REGULATION DySrEgUlAtIoN CO-REGULATION Cherisse Sherin, MA

1. REGULATIONDySrEgUlAtIoN CO-REGULATION Cherisse Sherin, MA

2. Objectives • Understanding Behavioral Regulation through DIR Perspective • Core Deficits impacting Behavioral Regulation • Emotional Development – Building the Neural Pathways • Strategies to support appropriate Behavioral Regulation

3. DIR Framework Affective Interactions Relationships Emotional Range Symbolic Capacities Abstract thinking Creativity Individual Differences Sensory Processing/Modulation Motor Planning and Sequencing Visual Spatial Processing Functional Emotional Developmental Capacities Regulation and Shared Attention Engagement Two-Way Intentional Communication Complex Problem Solving Symbolic Ideation Logical Thinking Multi-causal Thinking Comparative Thinking Reflective thinking

4. Meaningful Social Relationships How attachment shapes the brain and what patterns of attachment are embedded in the neural circuitry of the brain shape our 3 R’s: • Relating • Regulation of affect • Resilience Dan Seigel, “The Developing Mind”

5. Core Deficitof ASDExecutive Function • Inhibition/Initiation • Shift/Flexibility • Emotional Regulation • Working Memory • Problem-solving/Organization • Monitoring

6. Executive Functions “Definition” • Variety of “higher-order” mental processes and behaviors • Enables self-regulation, problem-solving and goal directed behavior • Integrates lower-level processes • Develops gradually over time

7. EF…..plays an important role…… • Estimating and visualizing outcomes • Analyzing sights, sounds, and physical sensory information • Perceiving and estimating time, distance, and force; • Anticipating consequences • Mentally evaluating possible outcomes of different problem-solving strategies • Ability to choose actions based on the likelihood of positive outcomes • Choosing the most appropriate action based on social expectations and norms • Performing tasks necessary to carry out decisions.

8. Lagging Executive Skills Can Impact Behavior 8 A child with difficulty shifting their attention would have a hard time complying rapidly with adult directions. They might experience greater than usual frustration when an adult insists upon rapid compliance. A child with challenges in memory or planning may have a hard time remembering previous consequences for misbehavior and may not anticipate consequences for their actions. Ross Greene, “The Explosive Child”

9. Theory of Mind • Difficulty explaining ones behaviors • Difficulty understanding emotions • Difficulty predicting the behavior or emotional state of others • Problems understanding the perspectives of others • Problems inferring the intentions of others • Lack of understanding that behavior impacts how others think and/or feel • Problems with joint attention and other social conventions • Problems differentiating fiction from fact

10. Lack of Empathic Responsein Social Relationships 10 • Lagging skills include: • Recognizing the impact of one’s behavior on others • Understanding how one is coming across to others • Attending to social cues • Understanding Intent • Appreciating social nuances • Perspective of others • Social Referencing • “Sharing” Ross Greene, “The Explosive Child” .

11. What's Mindsight?Emotional and Social Intelligence • "Mindsight" is a term coined by Dr. Dan Siegel to describe our human capacity to perceive the mind of the self and others. • It is a powerful lens through which we can understand our inner lives with more clarity, integrate the brain, and enhance our relationships with others. • Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds. • It helps us get ourselves off of the autopilot of ingrained behaviors and habitual responses. • It lets us internalized our emotional experiences and organize what emotions we are experiencing, rather than being overwhelmed by them.

12. Mentalizing A process to help people consider their own thoughts and feelings and differentiate them from the perspectives of others.  Handbook of Mentalizing in Mental Health Practice Edited by Anthony W. Bateman, M.A., FRCPsych, and Peter Fonagy, Ph.D., F.B.A.

13. LEFT SIDE Later to Develop Logical Linguistic Literal Linear Likes to Analyze Wants to know Why Concerned with the Outside World RIGHT SIDE Quicker to Develop Gut Feelings Cares about Feelings and Emotions Non-Verbal Wholistic/Relativistic Thinking Cares about the Big Picture Autobiographical Reflective about the Inner World Concerned with Whole Soothes Self LogicalEmotional

14. “Integration is Critical” • The left side of the brain is “logical, literal, linguistic, and linear” • The right side of the brain is “holistic and nonverbal, sending and receiving signals” • Allow us to communicate • Facial expressions • Eye contact • Tone of voice • Posture • Gestures. • “Instead of details and order, our right brain cares about the big picture – the meaning and feel of an experience – and specializes in images, emotions, and personal memories.” Dan Seigel and Tina Bryson, “The Whole Brain Child”

15. The Upstairs Brain (Cerebral Cortex and Middle Prefrontal Cortex) Mental processes Dynamic Intelligence Executive Functioning Thinking Imagining Planning Self-monitoring Decision Making Saliency More evolved and gives you fuller perspective of the social world The Downstairs Brain (Brain Stem and Limbic Region) Lower areas of the brain are primitive and responsible for: Basic functions Breathing/Blinking/Heart Innate Reactions Fight or Flight or Freeze Strong Emotions Anger and Fear Monitors Threat and Expresses Emotion Sensory Memory The Whole Brain Child

16. FAILURE TO DEVELOP HIGHER LEVEL INTREGRATION OF PREFRONTAL FUNCTIONING • STRONG TENDENCY TO SUBSTITUTE LOW LEVEL NONCONSCIOUS OR ROTE NEURAL PROCESSING • EXCESSIVE REINFORCEMENT LEADS TO BLOCKING THE DEVELOPMENT OF HIGHER LEVEL FUNCTIONING

17. RESULT • Over time a tendency for lower level processes start to dominate • Less prefrontal control mean less flexibility: • to orchestrate--to decide what brain centers to bring on-line or which not • how they should work together

18. Behavior vs Regulation • Compliance • Attention to Task • Over - Correction • Differential Reinforcement • Joint Attention/Social Referencing

19. Behaviorvs Organization • Reinforcers • Contigencies • Behavioral Charts • Contracts • Executive Functioning – Understanding consequences of actions

20. Functions of Behavior vs Emotional Regulation Functions of Behavior • SEAT (E) = Emotional Regulation • Antecedents= Emotional Triggers (Sadness →Frustration →Excitement) Anxiety (Sadness →Worry → Apocalypse) Individual Differences (Sensory Modulation → Visual Spatial Processing →Motor Planning/Praxis and Sequencing) Developmental Constrictions (Speech and Language/Communication →Physical Disabilties → Cognitive Processing

21. Subjective Reactions Salient Event Physiological Arousal (Feeling State) Overt Behavioral Reaction Cognitive Appraisal Sroufe

22. Reframing Behavioral Regulation Neurological Processing → Sensory → Emotional Regulation → Relationships

23. Mentalizing → Self-Reflection • Internalized motivation • Coping Strategies • Self-monitoring

24. Self - Regulation • Self regulation refers to the strategies a child uses to increase their attention to a task, to self calm and for impulse control • Ability for the child to develop control, to calm, to attend to salient stimuli  and to organize his or her own body.  • This enables the child to develop internal regulation and to control of his or her behavior.  • Self-regulation is the ability to achieve, monitor and change a state of attention and behavior to match the demands of the environment or situation.  • Self regulation enables the child to initiate and cease activities in relation to the task and situational demands and to comply with a request of another (e.g. parent, teacher or friend). 

25. Modulation • The child who is under responsive responds to environments and interactions that are stimulating for them.  • Affect should be “up regulating”, enticing the child with expressive facial expression, gesture and language.  • The child who is over responsive responds to activities that provide a clear localized sense of their body. • Affect should be “soothing” with the focus on “down regulation”. Facial expression, gesture and language should be clear, with rhythm and predictability.

26. SENSORY MODULATION • Sensory modulation is the description of the continuum of sensory registration and responsivity that enables one to arouse, alert and attend to stimuli.  • Within this continuum there is orientation at one end and failure to orient at the other end.  • Many children with difficulty in sensory registration and responsivity seem to swing to either or both ends of this continuum (failure to orient or under attend or over orient and over attend).  These individuals have difficulty attaining or maintaining the mid-range or selective attention (homeostasis).  • A child with a sensory modulation difficulty has more frequency and intensity of responses than a typically developing child.  • This contributes to variation in attention with over or under attention to stimuli in the environment. interacts with the child one should be aware of the power of affect and physical actions but we always need to constantly aware of the child’s underlying sensory profile. Rosemary White, OTR

27. Homeostasis • Defensive >Withdraw (extremely heightened response) • Defensive > Protective; fight and flight; approach/avoidance (extremely heightened response) • Defensive > Escalated - giggle; talkative; tangential; intense play; lack safety (heightened response) • Hyperfocus; overattentive (mildly heightened response) • Attentive - focused attention to salient stimuli with habituation to extraneous stimuli (homeostasis). • Lack attention,  low registration,, hyporesponsive, excessive habituation  - to body, to environment; to cues from those around him (mild to moderate low registration) • Shutdown  (extremely low registration) Rosemary White, OTR

28. Attunement – Regulation and Joint Shared Attention • Some children who are under responsive seek input but quickly become escalated as they experiences the stimulation that they seek in a disorganized manner. • Constant attunement with the child and adapt our interaction with the child and to change affect and physical interaction as the child changes in his/her response.  An intention, feeling or attentional focus that evokes an attuned response is one that is shareable and thus can be integrated into the child's sense of self whereas one that fails to evoke such a response can neither be shared or integrated. Daniel Stern

29. Lagging Emotion Regulation Skills Can Impact Behavior 29 Emotion Regulation Skills: A child who responds to problems with a high level of emotion (e.g., screaming, crying, swearing) has a reduced ability for reasoned, reflective thinking. A child who has a general emotional state of irritability, depression or anxiety will often respond to minor frustrations, such as simple directions, as if they were major obstacles. This interferes with the development of flexibility, adaptability, frustration tolerance and problem solving. Ross Greene, “The Explosive Child”

30. Emotional Understanding ‘Bad Behaviors” – without understanding developmental framework and neurological process then we become stuck • See child as a “Mentalizing Individual” = A self that has a feeling • Emotional Reaction – relates to a historical experience with a real and intentional feeling • Somatic Experience – Physiological Discomfort • Disorganization – Lack of understanding and ability to process information about the social/emotional experience • Dysregulation – Occurs as a disintegrated state of organization overwhelmed by lack of capacity to internalize emotional experience compounded by potential sensory processing

31. Engagement Joint Shared Attention • Intimacy • Trust • Attunement, • Being in a dance together • Synchronous rhythm (Pas de Deux) • Anticipation, • Sense of knowing, • Predictability • Joy and pleasure • Tolerance of Negative Affect • Ability to accept comfort.

32. Using a Relationship for Regulation and Joint Shared Attention ? How does the experience with a parent/caregiver become internalized • Need to have many internalized experiences – path to self-regulation and organization • Reliance on the need for the dependency of the relationship

33. Two- way Reciprocal CommunicationStaying Affectively Connected • Empathy – Child’s perspective • Giving emotional meaning to the behavior • Re-engage child continually bypassing fragmentation • Maintain assertive curiosity about child’s desires, wishes, wants, needs • Respond to Intentional Gestures • Opportunities for opening and closing reciprocal circles of communication • Wait time - Processing • Declarative language vs Imperatives • Leads to Inferent Thinking • Communicative Intent • Consideration of Individual Differences/Lack of Developmental Skills and Sensory Processing

34. Lagging Language-Processing Skills Can Impact Behavior 34 Language-Processing Skills: A lack of language processing skills can limit your child’s ability to label, categorize emotions, communicate feelings and needs, sort through options for outcomes, and receive feedback about the appropriateness of their actions. Problem solving skills of children and adults are largely language based. A lack of language processing skills can make it difficult for your child to find solutions to problems. Ross Greene, “The Explosive Child”

35. Moving towardCo-Regulation • “Affective reciprocal chains of interactions with clear intent and problem solving” – Affect Diatheses, Stanley Greenspan, MD • Modulation • Voice (Tone/Pitch) • Pacing • Simplify Language • Opening and closing circles of communication • Continual Reciprocity • Simple Problem Solving – opportunity for creating experiences to make choices • Sensory supported activity PARENT MINDSIGHT

36. Co-Regulation • Co-regulation has been defined as the social process by which individuals dynamically alter their actions with respect to the ongoing and anticipated actions of their partner. (Fogel, 1993) • When both partner’s actions are successfully anticipated and the altered actions of the individual produce continued interaction, communication about the relationship is interpreted by both. (Cortney A. Evans, Christin L. Porter)

37. Empathic Narration • Sharing of intentions and feelings defines the child’s intersubjective feelings of himself – the experience of within • An intention, feeling or attentional focus that evokes an attuned response is one that is shareable and thus can be integrated into the child’s sense of self. • Affect attunement – emotional resonance and communication convey the way in which an experience becomes internalized (cross modal – affective response) • Emotional attuned affect mirroring is contingent upon the child’s emotional intent • I’m not sharing what you’re feeling but showing you I understand what you are conveying

38. Lagging Cognitive Flexibility Skills Can ImpactBehavior 38 Cognitive Flexibility Skills: Children who are extremely concrete, black-and-white thinkers, who have strong preferences for predictability and routines may experience significant frustration in new or unpredictable situations. They may obsess on an idea or plan and have a hard time “shifting gears.” Ross Greene, “The Explosive Child”

39. Organized Sense of SelfComplex Problem Solving • Empathic Narration is a process which supports the regulation and integration of a child’s emotional intent and organization – using affect attunement to organize the behavior • Emotional attuned affect mirroring that’s contingent • Use of empathic narration conveys the child’s intersubjective experience with the parent • We decide who we are by looking in the mind of the other – Social Referencing

40. dYsReGuLaTiOnStaying in the moment Use of Empathic Narration • Re-organizing the child's emotional state by clarifying the child's emotional intent • Speak for the child • Saying out loud for the child what he/she is experiencing • Saying for the child what they would say if they could say it • Saying what you see the child doing • Not just describing the child’s feeling state • Acknowledge the positive aspects of the effort the child makes • Avoid making judgments about their behavior • Avoid asking, “Are you mad?”, etc.

41. Attunement + Emotional Regulation = Behavioral Regulation “Such emotionally attuned mirroring is absolutely critical for it is through “resonating with, reflecting on, and expressing the internal state which the infant displays” that the parents allow the child to gradually discover her own emotions as mental states that can be recognized and shared – a discovery that lays the foundation for affect regulation and impulse control.” Alan and Fonagy, 2002

42. Organized Sense of Self • Accessibility to the attic bridging the downstairs brain and the upstairs brain by creating and constructing opportunities to continue to develop neural pathways for organization of their child’s internal emotional experiences • Problem Solving • Collaboration • Negotiation • Compromise • Reasoning • Self-Reflection

43. Stanley Greenspan Quote of the Day “Parents are led to believe that they must be consistent, that is, always respond to the same issue the same way. Consistency is good up to a point but your child also needs to understand context and subtlety . . . much of adult life is governed by context: what is appropriate in one setting is not appropriate in another; the way something is said may be more important than what is said. . . ”

44. BEHAVIOR ANXIETY DYSREGULATION

45. ADDRESSING BEHAVIORAL REGULATION • THE ON-GOING PROCESS THAT SUPPORTS “APPROPRIATE” BEHAVIOR • HOW BEHAVIOR IS “FACILITATED” IN THE MOMMENT

46. Let’s Make a Plan 46 Plan A: Insist the child follow the direction. With Typical children the child ultimately meets the parents’ expectations. With explosive children, insisting the child follow the direction greatly increases the chances of an explosive episode. Example: Parent insists child brush their teeth properly. Plan C: The opposite of Plan A. This involves reducing or removing a given expectation. The goal is to reduce the likelihood of an explosive outburst. This is often the only option once explosive outbursts get out of control. This is “giving in” to the child, used as a new parenting strategy until skills are developed in the lagging pathways. Example: Parent would say nothing or simply convey that they do not object to the child not wanting to brush their teeth. Ross Greene, “The Explosive Child”

47. Let’s Make a Plan 47 • Plan B:The ultimate goal is to use Plan B, which is Collaborative Problem Solving, while we also teach the child lagging cognitive skills. We teach these skills when the child and parent are not emotionally charged or drained. Collaborative Problem Solving has 3 steps: • Empathize with the child. Get their concern on the table, and let them see that you care about them and their concern. • Define the problem. Get your concern on the table too. • Invite the child to come up with solutions. (You can as well, but most children have a higher investment in something they thought of, so if it seems like a decent solution, try their idea! • An acceptable solution is one that is realistic, doable, and mutually satisfactory. If it fails to meet any of those criteria, then keep proposing solutions until you find something that meets all three. Ross Greene, “The Explosive Child”

48. Promotes tolerance of delayed gratification Making Associations – Past, present and future Using Symbolic world in order to deal with emotional experiences Role Play Practice and Rehearsals Supporting Regulation Joint Shared Attention Co-regulation Complex Problem Solving Tolerating Negative emotions Internalization of emotional experiences Self-Reflection Supporting Behavioral RegulationHypothesis Testing – “What would happen if……”

49. We strive to ensure that parents feel empowered and competent in guiding their child’s development and that each child develops a sense of self-worth and learns to value relationships with the significant people in their lives.

50. Emotional and Behavioral Regulation Tool Box