As parents, we are all used to doing a lot of emotional regulation, ie soothing and calming. This is especially true when your child has autism, where the amygdala (center of fight or flight responses) may be intensely active, but the frontal lobe inhibitory and modulatory connections take extra time and practice to develop. That translates in real life to lots of tantrums. meltdowns, acting out, and other emotional storms we parents have to figure out how to navigate through every day.
A lot of us have been given a lot of information from our kids’ OT’s on first looking at sensory needs and making sure that we get the hypersensitive child out of noisy, crowded environments, remember hunger, thirst, pain, or the need to go to the bathroom in the child who can’t tell you, and make available the sensory toys they need like putty or trips to the swing or trampoline. This “bottom-up” approach is all good and essential. Got to make sure the lower brain/body essential needs are met.
Assuming those immediate body needs are not the primary issue, our kids’ psychologists make sure we understand how it’s important to address the child’s emotion before we start trying to fix a situation or attempt to problem-solve together. So they tell us to do lots of reflective listening, balance or buffer the child’s mood with our either calming or upregulating (high affect) demeanor, and remember all the hugs and affection our kids might need. That’s what Dr. Dan Siegel (2012, “The Whole-Brain Child”) coins “connecting to the right brain” before you can access the left. Got to make sure essential emotional needs are met.
Our kids’ SLP’s make sure we work hard on helping our kids to verbalize or otherwise communicate their distress, so they don’t have to act it out, and so they have the language they need to negotiate solutions together. This more “top-down” approach develops frontal lobe connections and communication capacities, and is also excellent and essential. Got to make sure the child has the language tools she needs. (Teresa Cardon, 2004, “Let’s Talk Emotions”)
Eventually, gradually, and with repeated practice of walking our kids through these fundamental processes, our kids do improve in emotional regulation. But there is another level that most of us parents perhaps don’t do enough of, sometimes because we aren’t sure our kids have the capacity to do it. That is what Dr. Siegel calls connecting the left brain with the right brain. That’s when after you’ve done all the above steps, and the child is calmed and regulated, you talk about what happened. You can make learning even more efficient if you not only walk your child through emotionally stressful situations at the time, but reflect and replay them later in conversation and/or play therapy. Ask your child what was going on inside when the explosion hit. Give him/her a chance to identify the emotion, learn to talk about feelings, and recognize gradations or degrees of intensity of feelings, perhaps with an emotional thermometer. You want the child to develop the capacity to recognize an earlier stage of emotional dysregulation, so she can take steps to calm herself and get her needs met before the emotion becomes overwhelming.
Help your child review the event, reprocessing it as you lend your perspective to help her understand what happened. “Oh yes, the circus did seem frightening at first, so we do understand why you cried and screamed so we had to leave for a while. But Mom and Dad were right there the whole time, with a comforting lap to crawl into. And wasn’t it fun to peek into the tent at the last act and see the acrobats? Plus there was that really fun pinwheel you got to blow.” Bring in other memories and experiences that bear upon the situation. “Remember how it was also hard to get out of the car last week when we went to the zoo for the first time? But once you got out and looked around, you saw the elephants and really liked it. Sometimes things are hard at the beginning, but if you give it a chance, you might like it.”
Then help your child apply what he thereby learns from his mistakes. Try what Noel Janus-Norton (2013, “Calmer, Easier, Happier Parenting”) calls “think-throughs.” In anticipation of entering similar stressful situations, you think through the upcoming event with your child as to what to expect and what emotionally self-regulatory strategies the child might initiate if needed. “Hey, tomorrow we’re going to Sarah’s birthday party. It’s a new place, but remember when you went to the circus? That was new too. Yes, you did get anxious, but in the end. remember how much fun we had? Remember this picture? Yep, there you are with a big smile. What did we do when you got anxious? Oh yes, we went outside for a while. You crawled into my lap, and we rocked and hugged under your blanket, and then we got that pinwheel and watched the wind blow it. And then we came back. You know I’ll still be there, I’m coming to the party too. And we can bring the blanket and the pinwheel. And you can tell me if we need to go outside for a while. How do you tell me? Sure, if you can’t find your words, you can point to the door. That will be our secret signal, and I’ll know.” When you do a reflection or a think-through, you are actually walking the child through the steps of cognitive-behavioral therapy, naming the emotion to objectify it and help your child see that it is something she can work on, part of her but not her, identifying the false thought (“all new places are scary and must be avoided”), replacing it with a more realistic thought (“I’ve been to lots of new places before and had a great time”), and brain-storming alternative strategies to screaming or crying (like making a signal to leave for a while, crawling into a parent’s lap, and bringing a transition object).
This process of left-right, top-down brain connection is taking an incident of emotional dysregulation, and making use of it to grow those frontal lobe connections by both looking back and looking forward. Each episode of emotional dysregulation is an opportunity to walk your child through this process, and grow those frontal lobe connections. Especially as she practices initiating the strategies herself, and as you allow her to walk herself through this reflective process, using narration first, then yes/no questions, then leading questions, and finally open-ended conversation, your child will learn to emotionally regulate herself, essentially learning how to do self-CBT (Ann Marie Albano, 2013, “You and Your Anxious Child”).
And I would add, be even more ambitious. Go ahead and introduce your child to bigger concepts like morality and community and virtues. I go ahead and name them. “Hey, Peter, looks like a good opportunity to practice some flexibility.” Or, “Maybe this would be a great time to exercise the temperance muscle.” Madrigal and Winner (2008) have a great book out called “Superflex.. A Superhero Social Thinking Curriculum” where they give the maladaptive behaviors goofy villainous names like “Rock Brain,” so that the parent can say, “Hey, I think Rock Brain just showed up,” and the child can take on the personae of “Superflex Hero,” and brainstorm alternative more flexible courses of action.
Does this all really work? Maybe for your “high functioning” child, you might say. But most parents I’ve met of seemingly less able children tell me they suspect there’s a lot more in their child than meets the eye. Peter was labeled as severely autistic, nonverbal, and low functioning at one time. But even when his expressive communication was at a very primitive level, I kept talking to him as if he could understand, just in case he could. With each episode of emotional dysregulation, I went through all the steps of bottom-up, right-left emotional regulation to try to help Peter feel his needs were met and that he was understood. Then after he had calmed down, we’d work on the top-down problem solving, and at the end of the day do reflections to work on the left-right brain connections. I started out doing nearly 100% of the work, but scaffolded my support and let him do more and more of the work, as he showed the capacity to do it, and developed more and more communication. Believe me, it wasn’t at all as smooth as this summary is making it sound. I didn’t know what I was doing, until I read authors like Cardon, Siegel , Norton, Albano, and Winner later and could be intentional about it. (That’s why I’m sharing this with you, so you can be intentional and efficient to begin with.)
In any case, whatever bumpy, twisty road we took, Peter did learn. He has developed frontal lobe connectivity to an extent that at one time I would have doubted possible. The other day, we went to the community park to watch the Memorial weekend fireworks. What I saw on the outside, was a somewhat anxious teenager who was holding onto my arm for part of the time, but seemed to have matured a great deal compared to his level of anxiety as a child. What I found out later after reading the poem he typed about the experience, was all the hard work of emotional regulation he had been doing for the most part on his own, and the sense of community and love, a highly top-down approach, that ultimately held him together and transformed his experience. (In the story, Joe, Teddy, Luke, and Judy are all siblings; Judy, his oldest sib has two young children of her own.)
Memorial Weekend Fireworks, 5/24/15,
by Peter Tran
“Hurry, hurry, Luke put on your coat.”
grab your shoes and open the door.
“Grandpa, tuck those elbows in,
don’t you remember banging them
through the last doorway?”
We rolled him safely through the front door,
and hoisted him onto the front seat.
We all piled in.
Then we arrived,
corner of Foothill and La Canada Blvd,
heart of our fair town,
We spied two tall lanky figures,
Joe and Teddy waiting to receive us.
We paused behind a firetruck
and unloaded Grandpa and his wheelchair.
I felt numb.
Crowds of people
all smiling and talking.
Mom grabbed my arm sand propelled me through a maze
of picnic blankets, chairs, and baby strollers.
It was chaos.
I heard a flood of brassy notes,
the high school jazz band playing their hearts out.
Hold on, don’t panic, it’s all just in fun.
I relaxed as the noise diminished.
Phew! the music stopped.
I sank into my comfy lawn chair.
Dad was there, Luke, coughing from asthma, rolled on the blanket,
Teddy positioned Grandpa’s chair, and Mom miraculously
found Judy and the babies.
Then after a brief lull,
That’s when it started.
Nothing prepared me for what followed.
The sky exploded in color!
Gold, crimson, all shades of brilliant hues,
spinning, darting, bursting bouquets of flashing stars.
The sights and sounds engulfed me.
I didn’t have ears enough to hear all the music,
reverberations from the explosions filled my head.
Then it was all over.
The lights went on,
and everyone started gathering
their blankets, ice chests, and children.
Pressed in by the happy crowd,
we flowed liked molasses slowly down the street to our cars.
I felt safely insulated by my family,
and families like ours,
And even Grandpa was smiling.
My point is, even though developing emotional regulation may be hard in our kids, and takes a lot of work and time, don’t despair. Over time and repetition, those frontal lobe connections do grow. Tackle episodes of emotional dysregulation from the bottom-up, top-down, and left-right, looking back with reflections and forward with think-throughs. Each episode of emotional dysregulation may thereby become an opportunity to connect the parts of the brain and get them to work together. If you miss a few, don’t sweat it. Heaven knows our kids give us plenty of opportunities to practice again!