Triage Parenting for Twice Exceptional Kids

Parenting twice-exceptional children often feels like working in an emergency room. Parents are constantly assessing, prioritizing, and adapting to meet the most immediate needs, whether that’s dysregulation, competing demands at home, school pressures, or simply getting through the day. Courtney introduces the concept of triage parenting, a framework that helps parents stay grounded, flexible, and compassionate while navigating these high-intensity moments. While triage parenting is exhausting, it is not impossible, and it is not a journey parents have to face alone.

Courtney will share insights from both lived experience and professional practice, offering reassurance, perspective, and practical ways to make this demanding parenting journey more sustainable.

Pillars of Triage Parenting.pdf

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0:00 With you. Click okay. I'm excited to share this um framework with you. And as uh Teresa mentioned, I am a parent of a child that well a young adult actually who's twice exceptional. He's now 23. Um, we didn't come to understand that he was twice exceptional until he was 17, which as you might imagine was, um, led us through some pretty curvy paths and challenging paths. Um, but I'm happy to say we're we're kind of on the other side of things and he's thriving now. We have a beautiful relationship. Um, he's working towards his degree in computer science. I have two other uh, young adult girls. One is a physician assistant. one is on her way to becoming a speech pathologist. So, we have a lot of medical people in our home. Um, I love to play tennis. I play on a competitive tennis uh women's doubles league every week. I love to travel. Um, and you can see my faithful companion in my office and on my kayak Baxter.

1:07 Um yes I've um as part of my background so I started this company to tame the shame inc which is a coaching organization service um for neurody divergent individuals across the lifespan and their parents. Um but I came to that through uh the field of physical therapy and my son merging together. Um so I was a pediatric physical therapist. I'm still licensed and I also worked with uh people that have uh complex pulmonary um diagnosis uh progressive um pulmonary diseases. Uh and my brain has been trained and my brain works as for problem solving, right? And for relationships and I couldn't figure out how to support my son. And when I finally did and the portal opened and this world of twice exceptionality um be I became aware of I was finally able to say ah the tools that I've been looking for and I'm going to sh it's it's really truly my calling to share them with others. So I'm excited to move forward and start to share this concept of triage parenting with you. And I think the the language triage comes naturally because of my medical background.

2:29 Um, and also if you're interested, I co-host a podcast on Apple and Spotify called the See Me podcast with I host it with another parent of a person who has a twice exceptional son. So, what are tonight's objectives? I'm hoping that um, similar to what Teresa did, we'll review a little bit of the complexities of raising a twice exceptional child. you've got a great definition that she provided about the distinguishing strengths um and the various challenges that exist simultaneously um and there are complexities that come in raising a two-way child as a result of those that asynchronous development that we like to talk about. I want to review some basic principles of triage and emergency room care. Um we're not going to get into the clinical side of things. It's really just understanding the philosophies and approach that exist with triage and emergency room care. Um, and then explore and apply these principles to our lives as we're raising these twice exceptional kiddos and why those principles can be really really important as we're going through our days. And mostly I hope the biggest takeaway is that um you'll feel empowered and supported in this journey of raising twice exceptional child or children, teens, young adults wherever you might be in your journey um because of having these principles and kind of understanding this framework uh that I'll share tonight.

4:04 So what is as we get started let's just try to think about what is our role as a parent or a caregiver and I tried to summarize it a little bit and other people might have different things that might be included but in general my view uh and I think many people's views um is that we want our children to become confident we want them to be happy responsible respectful, well-grounded members of society who can be as independent as possible, right? And pursue meaningful work um and manage this roller coaster of life. And we do that by providing basic needs for them. We nurture, we validate them, we're encouraging and teaching them. And we're advocating for them, right? Um, and sometimes that we're trying to figure out like who is this child and how can I be the parent that they need me to be? And that's a question that sometimes we don't ask as parents. But when we are raising these twice exceptional children, it's so important to say, who is the parent that I need to be for you given the brain that you have? Sometimes it's the opposite. People are like, "You're the child. I'm the parent. You need to be for me the child that I need you to be." But I think it's super important to keep in mind the flip.

5:28 So, in addition to being a parent, we also have so many other hats that we are wearing, right? We cook, we're driving our kiddos, maybe, you know, we have a spouse, we have a partner, maybe we are doing things solo, so we have even more hats. We're the household CEO. Um if we might be working, we might be volunteering, we might be doing both, right? And then we also are our own person who we came to this parenting role before, right? So we were we were individuals even before we became parents. And so we have our own hobbies, we have our own strengths, we have our own challenges. And we bring our own interests, right, that sometimes we have to put on pause or manage. But we're wearing all of these hats. and so are our kids, right? And that results in all of these competing demands that we are trying to manage and navigate on a daily basis, weekly basis. We're trying to make sure the kids have clean clothes, there's food on the table, the lunches are packed, right? Everybody's academic needs are met, emotional needs are met, social needs are met, their interests are met. Not to mention, right, we've got we're trying to get out the door to work or we're trying to pay the bills. So, there's all types of competing demands. And that's just when you are a parent in general.

6:52 But when you add a child with multiple exceptionalities to the mix, it gets even more complex because we have bigger emotions with people who are twice exceptional, right? We have more needs that our children have more needs that have to be met for our children with their lagging skills or um their um intensities, right? They have heightened emotions. They might have sensory sensitivities and they have this thing called asynchronous development. And that's a whole another topic that I'm sure you can find more information about on the real.org website. But effectively that means that their brain is developing at different rates. Different parts of their brain are developing at different rates and importantly can develop at different rates compared to their chronological age. So you can have someone who has, you know, abilities in as as a 16-year-old when they're chronologically 12 and abilities simultaneously at that 8-year-old level. So we're talking about are we talking with an 8-year-old? Are we talking with a 16-year-old, right? Or are we talking with a 12-year-old? And that creates all types of complexities.

8:11 And we also know that our children are wonderful. And they are simply these actions that they have, the things that they do, the complexities that they have are simply a part of who they are. And sometimes what makes it even harder for us to understand and to grasp is these differences are brainbased. It's all invisible, right? So unlike many other challenges um that people might face that might be physical, we can't see them. They come out through their actions. And that's sometimes what makes this even more complex because we're seeing it through the lens of what we understand behavior to be. And there are so many societal and traditional ways of perceiving behavior that are not brainbased that make it really challenging for us to figure out how do we approach this if rewards and consequences and traditional parenting approaches don't work.

9:13 And so we have these wonderful kids with these strengths with these challenges. We have all the hats that we're wearing and we're trying to make it through daily life and the ongoing challenges are real for everyone. They're real for our kids, right? They're having meltdowns. They're not getting what they want. They're feeling things very deeply. They're not necessarily in environments that are working for them yet, right? They're avoiding school. They're lying to us. Um they're forgetting things. They're distracted by things. None of this is happening intentionally. It's a part of their neurohysiology. And the challenges are real for us, too, because we're really trying to figure out how to support our kids. But sometimes we can feel lonely. We can feel frustrated. We can feel sad, right? We're confused, unsettled. I know that's how I felt a lot of those first 17 years with my own son. And I know that I have a lot of parents that I speak with who are calling and saying, "My kid's forgetting his homework." you know, he's melting down all night long. We're screaming at each other. It's just not working. And it's because the traditional approaches won't work with our kids who are twice exceptional.

10:31 And so, we have these homes where our parenting experience is just like, "Please help me. Things are chaotic. They're constant. They're overwhelming. I've got competing priorities." And because of the nature of our kids, things are intense, right? They're uncertain and we can't hit pause. We have to keep going. So that's where this triage parenting concept came in to play, right? Because when I think of a home that has those similar character that has those characteristics, I was talking with a parent and I one time and I said, you know, we just have to triage what's happening in our homes. And when I thought about that even more, I actually came to think about the emergency room has such a similar type of environment and how do they manage with grace, perseverance, all of these unpredictable things happening that are constant with competing priorities that are overwhelming, intense, uncertain, chaotic, and they can't stop either, right?

11:44 So, it made sense that not only was this the competing demands that we have to manage in our own home needing to be triaged, but how can we use the response of the emergency that the emergency room providers have to inform what we do? And that's sort of how it all came into play. And when I think about it even more, I think about the patients in the emergency room. I think about our kids, right? They're not. Nobody no patient in the emergency room is intentionally giving anybody a hard time. And our kids are not giving us a hard time either. People in the emergency room are having are disregulated. They're emotional. It's an emotional time. Kids in our homes who are twice exceptional have heightened emotional experiences. There's a lot of uncertainty. The patients want to be well. Our kids want to do well, right? Parents want to do well also, right? And patients neither neither patients nor kids can figure things out on their own. They need help. And that's where we as parents come in and the providers as well.

12:56 So what doesn't help? So if I go into an emergency room and the doctors or the triage nurse would roll their eyes at me or say, "Oh my gosh, what how could why did you break your arm?" Like how silly. Couldn't you have done better? Right? Or if they criticized me or roll their eyes, like they're not providing any judgment or shame. They're not going to give up on me. They're there to help me. What can I do to help you? It's not necessarily what they're going to say, but Right. And so, we as parents can learn from that. And I think the one of the things that I had to learn as a parent and that I help parents learn in my coaching is that these traditional parent perceptions that kids are intentionally doing certain things. I have to help retrain the way that you perceive things. They're not intentionally being disrespectful. They're not intentionally um doing things to make us mad. They're they're doing things that their brain is telling them that they should be doing. And there that's a whole another talk, right? But that but they're doing things because of the neurohysiology of their brain. In the same way that when we're seeking medical care at an emergency room, it's because our body is doing something and we need help that we haven't yet been given.

14:19 So we need a different approach. We need a different toolbox, right? And so there are other things that we can learn from the ER. How do they not respond? We know what how do they respond? They respond. They're composed. They're calm. Hey, come here. Let me let me check let me check you out and see what's going on. They're validating. They listen to what we are telling them in order to help inform our response. A response. They're flexible. Okay. This is an ideal ER, right? But for the most part, this is what they're doing. And certainly, if there's a true emergency, they're acting more swiftly, but they're still using the same principle approach. They're acting swiftly. They're they're figuring things out quickly while also remaining calm. They're thinking creatively. They're problemolving, right? And they're responding rather than reacting. And I hope you understand when I make um that differentiation that their responding is coming from kind of a frontal lobe logical response as opposed to an emotional reactive place. I hope that makes sense. And of course they have a team around them where they can be collaborative or they're working with the patient, right? And that's why a place like Real 2 is so important because we need to have our team around us as well.

15:53 All right. So when we think about the ER and we think about the tri triage parenting and we think about similarities, there also are differences. And I want to make sure that this is a framework. It's not like we are medical providers because there are definite differences between the medical um triage and ER providers and us. The relationship is shortterm. Ours is long term. We have a very strong hopefully very strong emotional connection to our kids and it's a very professional relationship. Hopefully no emotions are involved beyond the humanto human connection right like I mentioned before they're part of a system of support and a full team whereas many times we're working alone surrounded by a community hopefully but in the moment it's sometimes it's just us. They're doing shift work. We're always on duty, right? They have years of training. We're trying to come to things like this to help expand our learning, but we're really doing some on in the- moment training, right? Sometimes we haven't we're faced with a situation that we've never faced before, and we have to figure out how to think clearly in the moment to manage it. we're learning something new about our child and we have to figure out what to do in the moment, right?

17:19 And then um as a medical provider in the ER, they're only responsible in the moment, right? Whereas we they're only responsible for one patient. Well, they're responsible for the patient in front of them at the moment. whereas we're responsible perhaps for three children plus the bills plus dinner plus trying to get three kids out the door all at the same time. Right? So there are differences. It's a framework. But what we can learn is this crossover space and I used the yellow and blue intentionally with the green in the middle, right? Um so that we do in both the triage and the ER providers and parents can have a similar response, right? And it's that response that is so important for us to learn from when supporting our twice exceptional students or twice exceptional kiddos. What I also would argue though is that in any relationship, if we can use these principles, it would make the world a kinder place, right? If we can always remain calm, we can um think about positive intent that no, everybody is having a hard time, not giving a hard time.

18:42 And so when we think about triage medicine versus triage parenting, it's a very similar process, right? It's a similar framework. We're gathering information. We're assessing. We're prioritizing. Right? In medicine, they're stabilizing. In parenting, we're regulating. Right? But we always want to get curious. They're going to treat clinically. We're going to respond and they're going to discharge. And then we get to follow up and keep doing the cycle again and again and again.

19:18 And so when we think about triage parenting and kind of the pillars of it all, there's this triage color code system. And I intentionally left the black off because we don't want to go to that place where people are deceased or it's just nothing more can be done, right? So we don't want to go to black. This is not salvageable is the language that they used. But really, if we can think about when when things are urgent, when things are important, and things are like they can wait, it's kind of the last step. Um, right? But when things are urgent, one of the most important things that we have to remember is we want to make sure that we're staying calm. We're regulating. And that's the first step is to get calm and to regulate so that we can then respond to the important things. We want to make sure everybody's safe. We want to make sure everybody's feeling emotionally safe because when we can't when we are reacting when we are are acting from an emotional brain it's going to result in everything escalating.

20:31 When our child is res is is responding or reacting from their emotional brain nothing is going to get through to their logical brain. they won't be able to access any of the information that we're giving them. It's it's there's a lid on their ability in their brain and on their ability to receive that information. So, the first thing that we have to do triage in order of importance is manage our own emotions and support or co-regulate the emotions of of of others around us. I always say making sure people are safe first physically trumps any type of co-regulation, right? So, we have to make sure that we're responding and keeping people safe and then making sure that we're all managing our emotions. So, sometimes we have to act and say, "I'm going to talk about this with you afterwards, but right now we have to go." Right? But we're making sure that we are responding as a triage nurse would. Okay? I need you to come here and you're going to go to this bed. So you have a confident, calm, composed voice while you're taking that action in order to help ultimately the person to co-regulate and get to a safe space.

21:52 And then we can go about doing the important work of what's important. What's the most important thing that I have to do here? Is it I think I have some um examples, right, of can't get past the edit, right? I'm at home and I have a variety of different things happening. I've got, you know, Jason has his room and he's got computer parts all over his floor. We're concerned that the dog's going to eat them. Um, I've got um Jeremy down here who built this massive Lego structure and Jason knocked it all over and now he's up in arms. I've got laundry that needs to be done. I've got to get John to his robotics practice. What do I do first? Right. So, I probably pick up and console, if I were putting my triage parent hat on, right? I would pick up and console Jeremy to try to support his regulation. I would talk with the with Jason about needing to go and getting into the car and talk to John about getting into the car to get to robotics practice. And then at a later time, I'm just going to leave the laundry. That's the green, right? The green the laundry is going to have to wait till later.

23:17 The talking with J Jason is going to have to happen at a later time also because what I need to do right now is console Jeremy regulate, right? Get John to robotics and then I can come back and have a conversation with Jeremy about what happened and do some repair work between the two boys and then at some point I can get the laundry done. Right. So, I'm trying to figure out like sometimes I might want to have a conversation between Jeremy and Jason about what he did, but in the meantime, but I can always go back and do that. In the meantime, I want to regulate first. And here are some other scenarios that I put out. But I don't know if people who have come here tonight might have questions or situations and scenarios that they have come about um have come up in their own lives and how we might be able to put our triage hat on for them. Because ultimately when we put our triage hat on, you know, the goal is to assess the situation, make sure everybody's safe, stay calm, regulate to avoid escalation, prioritize things, and say, "What's the right next step here?" Right?

24:40 And be flexible, patient. Um, one of the most important things is to validate other people's experience. Get curious. Right. And and continue to be creative in our ability to multitask. Um and then when you go back and see that green, we always want to reflect on what we did to see what we might be able to do going forward, right? What are some things that might help us to avoid situations in the future or increase independence in the future for other people? Um, and one of the most important things to do is celebrating success, right? Validating success. So, if you're looking at these on the right, these are kind of the things that I think of as um examples of the different triage levels. So, the managing emotions and and safety and health, the things in life are important, but they're not as important as relationships, right? When we're managing our twice exceptional kiddos, well, supporting. And one of the things that I always say um and has been true in my life is from our relationships skills will be built. If our relationships are not if our relationships are strong, connected, and trusting we'll be able to get to where we want to go. It's from these the strength of our relationships that we find the path forward. It may be a different timeline.

26:38 Um, and then I gave some examples in the last thing of things that we can just let go of because we can ultimately have conversations about them, but it's not the highest top priority of things to pay attention to. Whether it's mismatched clothing or it's not the best meal on the table or there's a mess of toys on the floor or a lot of times we get stuck in future thinking. Well, if I if he's not able to do this now, he's never going to be able to do it. If he's not able to do this now, he's not going to be able to get into the job. Well, the most important thing is what's happening now and what's the right next step. So, I'm hopeful and I'm happy to go through these scenarios if people want to. I don't know what the time check is at this point um Teresa but um ultimately this is the goal of the triage parenting toolbox and I'm hopeful that it will um provide a framework for you to think about putting your triage parenting toolbox on manage relationships. Think about what are the priorities. How do I prioritize relationships first? being calm and then responding from there.

28:04 Um, wonderful. Thank you, Courtney. Um, yeah, I think that why don't we take maybe one of the scenarios and just for me as a parent, um, it sounds like the co-regulation. So, first regulate yourself. Second is the co-regulation which supports the overall relationship, right? That's kind of why we went to the kiddo who was having, you know, the meltdown first was because we wanted to help co-regulate, which would then help in future times that he knew he was sick. Kind of things like that, you know. So, it's it's it's that relationship part of through co-regulation if I'm mistaken. Okay, cool. Yeah. Do you have one scenario that you hear a lot or um let's see, Yel, do you have one in the comments, too? We did we did put a uh if you want to drop something in the comments, maybe somebody has dropped one in the comments. Yay. Ya, do you see?

28:55 Yeah, I'm constantly having to triage between fighting the school with my child who has an IEP and my 2E child who needs support as well isn't getting it in school because, and I quote, she gets good grades because I'm constantly putting out fires on the other end. So the the challenges are the I'm a visual learner, Yael. So process things. It's in the chat. It's in the chat if you'd like to. Ah, okay. Perfect. Look. And if you'd like the person to if they want to come on off um mute and talk, we can do that as well. So, fighting the school with my child who has an IEP and then also has a two-ye child who needs support but isn't getting it. So, always putting out fires. Oh, yeah. So, you're always putting out fires with the school. Is that I can stop sharing. And there it is. So you're trying to triage.