resiliency, which I, I wanted to circle back to, uh, I wanted your thoughts on teenage girls with ADHD.

Because when most people think of ADHD in their head, they may think about a little boy that's running around getting in trouble in school, and it's not just little boys, it's also 14, 16-year-old girls. It may present slightly differently, but there's there, there can be kind of a a, you were talking about self-esteem as well.

And one of the things that, that I've learned is that self-esteem can be very difficult for individuals with ADHD when they are struggling and it's not really identified to be a part of ADHD or, or a part of, um, that struggle. And, and wondering if you can talk about teen girls with ADHD.

Dr. Hallie Fetterman: Um, so girls with ADHD in particular, but certainly teenagers tend to be more internalizers, so they'll, they can experience more symptom of anxiety or perfectionism, which ultimately on the surface looks like they're doing very well in school or with friends because they are overachievers or, you know, they, they want to do well.

Um, but it usually comes at great cost that we're not seeing, um, on the surface, whereas again some of our externalizers, we, we might see some of that disruptive behavior or hyperactivity, impulsivity and girls inhibit typically a bit more.

So what this means is that particularly parents or caregivers of teenage girls with ADHD should really try hard to help girls learn about their symptoms, their presentation, um, you know, help them learn to advocate for themselves and notice signs of having difficulty in this area or this area so they can be a little bit more proactive.

Uh, because what happens with ADHD in general is things just move faster 'cause it's a type of, uh, diagnosis where things move quickly. So, um, usually when a problem happens, it's somewhat of a large problem. Um, and really we can't, you know, cure ADHD, we can only treat the symptoms.

So as much as possible, being aware of, of those, um, and helping them advocate, you know, for themselves is really important. But that comes with you know, open communication and uh, really playing the long game again of um, not just all of a sudden one day expecting your teen to be incredibly open and vulnerable with you, but fostering this relationship throughout time so that they can get to that place.

Dr. Ethan Benore: Excellent. And I love the concept of making sure that you're talking openly about the symptoms. I think it's helpful for kids when they can recognize, oh, that's why I am struggling. So it's not a level playing field out there in certain situations. Like I show up in this way and therefore it's not that I am losing this game. It's not that I don't fit in. I just have one particular way that I struggle and I need to address that.

Dr. Hallie Fetterman: Yeah, often caregivers want to avoid talking about any type of diagnosis because they don't want their child to use that as an excuse. Whether it be for, um, why they have trouble with friendships or academics.

Um, and our advice is often not to avoid it 'cause it's gonna come up here or there. It will come up. And if you can talk about it proactively, it's likely more helpful. Um, and a good motto is, it's a reason, but it's not an excuse. So it's a reason why something happens, but I still need to, you know, deal with it and manage it.

And I can be as successful as everyone else, but the way I do it might be a little different or tailored to my needs.

Dr. Vanessa Jensen: Yeah. I often use the phrase, it's an explanation, not an excuse. So it's, it's exes, but it's not excusing behavior, but it does help understand, and as you said, it's a reason for. And I think that's an area where parents struggle is when do I embrace the child's differences and acknowledge it and move around it versus when do I pretend it's not there?

And I think we see this in all kinds of kids who are different, whether they have a hearing impairment and wear a hearing aid, if they're blind, if they have a physical difference or a physical anomaly that makes people look at them funny or a cleft lip, it doesn't look perfect.

Well, you know, I want kids to not notice it. Well, some things are very noticeable and helping those those kids understand yeah, I have that. Okay. And have the confidence and the resilience, as you've said to move around that. And so that other kids, including things like laughing with other kids, you know, being aware that other kids have differences so they don't feel like they have to hide in, in the, in the bushes. Which I think often what we see in kids with differences.

Dr. Ethan Benore: I think that's a very important point. You know, I think as parents sometimes we, we want to protect our child, so we want to shelter them from things that might cause them harm and distress. But there is a real world out there that they do have to engage with. And so we also have to prepare them for that in some way.

And so helping them to understand, accept some of their presentation can, and then gradually finding the opportunities to expose them is very helpful. I think about, um, children with, in, in my mind, I have a, a, a teenager with, um, a tick disorder right now and, and Tourettes that it can be very upsetting to some individuals when it happens in a social environment, but he knows it. He owns it, his friends get it, and so when it happens, they just roll with it and move on. Everybody's got something and, and shielding and protecting uh, a child from all experiences is not preparing them for what they will experience in the future.

Okay. I wanted to, to move on. You guys both said some really important points. You talked Dr. Fetterman about if a child has one, um, friend that can be a really strong support for any challenge that may come their way. Dr. Jensen, when you were talking, I was thinking that the business side of me was thinking, diversifying your assets, so having lots of different areas of interest so if I struggle in one that I, that I don't, um, struggle altogether.

Let's talk about resiliency and how parents can help their child develop resiliency skills or, or feel more resilient in this challenging social world that they undergo. What seems, uh, to be good advice that you've been giving parents when their child is going through this or maybe you have a a, a child in mind.

Dr. Vanessa Jensen: Limiting social media. Can I start with that one? Mm-hmm. Yeah. That's a very broad statement and I know that. Um, you know, I think of social media, sort of like we do, we teach swimming. We don't throw a child in the deep end with no little floaties. You start out with your child in your arms, in the shallow end with everything there to support it and learning how to get their face wet, and then you gradually go on from there.

So with social media, what I recommend is in the beginning when you decide it's appropriate, because your child needs whatever social media they need to keep up with their soccer team you monitor everything and it's just part of the deal. If you're gonna have a phone. I have access and I'm gonna watch everything you do.

As they show that they're being responsible, then you, you wean off. It's like, okay, just so you know, at least once a week randomly, I'm still gonna check your phone. And then by the time they're hopefully in high school, you only check when there's a concern when something rears its ugly head. Then you say, okay, hand it over. As long as you still put it away at nighttime and all that good stuff. But helping them learn how to understand social media and the manipulative nature of it. So I think that's, to me, one of the big things-

Dr. Ethan Benore: and you're not a bad parent if you are policing social media, there're you're a good parent. There's actually sufficient research on the harm that it can cause children, particularly if exposed at a young age or if allowed free reign.

Dr. Vanessa Jensen: Right? And I would even get rid of the word policing in your own parent heads. You're not policing, you're teaching. You're, you're teaching them to use. Just, you know, back 30 years ago, we used to teach kids about commercials that commercials aren't there to make you happy. The commercials are trying to sell you. Therefore everything you see is the best in the world. Social media is there to sell you something, and it's not there to make you happy and to make you a stronger, more resilient person. So it's teaching your kids about the world around you. So that's my, my first recommendation.

Dr. Hallie Fetterman: I often coach parents to increase the practice opportunities that they give their child. So however they have developed, um, their kind of discipline or behavior management routines at home, ultimately a lot of families have learned to either punish or take things away, which doesn't produce a learning opportunity to try again.

Um, and so sometimes kids need to try again multiple times before they finally hit that goal. And then it should be an even bigger celebration because despite having gone through a couple hurdles, they've, they've got it or they made it. So that could be with expected behavior at home. And this does go into, um, you know, part of helping kids learn to regulate their emotions.

Um, a lot of what I typically see is, you know, the, the big emotional reactions or developing consistency in their use of coping skills and frustration tolerance. Uh, and that certainly directly shows up in peer interactions too. So, you know, teaching that at home and being patient and giving them, even if it is, you know, draining on your resources and it's exhausting given everything else you, you have to manage to give them an opportunity to play with the crayons in an appropriate way again. Um, it's, it's an important learning opportunity.

And part of, I think some of the services that we provide at the ADHD Center that are the most intensive and the most, you know, we get a really big outcome and it's so fun to celebrate successes of kids who, you know, previously had a really difficult time and then they realize I can do this is because of the, just the incredible amount of practice and repetition.

And that certainly, you know, comes into play for younger kids, but also if they have any sort of mental health, um, diagnosis or diff- difficulty that makes things a little more challenging.

Dr. Vanessa Jensen: I would also wanna add that the idea, repetition in practice is essential in opportunities, but also what things parents can do is focus on the successes.

So little child comes home and says, you know, again, once again, nobody would play with me at recess. Well, what happened? Well, I ended up, you know, playing next to somebody and they were okay with me playing. Great, you found someone you could play with on the side. So focusing on little successes, and again, focus those raindrops of skills because it's, it's not gonna happen overnight.

And the more we can focus as parents, and again, that's not easy when you're about ready to scream inside your head. You just want this to be fixed. But the more you can focus on the positives and the other parent comes home and you can say, Hey, guess what happened today? And focus on the pluses, not just the sense of failure and doom and gloom.

Dr. Ethan Benore: I love that. And the verbal praise is, is important, being able to label what your child does, so they develop a sense of, um, confidence, uh, or competency that can really help buffer them against the other challenges that they have.

So, thinking about the social world as, as we, as we try to close up here, but thinking about the social world, that can be challenging for them, what, what advice would you give to parents so that home is home base? It's a, it's a safe space. How do we, knowing that I go out in the world and I struggle, what can we do to make home a comfortable, safe place for a child who is struggling out there?

Dr. Vanessa Jensen: I think of the idea of having strong sense of family activities, whatever those are, whether they're playing a board game, sitting in the living room together, or the den or the library and everybody reading their own book, but you're in the same space, going to the park, going to the museums, having sort of their own social milieu, social activities within the family.

Or family, friends, you know, family adults tend to be much more tolerant of kids who are different and maybe don't fit in so well socially, but it's still social practice, right? It still allows some of that practice and repetition in a little safer space, whether it's with relatives, neighborhood friends, family, friends.

Dr. Ethan Benore: Thank you for mentioning that, having social interactions when your child comes home, it is not just go play the video games, go on social media. It is, it is having good social connection and feeling valued, welcomed, supported by another person.

Dr. Hallie Fetterman: Yes. In addition to that, my mind goes to modeling the behaviors you would like to see in your child.

So they're always watching you. Um, and for some kids who may not accept your coaching as willingly as others, uh, it may feel like you can't do anything. But just modeling how you speak about others or your own friendships or even how you define normal or popularity or the way you approach differences is really important. And that's how they learn their values and how to, uh, conceptualize those concepts as well.

And my other, um, coaching or recommendation would be, you know, there's a really big space for kids who are particularly younger kids who are still doing play dates or having trouble with play dates, um, to do what we would call like a structured play date.

Um, so purposely picking out a peer who they can get along with, or maybe more of an easygoing peer. Then planning everything out to the T. So what are we going to do? These toys cause difficulty. So we're gonna put those in the closet so we can't even see them. They're not an option.

You know, talk with your child what are you gonna do or say if you get bored, what are you gonna do or say if they get bored, how do you know they're feeling bored? Um, so really if you're having a difficulty finding a place to start, um, first and foremost, like, you know incorporating family activities is very important, but if you feel like you wanna put a little bit of a foot out to practice with peers, um, those kind of structured activities are important too.

And for a young kid, like six to eight, you know, 40 minutes tops is, is good. It does not have to be super long. And again, it's, it's really something that you have some control and can kind of create some code words or motions to pull them out, ask them how they think it's going, or give them a bit of coaching and send them back in.

Dr. Ethan Benore: End on a success.

Dr. Hallie Fetterman: Mm-hmm.

Dr. Vanessa Jensen: Right. One of my favorite stories, one of my very first mentors back in graduate school is his first name was James. Uh, he used to talk about telling little Jimmy stories, and I've taught parents this ever since in almost 40 years now, you know, in a quiet moment, and your child's going through something, think back to your childhood. Tell them a little Ethan story mm-hmm. About something that happened to you, whether it's totally, exactly accurate or maybe a little made up. There's some variation of what really happened, but to help them feel like, you know, you had times too where you didn't feel like maybe you fit in well, or one of your friends struggled.

Especially younger kids, I'm thinking up through nine or 10, really can get a kick out of it and they also can hear the message without being told the message.

Dr. Ethan Benore: Right. I, I think with what you were talking about, about modeling um, Dr. Fetterman and, and Dr. Jensen, uh, um, now about the, your own stories that that level of empathy is very validating for children, that they need to know that it's, it's okay, um, to struggle and they can get through this.

So thank you. This has been really enlightening. I, I appreciate this conversation. When your child feels like they don't fit in, it can be painful for both them and you. The good news is your support can make a significant difference in their emotional and social wellbeing. Cleveland Clinic Children's provides comprehensive mental health support for kids, teens, and their families during challenging times.

If you'd like to schedule an appointment with one of our providers, please call 216.444.KIDS. That's 216.444.5437. Thank you, Dr. Fetterman. Thank you Dr. Jensen.

Dr. Hallie Fetterman: Thank you.

Dr. Vanessa Jensen: Thank you very much for having us both.

Speaker 4: Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the little health tips coming, subscribe wherever you get your podcasts or visit Cleveland Clinic Children's.org/little-health.