— Podcast

#10: Teaching-Family Model and therapy with Jesse Heaton

The Teaching-Family Model and therapy go hand-in-hand in helping families regain control.

In Episode 10, ADHD parenting coach Siope Kinikini, talks with therapist Jesse Heaton and how he uses Smarter Parenting to help support his ADHD clients.

The most effective behavior management plans involve both therapy and behavior skills at home. A therapist will only work with your child for a few hours during a therapy session, and why valuable, they can’t address everything.

Using behavior skills in conjunction with therapy, allows you to continue to address what they are working on at home. It also gives you and your therapist the same language that reduces confusion and ensures that all are on the same page. This can be especially helpful for your child as they know both you and their therapist will be using the same words and instructions.

Purpose of therapy

Therapy helps your child understand what they are feeling and how to express those feelings appropriately.

Often the behavior issues you see at home, your child doesn’t show at therapy. Be open with your therapist about what behaviors you are seeing and what is their triggers. The behavior skills of Effective Communication and Observe and Describe are especially helpful.

Using the Teaching-Family Model and therapy together will bring significant changes as you consistently use the behavior skills with your child at home

Smarter Parenting is a division of Utah Youth Village.  Utah Youth Village is Utah’s largest not-for-profit provider of services for children. Since the 1960’s, Utah Youth Village has helped throusands of children and families find success.

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Podcast Transcript

The transcript text is below. You can also download the PDF file of the transcript here.

Episode Transcript

Siope Kinikini: This is episode 10. Let’s get started.

Smarter Parenting welcomes you to our podcast series, the Parenting Coach for ADHD. Here to heal and elevate lives is your parenting coach, Siope Kinikini.

Siope Kinikini: Hi. I’m here with Jesse Heaton, actually. He is a therapist out in Nebraska and I’ve asked him to join me. Jesse and I have known each other for a long time. And so I’m going to have him introduce himself and the work that he’s doing and what he’s involved with there in Nebraska.

Jesse Heaton: Thanks, Siope. Yep, so, as Siope said, my name’s Jesse Heaton and I am a clinician here in Lincoln, Nebraska. I have a small private practice here, and I work with families, mainly helping parents who have children with ADHD and/or Autism. And so the majority of my clients have children either on the Autism spectrum or are challenged with ADHD, so.

Siope Kinikini: That’s great. So, can you tell us a little bit about your work? With the kids that you’re working with, what are the types of skills that you work with them with? What type of interventions do you use?

Jesse Heaton: Sure, sure. So we use the Social Skills Development Curriculum on Smarter Parenting. And the Teaching-Family Model is a major part of the social skill development that we do. When I work with parents, we spend a lot of time focusing on Effective Praise and Preventive Teaching. Everybody that comes into my door gets introduced to Smarter Parenting.

Siope Kinikini: Ah, great.

Jesse Heaton: They see all the videos. We refer back to Effective Communication quite a bit in family therapy. And then on the kids’ side, without fail, they will learn the four basics, so they learn Following Instructions, Accepting No, Disagreeing Appropriately, Accepting Consequences. How do I know that I’m starting to get distracted? What does that feel like? How do I know when I’m starting to feel frustrated and angry? What does that feel like? Or overly excited, what does that feel like? What triggers in my body telling me. And so we do a lot of emotional regulation stuff, and then a lot of experiential things.

Siope Kinikini: Can you explain a little bit about the experiential stuff? So, you start with skills first so you can have a dialogue and a communication. That actually is common between everybody. Then you focus on how a body responds, and then you do experiential after that. So

it seems pretty sequential, but can you explain a little bit what are the techniques used in the experiential part? This is actually for me, because I’m super interested in knowing what your approach to that, because-

Jesse Heaton: I think you’re the king of experiential activities.

Siope Kinikini: I don’t know about that.

Jesse Heaton: Honestly, I’ve seen you do so many experiential activities, and I’ve learned a ton from you in doing co-therapy with you. So I’ll just give you some examples of yesterday, just some things that we did in session. So, I have a young kiddo who really struggles maintaining self-control.

Siope Kinikini: Oh.

Jesse Heaton: And so yesterday, after learning the skill of expressing yourself appropriately and maintaining self-control, we played Uno and every time we gave each other a draw two or a draw four, we had to look at the other person, make eye contact with a calm face, and say, “Thank you. I really appreciate that.” And what this teaches is the ability to recognize that something negative might be happening to me in the moment, but it doesn’t have to impact the way I respond.

Siope Kinikini: Right, okay.

Jesse Heaton: And so we’re teaching emotional regulation. I’m feeling a certain way, but then how do I express myself and maintain some neutral or even positive outlook on the situation, so.

Siope Kinikini: Oh, that’s great. That’s fantastic. With the kids that you’re working with, now, you had mentioned autism and ADHD. And really, ADHD usually doesn’t come by itself. I mean, there’s usually a bunch of other things that are going on. And so how do you work with children when they come in with multiple issues? ADHD is one thing, but they’re dealing with all these other things. What is your approach to that?

Jesse Heaton: That’s a good question, Siope. So, I initially, after doing a mental health assessment, try to identify what the priority problem is and what’s causing the most dysfunction in the moment, in the home, in the school room. And so what’s the priority problem? Is it anger and aggression? Is it anxiety? Is it impulsivity? And so all of these little sub-components of ADHD then come to the forefront of the work, and then we target the priority problem. So let’s just say that it happens to be impulsivity. And I’m making really poor choices because I’m so caught up in the moment, whether or not it’s an adrenaline rush or peer pressure or there’s just something that I can’t delay my gratification, that I’m in the moment and I’m just really impulsive. And so then that becomes our first target area.

Siope Kinikini: Okay.

Jesse Heaton: And then a lot of times, I mean, anxiety is a very common subcategory of ADHD. Irritability is a subcategory. Anger and aggression is a subcategory. A lot of times, ADHD just gets broken down into these smaller components, and then we work on those individually.

Siope Kinikini: Yeah, yeah. It’s interesting that you are able to pick that apart. Do you rely more on your assessment of the child or on reports from the parents and teachers? Or how do you determine what is the most important topic?

Jesse Heaton: Yeah. Good question. So, I think that kids tend to come into therapy just happy, they’re excited to get out of the house, they’re excited to impress whoever they’re talking to. And so the version of the little kiddo that I see is very rarely the same kid that parents see at home. And it’s interesting. Just a few days ago, I heard this nasty argument walking down the hall to my office. And I’m like, “Oh, this is going to be an interesting couple of minutes. We’ll see how this goes. Hopefully it carries on into my office and we can work on it.” Sure enough, the door opens, kid is just smiley-faced and happy. And so to answer your question in a long way is the parents, I think, have the best impression as to what’s happening, what it’s happening, and where it’s happening. And so working with the parents, getting their understanding and their exposure to the behaviors, getting their impression as to what the triggers might be, is so invaluable. I mean, so much more valuable than a little hour and a half assessment that I could complete in my office, in an unfamiliar place.

Siope Kinikini: Right.

Jesse Heaton: Yeah. Second to that would be the teachers, right? That the teachers see. In my experience. The teachers see them if not more than the parents do during the day.

Siope Kinikini: Right.

Jesse Heaton: Getting the teachers’ opinion is so valuable, as well.

Siope Kinikini: That’s great. So in your treatment, it sounds like you work with the parents pretty closely to get information and input. And so how long would you say an intervention would be for a typical client that you would see? As far as ADHD. How involved are the parents with treatment?

Jesse Heaton: The majority of the sessions that I have are come into my office. As part of my private practice, I offer one in-home session per month.

Siope Kinikini: Oh, that’s great.

Jesse Heaton: I do.

Siope Kinikini: That’s not very common, right? I mean, that’s not really a common thing to do.

Jesse Heaton: I don’t think it is, in private practice.

Siope Kinikini: Yeah.

Jesse Heaton: So the work that in-home providers do I think is invaluable. The majority of my young career as a clinician happened in the home.

Siope Kinikini: Right.

Jesse Heaton: And it’s just really hard to recreate that environment where kids feel comfortable, where you get to see genuine behavioral and emotional responses to things.

Siope Kinikini: Yeah, no, I agree. I have to interrupt real quick, just because if somebody’s listening or watching, then they really need to know this. Jesse actually has spent time doing in-home work, so years and years of experience and then supervising other people who go into homes and do interventions, behavioral interventions with families. And, actually, Jesse was my supervisor. So, for a long time, which was great, actually. I gave him a hard time with my paperwork, though, because paperwork, ugh. Ugh. Can’t I just work with kids? I would just want to work with kids. So, that’s really unique, because I don’t think I know any other clinician that actually will see a client in their home. Has that been more helpful for you and for them? Or is that more difficult because you have to leave your office and drive somewhere, right?

Jesse Heaton: Well, so, economically, it’s probably not best practice.

Siope Kinikini: Yeah. Right, right.

Jesse Heaton: In regards to treatment success rates, invaluable.

Siope Kinikini: Yeah, that’s great. That’s fantastic. Holy cow.

Jesse Heaton: Not every family takes you up on it. I mean, not ever family wants you to be-

Siope Kinikini: In their home.

Jesse Heaton: See the immediate-

Siope Kinikini: Yeah.

Jesse Heaton: The immediate surroundings. And that’s okay.

Siope Kinikini: Yeah. No, but to have that offering. I think this is a great thing for parents to know is that if you want that type of thing, maybe you should request it, or find somebody who would do that. But I, for one, feel like it’s super valuable to have somebody there at the house to see what’s happening. Because it’s one thing to hear about it and then to have the therapist interpret it. And then another thing to actually be in the environment and get a feel for what’s happening, so.

Jesse Heaton: Right, sure.

Siope Kinikini: That’s great. Okay. So, the parents are involved? The parents are, yeah, very much involved.

Jesse Heaton: Yep. The beginning of the session or the end of the session, we’ll typically take some type of 5 or 10-minute collaboration with the parent. So just giving me a brief update. I probably do this more often than I should, Siope, to be honest.

Siope Kinikini: Yeah.

Jesse Heaton: I ask parents to send a weekly email prior to the session to get an idea of what they’re seeing, what they’ve observed, what their impressions are, what they mood has been like, how are the goals coming along. It’s very rare … I work with kiddos from 4 to 19 years of age.

Siope Kinikini: Yeah.

Jesse Heaton: If I ask a kid how they’ve done, have they worked on their behavioral assignments, they’ll be like, “Yeah, yeah, yeah. For sure. Just give me my candy bar, things are good.” And so without parents’ feedback and communication, it’s just really hard to gauge how they’re really doing.

Siope Kinikini: Yeah, yeah. No, that makes sense. That’s cool. In your practice with ADHD clients, what are the ages that you see? Do you see all ages, pretty much, or … And are they pre-diagnosed before they come to you? Are they diagnosed by a different team? Or do you do the diagnosing?

Jesse Heaton: Yep, good question. So, I do see kids starting right around the age of 4 up until they become adults, and I work with adults that have attention deficit concerns, as well.

Siope Kinikini: Right.

Jesse Heaton: And a lot of times, the interventions and the techniques are the same and just generalized to an adult brain, a fully developed brain.

Siope Kinikini: Right, right.

Jesse Heaton: But your second question was good. Oh, pre-diagnosis, right.

Siope Kinikini: Yeah. Yeah, yeah, yeah.

Jesse Heaton: So, yeah, unfortunately, kids come to my office with a lot of behavioral things and parents are like, “They’re just making these awful choices and I don’t know why they do what they do.” And then we break it down and then we spend some time with them and within a little while, three or four sessions, it becomes pretty apparent that they have several of these symptoms of an attention deficit diagnosis. And whether or not it’s ADHD combined type of ADHD inattentive type, a lot of times, the inattentive type goes significantly, severely underdiagnosed.

Siope Kinikini: Okay.

Jesse Heaton: They just get lost in the crowd. And so it’s very rare that somebody will come to me and have an ADHD inattentive type diagnosis.

Siope Kinikini: Right.

Jesse Heaton: There are all kinds of behavioral symptoms happening, and the parents can’t quite put their finger on it, or the school can’t quite put their finger on it. And so coming pre-diagnosis is pretty familiar, pretty.

Siope Kinikini: Okay. That’s great. That’s pretty great. All right. What’s it like being in private practice? I mean, this is a clientele you’ve chosen to see.

Jesse Heaton: Yeah.

Siope Kinikini: Because you could see a range of different issues and ages, but why this age? Why this diagnoses? Why this population?

Jesse Heaton: I wish I had some miracle tearjerker story. But I really don’t. I think it was just a matter of who I worked with going through my undergrad and then graduate school and cases and clients that I just felt really familiar with.

Siope Kinikini: Yeah.

Jesse Heaton: And then I do see a handful of other clients for other things.

Siope Kinikini: Yeah.

Jesse Heaton: I think that word just gets out that somebody specializes in a certain diagnosis, and then the … For some reason, I just feel … This is going to sound crazy, but I just feel really fortunate and lucky that I went to so many Autism Spectrum trainings. The State of Utah had so many just awesome, really educational conferences and that kind of tapped me into that community. And so I feel like it was almost by chance. And then the ADHD thing has a really special place in my heart, as somebody that has ADHD inattentive type.

Siope Kinikini: Yeah.

Jesse Heaton: A long, long time. And I feel like I was a pretty functional, semi, I should say … You could ask my wife if I’m functional, but. But, I mean, I did okay, right?

Siope Kinikini: Yeah.

Jesse Heaton: And it wasn’t until much later in life that I realized, oh my word, I really have some attention issues.

Siope Kinikini: Yeah.

Jesse Heaton: And so they have a really special place in my heart, and I just tend to gravitate and just love and appreciate who they are and what they’re bringing to life.

Siope Kinikini: Yeah. I think that there’s a misconception that they’re not contributors or they don’t find a way to contribute. And my what experience has been is they find a way to make things work. They’re almost more-

Jesse Heaton: More creative.

Siope Kinikini: Creative, that way, just to try and compensate, I guess, for some of the deficiencies that they struggle with. You know what I mean?

Jesse Heaton: I totally do. I would agree.

Siope Kinikini: Yeah.

Jesse Heaton: That’s-

Siope Kinikini: So, any other things that you’re working on? Any other exciting projects that you’re involved with?

Jesse Heaton: So, I could go on and on. But I recently have tapped into a community that tracks internal biorhythms through metronomes.

Siope Kinikini: Okay.

Jesse Heaton: And the really cool thing, I think, about our field is that research is incessant.

Siope Kinikini: Yeah.

Jesse Heaton: New things that are coming out and new strategies and evidence-based practices are coming out, and it’s just constantly being researched. And so just recently, I’ve tapped into this internal biorhythm community where … It’s very similar to biofeedback.

Siope Kinikini: Yeah.

Jesse Heaton: But helping develop some equipment that tracks internal rhythms, heart rates, the timing and the space between heartbeats, and the amount that a kiddo sweats under stress, the amount of muscle tension that’s in their body when they feel stress.

Siope Kinikini: Yeah.

Jesse Heaton: So helping them self-soothe through some of this timing and pattern work.

Siope Kinikini: Yeah. That’s kind of cool. So are there specific exercises, then, that you teach them to help them regulate some of those, I guess, right?

Jesse Heaton: Have you heard of tapping?

Siope Kinikini: Yeah. Yeah, yeah, yeah.

Jesse Heaton: It’s really similar to tapping. And so there is some type of a beat or a rhythm that’s happening in the background, and then they get hooked up to some biofeedback-like equipment and then they tap to certain rhythms that increases attention to focus and attention to detail. And watch their internal rhythms just slow down.

Siope Kinikini: Yeah.

Jesse Heaton: A lot of times, when you have a kiddo with anxiety, there’s a really fast-paced kind of personality trait that comes with that. Getting them to slow that down through their biorhythms and being able to manipulate that through their breathing, through muscle relaxation techniques, is just super cool.

Siope Kinikini: That is amazing. I was introduced to some of that in a mindfulness training, but the mindfulness wasn’t about sitting still. It was actually integrating some body movement in order to be aware. And, yeah, I mean, it’s fascinating. I think you’re right. When you’re able to shift the focus from the inattentiveness to something very particular for an ADHD type issue, it actually helps the child figure things out a little bit better and calm down. And, anyways, yeah, that’s fascinating. I didn’t know you were doing that. That’s really cool.

Jesse Heaton: Yeah. When you think about coming into a situation that feels out of control and ungrounded and then you can control and you start this belief, I can control my body in this situation, that I’m not a victim to happenstance, I’m not a victim to the environment, but I can really control my response-

Siope Kinikini: Right.

Jesse Heaton: In every situation.

Siope Kinikini: Right.

Jesse Heaton: That’s pretty powerful encouraging.

Siope Kinikini: Yeah. Yeah. I think it’s that spiraling thought that you’re out of control that kind of just beads on itself and pretty soon, you are out of control. So that’s fantastic. That’s great.

Jesse Heaton: My mom had this metaphor that she told me years ago about waves and being blown around in the wind and being a ship lost at sea without a sail. Think about a kiddo that just can become distracted by anything, right? A clock ticking.

Siope Kinikini: Yeah.

Jesse Heaton: Right? Or somebody sniffling in class. Or somebody rubbing their shoes on the ground. Or some thought about the car that I saw on my way to school, right? And just helping them feel grounded, establish their sail, I’m headed in a direction and I’m going to keep that course.

Siope Kinikini: Yeah.

Jesse Heaton: Tools to maintain that course I think is a great educational metaphor that kind of gives us some insight as to what it’s like for kiddos that have ADHD.

Siope Kinikini: Right.

Jesse Heaton: So.

Siope Kinikini: That kind of … Yeah. That’s great. Wow. Is your mom a therapist? I’m curious, because she sounds smart.

Jesse Heaton: No. My mom actually is a college professor. She teaches at a university there. And that she teaches child development, and-

Siope Kinikini: Oh, wow, so she is in the field. I mean, she’s very aware of issues and growth and that’s fantastic. So in a way, she is a therapist. I mean, she is a-

Jesse Heaton: Yeah. She was my therapist, for sure, growing up.

Siope Kinikini: I think all our moms can be therapists. I mean, yeah, all depending. That’s great. I’m trying to think if there’s anything else I wanted … I just wanted to get an overview, kind of talk about ADHD, what you’re doing. Do you have any recommendations for parents? When they bring their child in to a therapist for treatment, do you have any recommendations for them? Things that they should do or consider doing, or things they should ask the therapist before treatment?

Jesse Heaton: Yeah. Speaking from personal experience, it can be hard, at times, to give parents feedback. And it’s hard to give parents instruction, because it’s one adult to another adult. And parenting is a really sensitive topic, right?

Siope Kinikini: Yeah.

Jesse Heaton: Something that we personalize and that we all take so serious. And so I think my feedback or my suggestion would be to just come to therapy and know that this therapist might have some ideas and suggestions, and they’re not beating up your parenting style and saying that you’re a bad parent. And I think sometimes, I am probably overly cautious. I think parents are like, “Hey, just give me some ideas.” I’m overly cautious, not wanting to overstep my bounds. But just come to therapy with an open mind. Things that I could do in addition to what I’m already doing that will help my child be successful.

Siope Kinikini: Yeah.

Jesse Heaton: So.

Siope Kinikini: Well, that’s great. Yeah. I think that there is this idea … It’s weird, because when clients do come in, there’s almost this expectation that they want you to magically do something that will fix the problem. And at the same time, you will completely side with whatever they say, and that … You know what I mean? And when you’re working with a child or in therapy, there’s a fine balance, because you’re trying to build a relationship. At the same time, you’re trying to offer suggestions for change and you’re removed from the situation enough that you can see things that maybe they miss. But it’s hard. It is hard for a therapist to walk that fine line between suggestions and offense. I don’t want to offend you, but this may be something you may want to consider. So coming in with an open mind is super helpful. So, great advice. That is great. Is there anything you wanted to talk about?

Jesse Heaton: I think that’s it. I’m happy to talk or answer or-

Siope Kinikini: Questions and stuff.

Jesse Heaton: Gab about any ideas that you have, but-

Siope Kinikini: Yeah. This is kind of just an introduction. And the other part I do want to mention is that Jesse has written quite extensively, actually, on Smarter Parenting blogs. So we’ve compiled those blogs into an ebook that is going to be available for download. So would highly suggest that you read what is in there because it has great information. And he covers everything from, gosh, everything that has to do with ADHD. There’s quite a bit of information in there, but you’ll find more information on the Smarter Parenting website about the download, so. Did you want to talk about that? Your blogs, things that you’ve written, or anything like that?

Jesse Heaton: Sure.

Siope Kinikini: Okay.

Jesse Heaton: A lot of times, I think what I would just encourage parents to do is understand that any time that your kiddo is diagnosed, that’s a really stressful thing.

Siope Kinikini: Yeah.

Jesse Heaton: It’s a time of maybe a lot of doubt and uncertainty. I would just encourage parents to tap into the community.

Siope Kinikini: Yeah.

Jesse Heaton: That you’re not alone. That the websites like Smarter Parenting are out there to serve as a resource and an extra layer of support. And that there are a lot of parents that have gone through what you’ve gone through. A lot of them. And it feels overwhelming, but there’s hope.

Siope Kinikini: Yeah. In some of the parents that I’ve worked with, they’ve had that dual experience where they tried to figure out what’s going on, and when they find out, they’re super happy, and then they’re super sad. And it’s like, I found out what it is. And now it’s like, oh, that’s just too much. And it’s understandable. It’s a lot to deal with. But reaching out to the community is helpful. Because there are a lot of ADHD communities out there. So reaching out is definitely a great thing to do. That’s wonderful. Okay. Anything else you wanted to chat about or talk, or?

Jesse Heaton: I could talk to you for hours. I think that’s good for today.

Siope Kinikini: Yeah. No, I think that’s good today. I know we could talk, but actually, we should talk off the record. Things that are happening and stuff like that. Anyways, I wanted to thank you for at least communicating, talking a little bit about ADHD, what you’re doing in your neck of the woods. I think there are some really great things that you’re doing that I think other therapists should be doing. An in-home offering is super helpful. I think that’s something that most therapists should do or consider doing. But you’re right, as far as economically, that’s difficult to do because that takes time and it takes resources to actually make that happen. But sounds like you’re doing what’s in the best interest of your clients, which is super great, so.

Jesse Heaton: Okay, well, thank you. I appreciate all you do. We use Smarter Parenting three or four times a week.

Siope Kinikini: Oh, that’s great!

Jesse Heaton: And everyone that I work with is just loves the videos that Smarter Parenting puts out. The charts, the chore charts, the reward charts, the behavioral charts. I mean, it’s just quality, quality, quality.

Siope Kinikini: Yeah, no, that’s great to know. Thank you. We’re actually doing quite a bit, actually, in expanding in the next little while, as far as trying to find additional ways to reach out and focus the attention. Because we did mostly general parenting, initially, with Smarter Parenting. The skills are pretty general. So now, we’re focused on ADHD, trying to get a community around that issue.

Jesse Heaton: Yeah.

Siope Kinikini: And focus our efforts on addressing those things, so. But, yeah, I think that’s it. Gosh, thank you so much, Jesse!

Jesse Heaton: Absolutely. My pleasure.

Siope Kinikini: We need your help, and the way that you can help us is to subscribe, to like, to share, and to comment on this podcast. We want to reach out to as many people as we possibly can in order to help those families who are in desperate need of resources. So again, those are the things you can do. Like, subscribe, comment, and share. Please do that. Help us grow. Help us move forward and accomplish what we want to do in helping families around the world.