128: ADD, ADHD & Behavior Challenges with Psychologist and Nutritionist Dr. Nicole Beurkens 128: ADD, ADHD & Behavior Challenges with Psychologist and Nutritionist Dr. Nicole Beurkens

Child: Welcome to my Mommy’s podcast.

This episode is sponsored by Four Sigmatic. You’ve heard me talk about Four Sigmatic before because I love their coffees, teas and hot chocolates. Now you can get 15% off any order with the code “wellnessmama”. But these are not ordinary drinks. They’re delicious combinations of coffee, cocoa and adaptogen herbs, now with the benefits of Chaga, Cordyceps, and Lions Mane for an extra brain boost and clean energy. My long time favorite is their instant coffee with the benefits of these mushrooms but lately I’ve also really been enjoying their caffeine free blends. Try out all of these delicious drinks at foursigmatic.com/wellnessmama and make sure to use the code wellnessmama to get 15% off of your order.

This podcast is also brought to you by ButcherBox. And if you haven’t heard of them, they’re a great company that ships really high quality meats to your door. They carry 100% grass fed beef, organic and pastured chicken, and heritage breed pork and they deliver it directly to your door. All of their products are humanly raised and free of antibiotics and hormones. And as a Wellness Mama listener, you can get $15 off plus free bacon in your first box. Go to butcherbox.com/wellnessmama and use the promo code HEALTHYMOMS (in all capital letters).

Katie: Hello and welcome to “The Healthy Moms Podcast.” I’m Katie from wellnessmama.com and I am here today with Nicole Beurkens, and I’m really happy about this interview because I get so many questions about these topics that she is, by far, an expert on. So, Nicole is a unique combination of psychologist, nutritionist, and special education teacher. And she has 20 years of experience supporting children and families to improve behavior naturally. So, she’s an expert in evaluating and treating a wide range of learning, mood, and behavior challenges, including ADHD, autism, anxiety, and even brain injury. And she has a doctorate in clinical psychology, a master’s degree in special education and nutrition, and is a board-certified nutrition specialist. And on top of that, she has four kids, so I can’t even imagine how busy she is. But Nicole, welcome. Thanks for being here.

Nicole: Thanks so much for having me, it’s a pleasure.

Katie: Well, I get so many questions, like I said, about these topics. And I think that there, at least from what I’m seeing, really seems to be a rise in ADD, and ADHD, and behavior-related problems right now. And I’d love to get your take on that. Do you think that they’re actually…are these problems on the rise? And if so, why do you think that is?

Nicole: Yeah, it’s a great question and it’s one that I get pretty regularly, too. And I think absolutely, these types of symptoms and issues are on the rise. You know, if we think about when we were growing up and when many of your listeners were growing up, and in the generations even before us, you could maybe, you know, pick out a couple of kids over the course of our school career, you know, who maybe had some challenges. Or, you know, you say, “Well, that kid was pretty hyperactive,” or whatever. But it wasn’t nearly as prevalent as it is today. And when you talk to parents today, when you talk to teachers today, especially teachers who’ve been in the field of education for a long time, they say, you know, the number of kids coming into schools with challenges, whether that be, you know, attention issues, hyperactivity, behavior challenges, emotional issues like anxiety just seems to be rising more and more with every year.

And I certainly have seen that clinically as well. There have been some interesting studies done on the prevalence of these kinds of issues in kids over the years. And, you know, one of the most recent studies done in 2013 showed us that over 50%, about 54% of children in this country have some form of chronic illness. Now, that includes all different types of chronic illness issues: obesity, allergies, you know, asthma, physical kinds of things. But it also includes chronic mental health kinds of issues: ADHD, anxiety, depression, different kinds of mood and behavioral disorders. So, we’ve got a massive increase over the course of time in kids with these challenges. And I think there’s a number of things that are going on with that.

You know, we know that there is obviously a combination of genetics and genetic pre-disposition, and environmental kinds of factors. And, you know, genetics don’t change too much over time, from one generation to the next. But wow, have there been a ton of changes in the environment, not just the physical environment but also the social environment, you know, over the last several decades. And I think that that’s really why we’re seeing a huge increase in the number of kids that are having more difficulties. Everything from increase in environmental toxins, chemicals that are in our air, our water, our soil, that impact the food that we eat.

Kids just not getting adequate nutrition in the heavily processed diets that many of them are eating, so their diet quality is poor and that increases, you know, the prevalence of these kinds of issues. We have a more sedentary lifestyle. Technology is great but it’s led to a significant problem with lack of movement and just physical activity for kids and that increases these kinds of developmental and mental health problems. Our schools have changed and become less developmentally appropriate over time. And we could probably talk for a long time about how those kinds of issues impact kids and how they present and the kinds of symptoms that they have. But there just have been a lot of changes in the environment that seemed to be leading to an increase of kids having these kinds of issues. So, yeah, it’s definitely on the rise for sure.

Katie: That makes sense. And I know like there seems to be, every time any of these topics come up in the mom circles, it’s like there’s a heated debate kind of about like the one group saying, “Well, these are just…kids are just being kids and acting normal.” And it’s just we’re expecting them to sit still too much or they’re not moving enough like you said. And like our grandparents, they’d move around enough, that’s why they never had these problems. But from what you’re saying, there really is like a physiological difference that’s happening in our kids. Is that right?

Nicole: Yeah. And I think it’s true that, you know, for some children who end up getting, you know, labeled with these kinds of issues. Some of them are just developmentally a little less mature, and if given more time and, you know, more of an opportunity to move around and not starting school so young, you know, might catch up and not have these kinds of challenges. So, there certainly is an argument to be made for that. But I think the bigger picture is that kids are being impacted by all of these types of changes that we’ve had in our culture, in our physical environment. And so for many of them, the impact is much deeper. It’s not just, well, if they were able to start school at age seven instead of age five or, well, if they got an extra hour of running around. For many kids, the issues go much deeper than that.

Katie: That makes sense. And I know I’ve been writing for years about just trying to have a more natural home environment. And how, even the home air can be more polluted and more toxic than outdoor air sometimes because of all the things in our environment. Are those things like you’re talking about, the environmental stressors, or those in the home or outdoors, or a combination of both? Or what do you see as being some of those big factors?

Nicole: I think they’re everywhere. You know, I don’t know that we can escape them indoors or outdoors at this point. Certainly, indoor air quality, especially, you know, we have things in people’s homes but you look at places like schools and some of the places where, you know, kids are spending a good amount of their time. And, you know, there’s a lot of factors as far as toxicity in those environments, especially with cleaners and, you know, poor ventilation, and things like that are concerned. But, you know, outdoors too, certainly, the environment, you know, has changed over time. And depending where people live, that can make a big factor…a big difference as far as air quality goes.

You know, there’s been studies showing that depending on different parts of the country or different cities or areas where people live, kids have a higher prevalence of these kinds of developmental and mental health issues based on things like air quality in those areas, water quality, those kinds of things. So, we know that those issues make a difference for the development of children’s brains and just their development overall.

Katie: That makes perfect sense. And so I’m guessing based on that, at least from the treatment I know from friends who have been through this with their children, the common treatment that’s often recommended is usually medication. But if, I’m putting the pieces together correctly, if all these environmental factors adding up is kind of causing a little bit of the problems to begin with is throwing medication on the problem. The best solution or the only solution, or I think you have a really unique view on this because you have the nutrition side and the psychology side. So, I’d love to get your take on that, like is medication the answer? And is there a time when it’s the answer? Or what do you think on that?

Nicole: Yeah. This is such a critical issue and I think it’s one of the big debates out there now both in the medical field, as well as amongst parents, is this issue of medication and is this the solution, is this the best solution, what are the other options? Because I think that really, the vast majority of parents are pretty hesitant with medication, especially psychiatric medication. The vast majority of parents that I meet at my clinic, they don’t want to place their child on medication but they’re not sure what else to do. Because those are the main options that they’re being provided with. So, you know, my stance on it is that medication even in the best case scenario is a band-aid for the real problems.

None of the medications that are used to help manage or address these kinds of emotional and behavioral issues, none of them get to the root of the problem. They all attempt to sort of compensate or put a band-aid on it. And I’m not saying that that’s never appropriate, but I think that the vast majority of children who present with things like inattentiveness or hyperactivity, or learning difficulties, or moodiness, or behavior issues, really could benefit and get much better using other kinds of treatments and interventions beyond medication. But medication is typically what’s offered to people and I think there’s the variety of reasons for that.

I think it’s seen as a quick fix, it’s seen as sort of an easy solution. But when we really start looking at it, what we see is that there are a number of problems with medication treatment. One of the main ones and this is something that a lot of parents and even a lot of professionals aren’t aware of, we really have very, very little research on any of these drugs in children. The vast majority of research that has been done on psychiatric medications and that includes things like, you know, anti-depressants and anti-anxiety medications, some of the anti-psychotic medications that are used for behavior issues, and even stimulants. The research on these things has been done in adults.

And the idea sort of is, well, if it’s been done in adults and we can use them in kids, and we’ll just reduce the dosage based on their weight and size, and such. But, to me as a clinician and a researcher, that’s a pretty scary proposition that we’ve got millions and millions and millions of children now, even little kids, people are often shocked to hear that we see kids come into the clinic at two and three years old who have been placed on these medications. So, we’re even using these with little kids with really no understanding of the short term or long term effects of these drugs on children, on their development. What does it look like as kids get older, as they get into their teen years, young adult years, later adult years? What does that look like for them if they’ve been on these medications since they were young?

And we really have no idea. The studies have not been done, it’s not been looked at. We don’t even know what the ideal dosages are for these things in children. And a lot of people just aren’t aware that that’s really the situation that we’re operating in. So, I think that there’s some real…some legitimate reason to pause and really think about what we’re doing with these medications. And especially given the fact that we know that there are many potential side effects, some of them very serious. You know, and I have patients come in all the time whose physicians or prescribers have told them, “Well, side effects are rare. Most people don’t have them.” Actually, that’s not true and the research doesn’t bare that out.

Most people experience at least some type of side effect, maybe not a serious side effect but side effects that can impact their life significantly. Things like sleep problems, or weight loss, or weight gain, increased risk of diabetes, increased irritability, things like that, you know, are some of the things that are not necessarily considered serious but really can be a problem especially in children. So, when we look at the fact that we’re really lacking research on understanding how and why they work, and especially how to use them in a pediatric population. We look at the fact that there are many potential negative side effects, and the fact that they’re just plain ineffective for many people. It kind of, you know, leaves me saying as a professional, we really need to be looking at some other things.

And actually, there are a lot of research based treatments that are very effective. That the research shows are even more effective than medication. And I think that we need to be educating parents about those options. We need to be talking to parents about the potential risks of medication and offering them options and solutions that they can try instead, because I think most parents are really interested in that.

Katie: Yeah. I’d love to delve into those because I wanna be sensitive to parents who are in this and going through these struggles with their children because I know that can create a lot of stress in the family environment and in a lot of extra work on the parents. So, I totally understand why a parent might wanna choose medication if they saw that as a way to find some relief from that and to help their child. But that makes perfect sense what you’re saying and, especially, it’s terrifying that we don’t really know the effect of these drugs and we’re giving them. I can’t even believe that to two year olds, that’s crazy to me. So, what are some of the other options? Because I think, like you said, parents are, in today’s world, especially seeming to be very well educated, that they’re researching things. And it’s hard to find these answers sometimes. So, what are some of the ways that parents can address these and what are some of the solutions they can turn to?

Nicole: Yeah. I think about five main areas when I’m looking at a child and looking at a family and the difficulties that they’re having, and you’re absolutely right. When parents are struggling with their children, you start to feel desperate in looking for, you know, solutions for them. It can be very concerning, it can be very frustrating, it can be exhausting, it can be all of those things. And so, I agree, it certainly is understandable, you know, why parents would want to look for any type of solution that might help, including medication.

But the five areas that I really look at that need to be addressed for kids, the first one is nutrition and looking at, you know, specific aspects of nutrition. And we can certainly, you know, delve into that. Sleep is another one. This is a very often overlooked issue in children, but it’s a critical one. Especially when the research shows that, you know, 25% to 40% of kids who get diagnosed with ADHD actually have an undiagnosed and untreated sleep issue that’s causing their symptoms. So, sleep is another big area to look at and address. Movement is the third area. And I don’t just mean physical exercise but I’m talking about all the different types of physical movement that many kids are lacking today. The fourth area I look at is the parent-child relationship or the connection that kids have with other people around them, with their parents, with peers, with teachers, those kinds of things, the relational aspect.

And then the fifth area that really needs to be addressed is what I call cognition or the thinking and problem solving pieces of things. And being able to develop problem solving skills and resilience, and that kind of stuff. So, not all children need intervention or strategies in all five of those areas, some do. Some just need, you know, to hone in on one or two of those areas. But those are the five sort of main umbrella issues that I look at when I’m identifying what’s going on with the child with these symptoms, and then what we need to do to help them function better.

Katie: Awesome. So, let’s start with the first one and go into nutrition. That’s it. I love this one because that’s my background as well, and certainly in my own kids I know firsthand how big of a difference what they eat makes on their behavior. But I’m sure for kids who have a specific challenge, that’s even more so. So, when you’re looking at a child who’s maybe struggling with ADD or ADHD, what do you address with nutrition first? And specifically, how do you help the parents get these kids to actually eat the good food? Because that’s the question I get a lot, when I post healthy recipes, is parents saying, “Well, that’s great that your kids eat it but my child has processing disorder or has ADD and won’t eat this.” So, how do you address that with those kids?

Nicole: Yeah, that’s a great question. And yeah, so, let’s talk about that. Let’s talk about the nutrition, some of the nutritional components first, of kids who have these challenges. So, it’s important for parents to understand that the food that we eat, the nutrients that we take in determine how well our brains and our bodies can function. And, you know, it’s interesting, there’s sort of this idea out there that’s been perpetuated in the field of medicine, that brains and bodies are disconnected somehow, right? That physical health means, you know, everything from the neck down and mental health means, you know, everything in the head. And that’s really a silly way of thinking about it because the brain and the body are totally connected.

So, our physical health, which includes our nutrition and the foods and the nutrients that we’re taking in is directly connected to brain function, which means it directly impacts behavior, it directly impacts attention and focus, and hyperactivity, and all those kinds of things. So, sometimes people think that this is an oversimplification, right? Oh, my child has all of these issues, and you’re just saying that, you know, food is gonna make a difference. But really, this is one of the most fundamental things that we can do to address symptoms of ADD and ADHD, you know, and many of the other, you know, symptoms and conditions that kids have. And there’s several things that I start having parents look at based on the research.

The first is looking at the amount of real food that a child is eating during the day versus the amount of chemical laden processed foods. So, you know, kids who are eating boxed macaroni and cheese and McDonald’s chicken nuggets, and soda pop, and candy, and those kinds of things all day are going to have brains that aren’t able to function and regulate themselves as well as kids who are eating real food or whole food like, you know, meats and fish, and whole grain kinds of items, and fruits and vegetables. Fruits and vegetables have almost become, you know, non-existent in the diet of many kids and many families these days. And it’s not just, “Oh, kids should eat their vegetables because they should learn to do that.”

It’s, we need to eat our vegetables and we need to eat fruit, and we need to eat all these things because they contain nutrients that our brain and our body need to function well. And the research has shown over and over again that many of the chemical ingredients in processed foods, so things that are boxed and bagged, and have a lot of chemical preservatives, and things in them. A lot of those ingredients can be really toxic to the brain and can cause or exacerbate problems with things like attention and hyperactivity. And some of the big ones are artificial sweeteners, things like aspartame and sucralose that you find in, you know, diet drinks and low calorie kinds of foods, but now are being included in a whole bunch of other kinds of, you know, sweeter tasting foods as well.

High fructose corn syrup, food dyes, the artificial dyes, things like, you know, red dye number five and blue dyes, and things like that. And some of the preservatives that are in foods. And when you look at a food label and you can’t pronounce half of the ingredients on there, you’ve never heard of them, those are chemical kinds of ingredients that are used in foods. And what the research shows is that those can have a really negative effect on kid’s brain function. And for some children, there is a night and day difference for them with symptoms like ADHD for example. Where if they’re eating those kinds of foods and then you remove them, so you remove the artificial dyes for example, or you remove the artificial sweeteners, or you remove high fructose corn syrup.

Just removing those kinds of things for some children, you can get a night and day difference in their behavior, and in their mood, and in their functioning. Now, certainly, it’s not a night and day difference for every child. But I have yet to meet a child where removing those kinds of chemicals and ingredients from their diet has not made a noticeable difference in their behavior and in their functioning. So, I think that that’s one of the fundamental things that’s helping parents understand how to start to reduce the amount of chemicals and preservatives, and processed kinds of foods in their child’s diet.

You know, and other basic things are looking at water intake. Many of the kids that I see at the clinic are, you know, dehydrated. They’re not drinking enough throughout the day. And when they are drinking, they’re drinking things like, you know, chemically processed energy drinks especially in the teenagers and the young adults. Or they’re drinking sports drinks, so they’re drinking a lot of fruit juices or, you know, fruit punch, those kinds of things. Even some of the “healthier,” you know, water drinks that are out there now. And I know that you talk about this kind of stuff a lot in your community. You know, you start looking at the ingredient labels on some of those supposedly healthy waters and, you know, yeah, there’s water in it but there’s a lot of other things that aren’t very good, you know, for kids’ brains.

So, you know, just helping parents to look at how can we start to reduce the amount of these other kinds of beverages and just get kids hydrated with good, you know, water throughout the day, can make a big impact on these kinds of issues. So, you know, those are some of the more foundational kinds of things that I start to talk with parents about in terms of dietary changes.

Katie: Got it. So, I’ll be curious what your approach is with parents, especially like, is it better to, with nutrition kind of do the whole rip the band-aid approach and just make a big switch at once, and realize that kids are adaptable? Or do you typically have them kind of do a baby step approach? Which tends to work best especially with the child who maybe is struggling with the behavioral issue?

Nicole: Yeah. I think it really depends on the child and family because both can work very well depending on…you know, depending on the people involved, right? I find that in general, parents can have more of a difficulty thinking about making the change, and parents can get more stressed out about it even than kids can, for several reasons. Parents start thinking about, “Wow, I’m gonna have to shop differently. You know, it’s gonna take more time at the store. I’m gonna have to, you know, plan my meals.” And maybe even for some of them, they’d have to start thinking about cooking. And some families, you know, don’t do that.

Some of the parents that we see for a variety of reasons, busyness being one of them, tend to do a lot of drive-throughs, or things like that. So, I find that, in general, it’s the adults that tend to get more overwhelmed at the idea of making these kinds of changes to diet than kids do. Yes, kids will, you know, often fuss and complain, and those kinds of things. But the vast majority of children, when you set a boundary and expectation around this is what we have to eat, you know, we’re not buying these kinds of things anymore, this is what we’re going to have. You know, they go along with it. They may not be real happy about it but they will adapt to it.

Now, you always have a small segment of the population of children with challenges who are going to have a more difficult time with this, especially if they have a diagnosed feeding disorder, which is way more than just picky eating. These are kids who really have diagnosable feeding problems, where it’s never advisable for those kinds of kids to just dramatically change everything and take away the foods that they are used to eating. So, in those kinds of situations, we would do it in a slower type of way. But sometimes, you know, I find that really to make it work for the family, we have to kinda take it in gradual steps. So, I often, I’m talking with parents about what feels manageable to them.

Some families will say, “You know what? We just wanna tackle this all at once. We feel ready for it. We’ve been looking into some of this. You know, we know this is what we need to do and we’re ready to jump in and make the changes.” And others, we have to kind of help them take it in pieces and say, “Okay. This week, what can we do? You know, can we stop buying, you know, soda pop this week and start to, you know, offer water or a different type of beverage? Can we start, you know, maybe making a meal or two at home each week?” So, it really depends on, I feel, not only what the child is able to tolerate, but even more so what the parents feel like they can manage in the context of their life.

Katie: Yeah, I have found that, too, in writing. And also when I was working with people one-on-one on nutrition is, I think the parents a lot of times do. They assume that the kids are not gonna like something without even really trying it with the child. It’s just, I think part of that is our culture and that this whole weird mentality we have that kid friendly foods are just like chicken nuggets and hamburgers. And I think you’re right, that when you really start experimenting and adding in things, and I think also explaining it to kids. We don’t give them enough credit sometimes how much they can understand and how much when they understand things, they tend to actually make healthier choices. And certainly, that can take a lot of time.

But I think that’s one of those certainly things worth putting the effort into, and that makes so much sense. That depending on the child and the specific struggle that they’re having, the approach may be different but the outcome is still the same. Have you seen like even children with like sensory processing disorders and that kind of thing that don’t have a specific food…feeding issue like you mentioned. But will they even respond well to the nutrition changes over time?

Nicole: Absolutely. In fact, nutrition is one of the fundamental ways that we need to be treating and intervening for kids who have sensory processing problems. Many times though, when kids, you know, are having sensory issues around eating. And so, often when parents talk about that, it’s things like, you know, my child really, has an aversion to how things smell, or has a very, you know, sensitive sense of smell, or, you know, doesn’t like the taste or the texture, or things like that. Those issues can be rooted in nutrient deficiencies. And it’s something that’s not talked about often enough in the community of professionals or parents dealing with sensory processing disorders. But a lot of those kinds of sensory issues are rooted in specific nutrient kinds of issues.

And so those are specific types of things that we can address using nutrition. And sometimes, if it’s gonna be difficult to, you know, change a child’s diet initially, we can use some targeted, you know, nutrients and nutritional supplementation to help with that. A big one with that is zinc. The mineral zinc is really important for regulating sense of taste and smell, as well as appetite. So, I’ve had great success with kids who come in with a lot of food aversions because of, you know, sensory processing issues. And we start getting their zinc levels increased. And suddenly, their appetite regulates, their sense of taste and smell regulates better, and they’re able to tolerate and eat a lot more things.

So, that’s a great example of a very specific connection between nutrients and the kinds of symptoms that we see in kids. Iron is another big one for that. Iron is often an issue in kids with sensory processing issues and it can impact appetite, it can impact, you know, what they’re willing to eat, their tolerance for taste and texture, and those kinds of things. So, you know, sometimes it’s really helpful to either do some targeted lab testing with kids with those kinds of symptoms, to look at what those nutrient levels are for them. Other times, we, you know, just start supplementing them or looking at increasing some of the types of foods in their diet that can get those nutrient levels up for them. But, you know, there’s a lot of amazing things that can be done symptom-wise, just by targeting those specific nutrients.

This episode is sponsored by Four Sigmatic. You’ve heard me talk about Four Sigmatic before because I love their coffees, teas and hot chocolates. Now you can get 15% off any order with the code “wellnessmama”. But these are not ordinary drinks. They’re delicious combinations of coffee, cocoa and adaptogen herbs, now with the benefits of Chaga, Cordyceps, and Lions Mane for an extra brain boost and clean energy. My long time favorite is their instant coffee with the benefits of these mushrooms but lately I’ve also really been enjoying their caffeine free blends. Try out all of these delicious drinks at foursigmatic.com/wellnessmama and make sure to use the code wellnessmama to get 15% off of your order.

This podcast is also brought to you by ButcherBox. And if you haven’t heard of them, they’re a great company that ships really high quality meats to your door. They carry 100% grass fed beef, organic and pastured chicken, and heritage breed pork and they deliver it directly to your door. All of their products are humanly raised and free of antibiotics and hormones. And as a Wellness Mama listener, you can get $15 off plus free bacon in your first box. Go to butcherbox.com/wellnessmama and use the promo code HEALTHYMOMS (in all capital letters).

Katie: Got it. And the second factor you mentioned was sleep. And did I hear you right? That you said 25% to 40% of kids diagnosed with ADHD actually have an underlying sleep issue?

Nicole: Yeah, absolutely. And that’s a big issue, you know, that goes unrecognized I think by a lot of people. The research has shown depending on the study, that between 25% and 40% of kids diagnosed with either attention and/or hyperactivity issues have a sleep issue that has not been identified and not been treated. That’s how important sleep is for our brains. That when we’re not getting enough sleep or we’re not getting good quality sleep, it really can significantly impact kids development. It can impact their functioning. And, you know, we think about that for adults and, you know, many adults complain about not getting enough sleep or they don’t sleep well, or they need coffee to get through the day, you know, all of those kinds of things.

But what we often don’t realize is that sleep is even more important for children than it is for adults. Children need more sleep than adults do because they’re in a rapid period of physical and neurological development. And sleep is restorative and is necessary for that development to occur properly. So, when we have kids who are not getting enough sleep or they’re getting really disrupted sleep, so the quality of their sleep isn’t good, it can absolutely, you know, cause the symptoms that we call, you know, ADHD or those types of things. So, it’s a big deal and rarely do I have a child come in who’s been diagnosed or has the symptoms of ADD, ADHD, you know, autism, those kinds of things, where there isn’t some issue with sleep, either historically, you know, it’s a kid who has never slept a night in their life well. Or, you know, there are current issues with, you know, maybe taking a long time to fall asleep or having a lot of night waking. Sometimes, parents aren’t real aware of the quality of the child’s sleep on a night to night basis until they maybe go on vacation and sleep in the same room with the child, or something like that. And then parents will say, “Oh, my gosh, you know, nobody wants to sleep anywhere near him because he’s, you know, kicking and thrashing throughout the night, or throwing the covers all over.”

You know, often I’ll ask parents in getting at the quality of sleep issues. You know, “When you go in to check on your child in the night or when you go in to wake them up in the morning, you know, have they moved around a lot in the bed? Are the covers everywhere? Do you hear them in the night, like banging into the wall by their bed?” Those are all kinds of signs that the child is getting really restless sleep. They may be sleeping for a decent number of hours but they’re not getting good quality deep restful sleep and that can have a significant impact on their brain development and on their behavioral symptoms that they have then during the day.

Katie: So, how do you address those sleep issues? Because I think any parent, even those with children who don’t have any kind of behavioral challenge would be glad for their kids to sleep better or sleep more. So, I’m really curious, how do you address that in children?

Nicole: Yeah. So, there is a two-pronged approach generally. I mean, the first thing that we have to work on is good routines and what we call sleep hygiene. And so, educating parents and kids about why sleep is important and the routines and things that help us to sleep well. So, things like having a set routine leading up to bed time. Because that helps kids to calm and be able to settle down for sleep. Things like doing more relaxing and quieter activities in the hour leading up to bed instead of, you know, running around and wrestling, and really active kinds of things, because that actually gets kids more stirred up and it makes it harder for them to fall asleep. So, things like taking a bath and reading books, and coloring, and things that kind of help them to start winding down.

Teaching parents that it’s important to set routines and then enforce those. That, you know, kids may not want to get ready for bed at the time that they need to but it’s our job to enforce those routines and to have them do that. That kids, just because they might wanna stay up until 10:00, 11:00 at night, you know, we need to help them to see that that’s not going to be an option, and that they’re not gonna do that because it’s not healthy for them. This is an area where screen time plays a big factor too. And I know that you, you know, have written quite a bit about the impact of blue light and screens on, you know, adults and sleep, and all of that. It’s important for kids too.

You know, a child who is sitting with their face, you know, six inches from their, you know, smart phone or their iPad, or their video games, or whatever it might be, are gonna have a harder time settling down to go to sleep. Because that blue light from those devices tricks their brain into thinking that it’s day time. And we need our brain to release more melatonin, which is that hormone that helps us to fall asleep. And so when kids are, you know, having their face really close to a screen or engaging in, you know, electronics use right up until bed time, that’s going to make it more difficult for them to fall asleep. So, part of what I really teach families is that it’s important for at least 45 minutes, preferably longer before bed time to power those devices down and to have kids engage in other activities and routines, so that their brain can start to produce the melatonin that it needs to, to make it easier for them to fall asleep.

I also think that that’s a big issue as far as abstinence and irritability, too. I don’t know what you find with your kids, Katie. But I can say with mine, absolutely, the more screen time they have, the more moody and irritable they get. And the same goes for kids with, you know, these kinds of challenges, too. In general, kids are spending a lot of time in front of screens and electronic devices. And the impact that that has on their mood and their willingness to follow directions and do what we ask them to do, you know, just gets worse and worse the more time they spend with that. So, those are additional reasons to reduce the screen time. But especially at bed time because we want them to be able to fall asleep. So, you know, those are some of the sleep hygiene kinds of things that are important for parents to be thinking about.

Katie: Yeah. I’ve absolutely seen the same thing with kids and screen time. And I love that you mentioned the blue light connection especially at night, because I think it’s a perfect segue into your next factor to address the movement one. And I’d love to tie in, like the movement and the outdoors. Because from what I’ve seen on the research, not only do we need to limit blue light at night because that’s sending the signal to the body that it’s day time and it’s afternoon, which suppresses melatonin. But there’s a lot of research showing, we also need to get bright light during the day. We need to go outside when the sun is the brightest to signal the body that it’s day time, which helps that circadian rhythm cycle and really helps the brain develop those good wake and sleep patterns.

So, I’d love to get your take on the movement point that you talked about, but also how important is it to be outside? Because I’ve been doing a lot of research about ecotherapy and what the Japanese call like nature bathing. And it’s really staggering, there’s actually studies that I’ve seen on how this impacts behavioral challenges. And how just getting time outside with all of the benefits that come with it can really make a difference. So, I’d love to hear your take on that.

Nicole: I completely agree. It’s so, so true. You know, when we think about when we were growing up, when I was growing up like we spend most of our time outside of school, we were outdoors. And even when we were in school, we had multiple recesses a day. We were outside. You know, our parents were always saying to us, you know, “Go outside, go outside and play.” And, you know, that wasn’t just because our parents wanted us out of the house, it’s because we sort of inherently have known over the course of, you know, time that being outside is good for us. And we’ve lost that, I think especially with this current generation of children. We’ve lost that connection with nature, with being outdoors, and we’ve lost an understanding of how important it is for not only our physical health but our mental health as well.

It’s shocking how many kids come into the clinic and report…they and their parents report that they spend virtually no time outside. The majority of their time during the day is spent indoors, if they are outside, it’s going from the house to the car, or something like that. Many, many kids today are in school for six, seven hours a day. And then when they’re not in school, they are, you know, sitting on the couch with their, you know, electronic devices, or their, you know, doing other things indoors. And even playing inside, and while all different types of play are great, an indoor play is awesome, too. You’re absolutely right, that being outside in nature, being out and exposed to sunlight, being outside and exposed to fresh air, all of that is super important.

And so when I talk about movement with families and the role of movement in improving their kids’ symptoms, I’m talking about, yes, the importance of physically moving their body. And then another component of that is, as you said, getting outside and doing that outdoors. It’s clear in the research that kids are leading far more sedentary lives. And the thing that many people don’t understand is that physical movement is actually essential for brain development and physical growth in kids. Physical movement especially in the early years, from birth through elementary school, physical movement is how kids’ brains develop the connections that they need to develop.

And it’s not just about developing motor coordination or learning how to crawl or run, or things like that. Physical movement actually supports brain development and the development of connections that the brain needs for thinking, for problem solving, for regulating emotions and behavior, for managing attention. All of those higher level cognitive skills that we want kids to have and that kids with ADD and ADHD, and these other kinds of issues, the skills that they are lacking or struggling with, all of those develop in part through physical movements. So, when kids are not getting physical movement, especially in the first 10 years of their life, their brain development is going to be impacted.

And I think that’s a big part of, you know, getting back to what we talked about initially, which is why are so many kids having more problems? I think this is really a key part of it, is kids are not getting the kinds of physical movement that they once were. And I don’t just mean exercise. You know, a lot of people… I like the word movement instead of exercise because people really kind of have a lot of weird ideas about exercise and, you know, what that is. But I’m just talking for kids about moving, going for walks, riding their bikes, being outside, building forts, climbing trees, running around in the grass, playing tag, all of those kinds of things that used to be and should be a part of normal childhood experiences. They need those in order to function well.

And, you know, this isn’t just a problem at home. This is a big problem and a big issue that I have with the direction that many schools are going, at least in the United States at this point. Recesses are being pared down and taken away. Many school districts at this point, you know, kids are lucky to get one, 15 or 20-minute recess in a day. That is not nearly enough movement for them over the course of a six or a seven hour school day. And actually, what the research has shown in countries like Finland and other European countries that structure things in a much more developmentally appropriate way for kids. What they find is that giving kids opportunities for physical movement at least once an hour.

So, like, 45 minutes of, you know, maybe learning activities in the classroom or seatwork kinds of things, and then follow that by 15 to 20 minutes of physical movement indoors or outdoors, that kids are learning way better. The rates of ADD and ADHD are way down, and their test scores are better. They’re far outperforming us. So, we really have a lot to learn, I think in this country about how we need to get back to more developmentally appropriate. Schooling environments and that includes things like, you know, recess and physical education classes, and giving kids the movement that their brains and their bodies need. And, you know, you mentioned about the being outside in the sunshine, and that’s a big one.

You know, vitamin D, going back to the idea of specific nutrients that impact this stuff. Vitamin D is critical for everything, from our immune function to brain development, and you know, bones and just overall health. And vitamin D is something that our bodies can make from sunlight. And it’s, you know, yes, we can supplement, we can give kids supplements, and that’s good and appropriate most of the time. But being out in daylight is really helpful for increasing kids’ vitamin D levels. And many, many kids and adults are deficient, and part of it is because we’re not spending enough time outside. So, you’ve got the vitamin D issues, you’ve got the circadian rhythm issues that you mentioned of kids who are indoors and darker spaces all day.

The brain gets very confused about what is day time and what is night time, and how to regulate those rhythms of sleeping and waking, and all of that. So, yeah. I’m completely with you that this movement piece and this outdoor piece is a really critical component of supporting kids’ development.

Katie: Awesome. And I wanna come back and make sure we touch on the connection and the cognition. But before we do, something you just said reminded me of another question I was gonna ask you, which is, there’s a lot of home school parents that listen to this podcast. And so, I think we obviously need to do some major reform from the school system and help those children as well. But for parents who are teaching their kids at home and can control the environment, what would be some of those big factors that you would have them change to kind of help create a good behavioral related environment for the kids?

Nicole: Yeah, I love that. You know, I’m a real proponent of making decisions about schooling for each child based on what they need. And we have a lot of families at our clinic who we have recommended that they home school or look at alternative school options at various points in their kids’ lives, because it’s what their child needs at the time. So, I love it that you have so many families that are doing that. I think that one of the big things is just realizing that school or, you know, learning does not have to be about sitting at a table or sitting at a desk with a pencil in your hand doing things. And I know that that’s sort of the message that people get about what formal schooling is, at least in this country. But I really encourage parents to think outside the box and realize that, kids learn best, all kids, but especially kids with these kinds of challenges that we’re talking about. They learn best when they’re engaged in actually doing meaningful things.

So, I often will say, you know, to parents, “Okay, if your child is really struggling with math for example. And, you know, you’re having fights about it in sitting down and trying to have them do work books or things on the computer,” or whatever. See what happens if you involve your child in daily activities that involve concepts of math. Involve your child in cooking, where you’re using measuring, and all of those kinds of things. Do, you know, craft projects or building projects, or other kinds of things where they can actually learn and use concepts of math and math skills in meaningful kinds of activities.

And what you’ll find is that not only are kids more engaged and it minimizes a lot of their resistance and, you know, behavioral challenges around that. So, they’re more engaged but they’re also learning more. They are thinking more about what they’re doing, they’re internalizing the concepts, and they’re retaining it better. So, I think home schooling is an awesome opportunity to really engage kids in the kinds of life activities and things that really can help them be able to grasp these concepts in a much more powerful way. And that doesn’t mean that you don’t ever do, you know, workbooks or computer work. But I think that finding a balance that works for your child is helpful. And, you know, as I mentioned, the idea of spending at most 40 to 45 minutes out of an hour on, you know, seatwork or, you know, a specific focused learning kind of task, whatever that might be.

And then following that up with 15 to 20 minutes of downtime of movement, of outdoor time, of a leisure activity, or something like that. That’s a good way to think about pacing the day. Because the research shows this, even for adults, our brains really can’t stay focused on anything for longer than about 45 minutes at a time anyway. So, thinking about pacing the day as 40 to 45 minutes, you know, of learning activities. And then, you know, 15 to 20 minutes of movement or downtime is good. Now, obviously, for a younger child, that’s gonna be even shorter. You know, if we’re talking about pre-schoolers or kindergarten, you know, age kinds of kids, we’re talking about maybe somewhere between 15 and 25 minutes of targeted structured activity. And then, you know, a little bit of downtime and movement after that.

So, certainly it has to be, you know, adjusted according to the age. But I think that that’s one of the awesome things about home schooling or other types of options, is that you have a lot more flexibility to do what your kids need. And if you’re seeing that something’s not working for your child or you’re getting a ton of resistance about something, then step back and say, “Okay, this doesn’t seem to be working. Let’s just do something different and let’s see how that might work.” And don’t be afraid to be flexible with that and to say, “If this isn’t working for my child, let me, you know, try something else that might work better.”

Katie: Such good advice. And I have hopes in the future, hopefully that even in our school systems, that we can start implementing some of the things like you talked about in Finland or in these other countries that are seeing such good results, that we could learn from their experience and kind of implement that as well. I wanna make sure we touch on connection and cognition though. So, can you kinda give an overview of those and then what are some of the main points of focus that parents can work on, in each of those areas?

Nicole: Yeah. So, the connection is really about the relationship component. And what I really focus on here is, a parent education piece. How can parents be thinking about their connection with their child and how they’re communicating with their child? Because certainly, parents don’t cause these problems in their kids, but parents can have an important role in engaging with kids in ways that minimize the problems and just help things to go more smoothly. And, you know, kids do not come with instruction manuals. None of our kids do. And even, you know, when we’ve got kids with these kinds of challenges, it can feel really, really frustrating and parents can start to feel really incompetent and feel like, “Oh, my gosh, everything I’m doing is wrong.”

And it can feel really demoralizing. And so I wanna really speak to parents to help them understand, you didn’t cause this. And they didn’t come with an instruction manual and you can’t just be expected to know how to do this. So, you know, giving them some tools to make that go better. And I think some of the pivotal things here for parents to think about is their own emotions in relation to their child. So, it’s really easy when a kid is exhibiting really frustrating or challenging kinds of behaviors. It’s really easy for us as parents to get worked up and to get really frustrated, and for there to be a lot of, you know, it could be yelling or arguing, or just the day can get really, really negative. Because we’re feeling really negative about what our child is doing.

So, one of the big things that’s important for parents to start thinking about is their own ability to stay calm when their child is not calm. And it’s a tough thing for some parents to master or to think about this idea that the more upset or agitated or resistive my child gets, the more calm and quiet I’m going to get. But it’s a huge, huge component of helping kids to learn to manage their emotions and behavior better. And it’s also a big component of helping the day go better. So, what parents find is when they practice with keeping themselves calm and not yelling, not engaging, and, you know, arguing and negotiating, but just staying really calm and as quiet as they can. What they find is that the day goes smoother and their child starts to model that as well.

So, that’s one of the big foundational components of helping parents to strengthen that supportive connection that they have with their child. And there’s aspects of communication and how we talk to kids, and, you know, not peppering them with a thousand questions all the time that just make them feel on the spot and, you know, it can lead to arguments. So, there’s a style of communicating and a way of engaging our kids that can really reduce the amount of challenges and help things go better. So, that’s really the primary stuff that we think about with that parent-child connection component.

Katie: I love it. And I wanna make sure I respect your time because we’re getting close to… We’re over 50 minutes, which I can’t believe because it’s just been such a great conversation. But I know there’s probably a lot of parents listening who still have a specific question related to their child’s specific problems. So, I’d love for you to tell people where they can find you on the internet and if they live close, I’d love to, you know, tell them where they can find you actually if you still clinically practice. Where they can find you?

Nicole: Yeah, absolutely. I have a practice in Grand Rapids, Michigan. And we work with families throughout the country and internationally in various ways. And my clinic is Horizons Developmental Resource Center, and I’ll get you the link, you know, for that so that people can find that. I am still actively in clinical practice several days a week, and I have a team of people here at the clinic as well that work with these same kinds of issues. I also have… People can find me online on my blog and on my website, drbeurkens.com. And there, they can find all kinds of free resources, articles, videos, things that really get more in-depth on a lot of the topics that we’ve talked about today.

There’s a book that I’ve written called “Life Will Get Better,” that takes these five core areas that we briefly touched on, and flushes them out and helps parents really have some concrete things that they can do in each of those core areas, you know, to move their kids forward. There’s an online program that goes with the book. So, lots of resources available on the drbeurkens.com website. And I always welcome for people to send specific questions and things through the website. You know, I’m more than happy to connect with people and to help them understand what might be helpful in their situation, and get them connected with the resources they need.

Katie: That’s so wonderful and such important work that you’re doing. And I know that you’re, like I mentioned in the beginning, such a busy person with your practice and your children, and all the work you’re doing online. So, I am so honored that you would take an hour to be here with us and to help people. And, of course, those links will be in the show notes at wellnessmama.fm, so people can find those and find all the links to your website. I’ll make sure to include some of your blog posts as well because I know you have a lot of really good ones. But thank you so much for your time in being here. This has been wonderful and I hope very helpful to a lot of people who are listening.

Nicole: Great to be here. Thanks so much for having me.

Katie: And thanks to all of you for listening. And I’ll see you next time on “The Healthy Moms Podcast.”
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.

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