Emotional Dysregulation – Just like Regular Kids but “Only More So!

Emotional Dysregulation – Just like Regular Kids but “Only More So!

A very dear friend and expert special educator insists that kids who have neurological disorder are just like regular kids – “only more-so!”

Let me explain what that confusing statement means…

Kids who have neurological disorders have feelings just like everyone else, except their feelings are so much more intense. They feel so much more of everything. They experience more joy when happy, (hence their hyperactivity), they feel more pain when injured (we think they’re over-reacting), more anger when frustrated or disappointed (leading to rage) and more sadness (also misinterpreted as over-reacting).

This evening, my stepson erupted into a fit of screaming and pounding the floor in a rage over homework, then back to a total recovery and calm. Soon after, he collapsed into a heap of tears as he suddenly recalled the death of his grandmother from the previous year. The intense grief lasted about 2 minutes, and he recovered once again, to join his friends in playing basketball.

I shouldn’t be surprised by his behaviour tonight. He was bound to fall from perfection at some point. He’s been stable and even tempered for months – and it’s due to consistency at home and at school.

Kids with neurological disorders are incredibly susceptible to change, as we all are – “only more so!”

Change has an effect on us all, to varying degrees. Some people abhor surprises, which is just another name for change. Kids with neurological disorders often fall apart in these circumstances that arise from change.

Emotional dysregulation can be observed as intense or extreme emotional responses to a situation, aggression, impulsivity, avoiding behaviours, difficulty calming themselves and difficulty knowing what emotion they are actually feeling and especially, drastic changes in mood.

My stepson’s chemistry and subsequent emotional state is totally dysregulated today for any number of reasons. From my own personal Tourette experience, I know he could be unconsciously reacting to the onset of the Canadian winter – with a reduction of daylight hours and cold temperatures. This always messed me up. It still does, sometimes. When his chemistry is thrown into flux like this, Nathan’s behaviour is erratic and (almost) manic. He can swing from one extreme mood to another. As well, he is dealing with another ill family member. Although he seems calm, he is very prone to experiencing a quick thought of concern, then bursting into tears from a memory of his late grandmother.

By keeping Nathan’s life consistent, we greatly reduce the occurrence of mood swings and emotional dysregulation. At times of change, it is important to stay connected to any consistency and predictability you can find. For example, on a trip during the holidays, we can expect Nathan to be extremely dysregulated and prone to mood swings.

His normal routine of waking, going to school, coming home and going to bed ceases.

In these cases, we keep eating and bed times consistent. We maintain sleep hygiene so he can slowly unwind and fall asleep at a reasonable time using his normal bedtime routine.

We give him ample warning of the plan of each day with frequent recaps and updates to give him time to process the upcoming schedule and reduce over reaction when the changes happen.  Rules must be kept consistent, as well.  There are no exceptions such as, “just this one time”, or “it’s the holiday”.  There is no “flying by the seat of our pants” with our Nathan.

Keeping Calm

Meltdowns from emotional dysregulation can be minimized by maintaining routines, maximizing predictability, planning ahead, advanced warning of change and consistent rules.

For the times when dysregulation occurs, (and it will), it is helpful to keep in mind that kids with neurological differences actually do feel more, and they will respond more.  They are just like regular kids – “Only More So!”

Oxytocin and Attachment

Oxytocin and Attachment

Oxytocin and Attachment

A couple years ago, I began researching bonding, attachment and oxytocin.  My son was a bundle of nerves, so hypersensitive to my touch it appeared painful.

Oxytocin is a powerful hormone that is necessary for bonding and attachment.  It is often called the “love” molecule.  My son with tactile sensory sensitivity as well as TS Plus was not getting any oxytocin and it worried me.  When Nathan was a baby he pushed his body away from mine and cried louder when I tried to soothe him.  It was a painful phenomenon not being able to comfort or soothe your child with cuddling, contact and kisses.  Every time he pulled away or reacted with anger or violence to intimate touching was painful for everyone and it is hard not to just stop reaching out due to how uncomfortable he obviously was with touch.  I wondered what I should do.

When we hug or kiss a loved one, oxytocin levels drive up. It also acts as a neurotransmitter in the brain. In fact, the hormone plays a huge role in pair bonding. In Nathan’s case I had to restrain myself from doing what seemed natural because of his hypersensitivities.  If Nathan fell off his bike, I learned not to go and see if he was okay because his distress would amplify by my presence, I would end up physically hurt and not have been able to comfort him in any way in the process.  By age 7 or 8 his combined disorders made it difficult to tell if he would notice if I was suddenly not there.  I wondered if he had a bond with me.  I had a difficult time answering the question at that point and I didn’t like that at all.

We put together an experiment.  We needed a plan to get his body to make some oxytocin and hopefully in the process, bring us closer together.  Plans work better when we make them together so I talked to Nathan.  I told him about oxytocin, what it does and how we could potentially get more.  We came up with “cuddle time”.  We did have to implement a minimum time as it was very difficult and sometimes painful for Nathan with his disorders and sensitivities.

“Cuddle time” would happen at bedtime, when he was finishing a last game on his Ipod, I could read to him, I could scratch or rub his back…anything, even tickles.  The only rule was that it had to have skin on skin contact.

The proposed benefits:

Helping us create a greater sense of intimacy and bonding

Induced feelings of optimism, self-esteem and building trust

Reduced feelings of depression and anxiety

Increased empathy and generosity

For Nathan, the results of “cuddle time” have been astounding.  He is more likely to offer cuddle time spontaneously.  He may even ask for cuddle time, or a back rub at times.  He may still react negatively to touch that he is not expecting but will apologize for his reaction.  He will hug and kiss freely when appropriate.  I no longer wonder if there is a bond between us, there is and it is much stronger.  And we no longer need to plan cuddle time as we have many spontaneous opportunities throughout the day.  We hug and kiss and there are many “I love you”s going around our house.  I know as he grows older we may have to reinstate our planned “cuddle time” and we will and we know why it is important.

At the Tourette Syndrome Foundation of Canada National Conference of Tourette Syndrome Plus this past weekend I was reminded of this regimen I implemented and was validated as it is an intervention being taught to parents.  Jennifer Kolari did an informative and engaging presentation about her method, Connected Parenting.  Included in the therapeutic technique…baby time!

Here is a little bit about Jennifer and Connected Parenting.

Connected Parenting shares techniques that therapists use to help parents soothe their child as well as enhance the parent-child bond and is based on the understanding that correcting and guiding behavior works best when it is preceded by and linked to empathy. At the heart of this parenting model is the CALM Technique which helps parents accurately attune to children’s affect and experience. These empathic interactions release reward chemicals in the brain that stimulate positive emotions and increase order and balance in the nervous system. Reward chemicals, including natural opiates, endorphins, and a powerful hormone called oxytocin, reduce and inhibit stress hormones and bathe the brain in positive emotions that ripple through every cell in the body. The benefits of empathy and compassion have a strong base in science that cannot be underestimated. Simply put, it is brain food, the emotional nutrition all of us need, perhaps our children most of all.

Although many parenting techniques stress the importance of empathy, Connected Parenting will show you how to use it skillfully to repair frayed bonds, deescalate tantrums, contain and correct difficult behaviors and help your child to become more confident and emotionally resilient. We use a collaborative and supportive coaching model and provide inspirational, easy-to-understand techniques grounded in neuroscience and attachment. In the end, your child will be more compliant, more relaxed, and – most importantly – happier. Connected Parenting will bring out the best in you and your child.

I encourage you to check out her website.  It is packed with information, video, a blog and her books are available there.  If you have an opportunity to hear her speak, jump at the chance.  Her session was a highlight of the conference.

Medicate Symptoms of my Disorder? Should I?

Medicate Symptoms of my Disorder? Should I?

Many years ago, I (the lead Special Education Teacher in my school) was asked by the principal to tell a parent that her child needed to be on medication in order to succeed in school.  I refused to do so.  I believed that although medications might have helped this child focus in school, it was not necessarily the only answer.  I saw that this student’s deficits could be managed without medications, given he received focused support at school and at home.  I knew the academic support was provided by parents at home, and I knew they could be provided at school because his teacher had the understanding and training to provide the necessary accommodations to the student.

I have pondered the question to medicate symptoms both personally and as a parent.

My advice is as follows:

Educate yourself

Know the deficits you face due to your neurological disorder, and what you will gain/regain through use of a medication, and what the possible side effects might be.  Which is worse:  the deficit or the side effect?  If you are only slightly impaired by the disorder, it may not be worthwhile to suffer side effects for something that isn’t affecting your achievements in life.  However, for those who are profoundly impaired by their disorder, who need to gain control, and need an opportunity for success in their lives – it’s a small sacrifice to endure some side effects.  In truth, the side effects of the medication might seem minor compared to the suffering they endure because of their disorder(s).  It really is an individual decision based on individual needs.

Remember this:

We are made of chemicals.  Those lucky to walk among us who have typical chemical composition have balanced chemistry.  They are able to function “normally”.  They are chemically able to meet the behavioural expectations of society.  They can attend to conversations, respond in appropriate ways, and fulfill societal obligations (be kind, not hit, etc.) – even when they are being rushed/pressured/evaluated. Those who do not have balanced chemicals often cannot do these things when they are required.

By taking medications (chemicals), we move our chemical composition closer to a balanced state, to where it should be, enabling us to meet social expectations – to act “normally”.  In a school setting, a student can attend to instructions or lessons, thus increasing his/her ability to learn.  The challenge however, is to strike a balance between what is gained by artificially adding chemicals to our bodies, and what is lost through possible side effects.  It is a difficult decision, especially when it involves our children.


Weigh the pros and cons

Are the challenges posed by the disorder debilitating enough to warrant “chemical correction”?  To make this decision, you must be aware of the medication’s possible side effects.  You may need to try the medication to see if the side effects occur in your case, and if they do how severe they are.  As well, you need to be aware of other similar medications that have different possible side effects.  Keep in mind that it may be possible to take fast acting medications that can be taken as needed, rather than daily.  With these, you may only need to medicate symptoms when needed (not on weekends or holidays).

Milder symptoms can often be overcome through interventions other than medication. However even when medications are prescribed, they work best with additional interventions. Medical and behavioural interventions are the gold standard for treating these disorders. No problem can be simply solved with a pill.

In the case of a child, behavioural interventions (strategies) must be employed consistently at home and at school.


Dr. Kenny Handelman

Dr. Kenny Handleman is a Child and Adolescent Psychiatrist practicing just outside Toronto, Ontario. As one of our most trusted professionals we will refer often to his blog and videos.

Here is what Dr. Kenny Handelman has to say:

ADHD Medication:  How to Decide When to Use It?