Transcript for
Supporting children through understanding regulation – part two

Narrator [00:00:03] Welcome to the Emerging Minds’ podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy, and this is part two of a conversation with Ben Rogers about regulation and how understanding what is happening for children at the level of their body’s nervous system can support healthy development and wellbeing. Today’s episode begins with me asking Ben to flesh out an example of what coregulation would look like in the moment with a toddler who is very upset.

Sophie Guy [00:00:31] I wonder if you could talk in a little bit more detail to an example of, say, you’ve got a toddler who’s having a meltdown. What does coregulation look like in that moment? And what is someone like yourself who’s an OT thinking about in that moment to help coregulate a child?

Ben Rogers [00:00:50] Yeah, so I think first and foremost, when we’re experiencing an emotion of another. So let’s take our child. It triggers off certain things in us. And often they’re unconscious. And I’ve experienced this first hand. So there’s a level of self-awareness you need to bring to that interaction first and foremost, you know, for whatever it is. So being regulated in ourselves is the, is the key first step. So noticing what that’s triggered off in me, which happens in a microsecond, but if you can stop and reflect and say, okay, I need to respond opposed to react to this. And even the word, when you think about discipline, you know, it means to teach. And often we might be looking at discipline in a more behavioural kind of perspective, in trying to teach by correcting behaviour. But the real teaching in those moments is around supporting the emotion underneath the surface. So can you use your tone of voice? Can you use just really simple language to help name that emotion? I know Dan Siegel’s work has been brilliant for this in helping a lot of people understand that, you know, name it to tame it, or connection before redirection. And I find just body posture and positioning is really helpful as well. So if I’m standing up, I might just crouch down and just be there. I think ‘being with’ is a really good description of how to support those emotions. We want it to finish quickly because we don’t like the unpleasant experiences that it brings for us. But if we can hold that space, if we can name, if we can be a safe person, it can it can pass quickly. And then each time you kind of experience that, hopefully it’s a bit easier. But the developmental lens adds a whole other layer to this. You know, I’ve got a two year old at home and it might be one out of 20 times where that for me is working effectively and other things might be coming into it where he’s hungry or he hasn’t slept the night before. So, as I mentioned the nervous system is a complicated and integrated process but there are some things that you can do to support from a relational perspective.

Sophie Guy [00:02:45] Mm hmm. Yep. And I wanted to pick up as well on you talked about how understanding regulation and the sort of level of the nervous system can be helpful for understanding children’s behaviour. And so how does this understanding sort of reframe or bring a different way of understanding children’s behaviour? And obviously, you know, that children’s social emotional difficulties are on the rise. Children are presenting to different health professionals or being picked out for having emotional and behavioural problems. How does this understanding of regulation help to to make sense of that?

Ben Rogers [00:03:25] A good visual representation of behaviour is, is the iceberg that a lot of listeners might be familiar with, where we have the visual kind of iceberg above the surface that we can see really clearly. But what we can’t see and often the case with icebergs is the mammoth amount of ice that’s underneath the water. And this is really a good way of describing what’s kind of driving up those behaviours. And so regulation sits as the kind of foundation for that in many ways. And if you take an example of the levels of arousal that we’ve talked about and layer on someone like Stephen Porges’ work, it really helps us to understand how adaptive responses of built in in order for us to engage and behave in our environment. And so, first and foremost is this social engagement green zone that I’ve referenced. So we know a child is feeling regulated when we’re kind of observing them playing, we’re observing them settled, they’re calm, they’re curious. Then there’s other kind of skills and cognitive functions that are happening in that space. But when a child senses danger in that perceived kind of sense, it doesn’t have to be something that we can see, it’s actually in how they perceive their environment. Naturally, what’s going to happen in terms of an adaptive response of the nervous system is it will move into more of a mobilised state. So it will either move away from potential stimulus or threat or move towards it in terms of fight mechanism. And when you’re looking at from a behavioural perspective, certain things you might say during those moments is frustration, irritation, anger, rage, really heightened, you know, stresses and reactive states. And I think what Steven Porges does is introduce the third kind of perspective of this is when we move really into our most heightened state of arousal, when we can’t get away and we can’t fight, what does the nervous system do? And it shuts down. And this can be a, this can be behaviour that’s often missed. A child that’s flat, depressed, numb, dissociating in this kind of shut down response where we move from what we call sympathetic arousal into a parasympathetic response. And in those moments of shutting down, it’s a way of us coping with what is a really significant stressor. And so as a practitioner, you’re looking for all of those kind of triggers or visual cues and what the child’s engaging in to have an idea of what might be happening in their nervous system. And obviously, there’s a lot of different frameworks of perspective that can help understand that child. But regulation gives a neurobiological perspective on behaviour and what’s happening in those moments.

Sophie Guy [00:06:05] Mm hmm. The next question is around, what does it look like when a child has difficulties regulating? We’ve been talking around it and you’ve given quite a few examples already.

Ben Rogers [00:06:15] So for children that have difficulties regulating, it depends on what the task is that they’re engaging in. For a child who’s experienced trauma and being in a stressed, heightened state has been really important to keep them alive, to keep them safe. And that’s a really functional, important way that the nervous system has helped to understand its environment and engage in that environment. But when we think about if a child has difficulties regulating, we often think of it in the context of them engaging in learning or social engagement. And so a child that transitions from a really heightened home environment where those things are happening into a learning environment, it’s really tricky for them to switch in and out of those modes. And even the fact how the nervous system works when we’re in a heightened state of arousal, if we’re looking at a neutral facial expression, we’re going to misinterpret that as being dangerous or someone that’s angry. And even the way we process sound is changed as well. So for those children that have difficulty regulating, you’re going to see more hypervigilance. You’re going to see more heightened arousal states which include movement. You’re going to see more agitation and frustration. And that’s really an indicator that this child might be needing something to support them to to feel calm in those moments, whether that’s access to a safe space in the classroom, whether that’s a movement break. You know, a classic one that you might be able to give to a child when you’re holding the space of 30 other kids is allowing that child to take some heavy library books to the library as part of a job that they have. And I know it seems simple, but giving them a way of accessing an environment that’s free of sound, giving them access to movement, as well as that heavy work that we referenced with, you know, loading it up with books allows them to regulate and have that opportunity to regulate.

Sophie Guy [00:08:03] So we’ve talked about how children learn or their bodies learn to regulate through the experience of being coregulated. And within the mental health field and thinking about children’s mental health we often hear about this idea of self-regulation as well, and that the developmental task is to develop self-regulation. Could you talk a bit about that developmental process and that sort of transition from coregulation to self-regulation? I mean, when should we be talking about a child being able to self-regulate?

Ben Rogers [00:08:36] You know, self-regulation is really the panacea of regulation, isn’t it? It’s where we want to get to even as adults. And I know for me even I sometimes don’t access the self-regulatory tools, I need to feel calm and regulated. So for children, as I mentioned earlier, coregulation is really that, that key foundational piece for them and for many, many, many years through in utero even with of mothers passing on messages to children about what the environment is like, if there’s increased stress there or other things. And so coregulation happens through that utero, birth, childhood, adolescence, early adulthood process. The first part of that, I think, is really about understanding and limiting the environmental stresses that might be impacting regulation. So as OTs we work a lot with children who have experienced sensory processing differences. And these are children who might have difficulties processing sound, have a low threshold for visual stimuli and other, you know, factors in which they interpret the world around them in a different way to others. And I think the understanding of the environment and certain triggers of really important to helping a child to then be regulated. And when we think about self-regulation and any task or tool that we’re learning for ourselves. We need to learn and practice that when we are in a calm, balanced state. You know, if we are in a heightened state of arousal, it’s really tricky to to learn new skills because our brain isn’t able to access those, those tools and resources.

Ben Rogers [00:10:08] So I think first and foremost, understanding the environment and what’s triggering off a stress response for a child is really key. And then can we find a way of helping that child make sense of that experience? To build some level of self-awareness in what’s happening for them? And as I talked about the body mapping is a good example of that where a child might start to talk about and give labels to what their experience is. I know the zones of regulation is a great program for children, which helps them to give names and labels. It talks about the various zones that I’ve referenced today. And then the other factor there is, once we’ve looked at the environment, we looked at self awareness is finding the tools and approaches that they can use in those moments before they move into the red mist, or, you know, the storm comes as the children have labelled it in the past, and help them to regulate in those moments. I think thinking about those approaches, the breath is talked about a lot. And I think that’s a really powerful tool that anyone can use to self-regulate. You know, it’s something I used before talking in this podcast. And often we talk about the importance of diaphragmatic breathing, which is really important, taking nice deep breaths. But what happens when we get into really stressed or heightened response is that we tend to hold more tension in our body, our breathing positioning changes. And if we can breathe out, it actually talks to our vagal tone and allows us to calm down a lot more. I know Stephen Porges talks about when doing public speaking, if you can just slowly extend your talking it naturally can regulate how you’re feeling. But even something as simple as three in, seven out breathing is really helpful where we breath in three, as well as anchoring our attention on the counting, and out for seven can be really helpful in regulating the nervous system. So for kids, we can teach them this at a young age. And as well as layered on this is our thinking because we do have this primal response, as I’ve talked about from a physiological point of view. But also that comes with that is these kind of patterns of thinking that are related to certain experiences that can perpetuate in our mind. So any tools that we can use to identify with those thinking patterns and and redirect or re-evaluate or anchor on our attention or the present moment can be really helpful in teaching children how to self-regulate. So mindfulness based programs are a good example of that.

Sophie Guy [00:12:32] We would be talking about older children here, wouldn’t we? I guess I’m mindful that, I sort of have observed or heard people reflecting on this space a bit and saying that we’ve perhaps emphasised self-regulation a little bit too much, too soon. And it’s important to get across that message about a child learns to self-regulate through the experience, having many, many repeated experiences of coregulation. And in fact, that our nervous systems aren’t fully formed when we’re born so in fact, we are evolutionarily and physically designed to come out, caregiver waiting for us to do this regulating thing.

Ben Rogers [00:13:15] Yeah, absolutely. I think coming back to the importance of coregulation and what that means. You know, we’ve referenced some tools and approaches that we can use with children to help them regulate. But really, if we’re looking at one key approach, it’s using ourselves to coregulate with those around them. And that can happen as a parent, as a practitioner, as a person, you know, engaging in the world around us is that we are social beings and we’re built to engage with others. And I think if you layer the whole covid environment at the moment and what’s happened, it’s really shut down a lot of that kind of social engagement and reciprocity that we naturally share with others. So the more that we can be with others emotions as a parent or even as an educator or practitioner, the more children begin to understand that it’s OK and safe to have these experiences and learn just just at the foundational level what it’s like to hold all of that. And yes, I think obviously I agree with you in terms of coregulation being the foundational piece, the take home message from this podcast, I guess in many ways.

Sophie Guy [00:14:19] Is this something you want to say because in the back of my mind, I’m well aware that depending on the experiences we’ve had and many of us have not had necessarily the best experiences of being coregulated ourselves. And I think it’s fair to say that a lot of us walk around quite afraid of being in the presence of other people’s emotions, and so I’m just wondering if there’s anything you want to say to sort of speak to that and that tendency that we have to want it to be over quickly. Or to get dysregulated ourselves because it awakens something in us when we have someone, a child having a meltdown, or that idea that sort of knowing that it is an over arousal thing, it’s going to have a natural trajectory. It’s gonna come down. Do you want to say anything about that?

Ben Rogers [00:15:10] Yeah, it’s a good question, Sophie, because for parents and think about this for me, when I’m responding to or coregulating with my little boy, it’s highly likely that it’s going to be causing some level of dysregulation in me. And so the task in many ways for us as parents is to to learn the tools and strategies to be able to hold that in ourselves. And to find some kind of neurological space to then be self aware of that and then respond in an attuned way. Because it happens in these micro moments of stimulus, you know, crying, you know, the other day he knocked his plate off the table onto the floor. And then for me, that that just due to my upbringing, that that raised, you know, we had to be really clean and had to be respectful at the table. And in that moment, I noticed this some reactivity. And so you have to stop yourself in those moments and say, okay, what are we trying to do here? Obviously, there’s an emotion in that moment of of him and what he’s trying to achieve. And so this interplay of stimulus, reaction, and response is something that we should be self aware of as best we can and, and find the space to then respond in ways that are meaningful for that child. So in that moment of him doing that, it’s really saying, hey, you finished your dinner and you need a bit of time to go and play. And I can see you’re frustrated. I can see you really upset. And I’m here. I’m here. It’s okay. And once he’s calm and regulated, that’s where we can have an opportunity to teach him, you know, when he’s in that green zone again about, hey, you don’t knock your plate off the table, matey, because then we have to kind of vacuum it up afterwards and it’s not great. So I think this is a good example of the interplay of adults and parents working with children.

Sophie Guy [00:16:54] How can practitioners begin to apply the concept, this process of regulation in their practice with children and families, perhaps where it’s sort of a new concept for them and they’re wanting to start trying things out?

Ben Rogers [00:17:07] I think there’s a variety of ways in which they can embed some of this work. First and foremost, thinking about themselves and that therapeutic use of self that we mentioned. How are they using their facial expressions? Their tone of voice to convey safety in the interactions that they’re having with a child or family. Also thinking about some body based approaches and if you just come back to that idea of movement being really regulating for child. And also the breath being really supportive. One of the most favourite activities that kids engaged in in sessions with me was, as they reported, was the cereal box. You’d cut a roof off a cereal box, you’d have a couple of straws and a table tennis ball, and you just play table tennis soccer in between, you know, the cereal box. And so starting a session like that was really effective because no matter how the child kind of came into that session, we would have that fun, engaging relational activity that involved using the breath. And also this idea of just other little micro moments in the day where we can kind of feed children’s need for movement or regulatory inputs. For me in this podcast, in between our breaks, I’m using a CamelBak drink bottle, which is naturally regulating for for any adult or child. It’s the bight, suck, swallow synchronicity, which is naturally calming. And so you can have that as a child, as a student on a desk, at a school. And that can really feed your need to move and help you to stay regulated throughout the day.

Ben Rogers [00:18:32] The final piece of this is thinking about our environment. How do we create predictability and familiarity in our environment to support the nervous system, to feel calm? I talked about that concept of neuroception earlier and that never switches off. We’re always scanning our environment for danger. And so when things are predictable and familiar and there’s routines in place, that neuroception is able to turn down to a low level. Because I know what’s going to happen. I know that teacher. I know how they’re going to respond or I know that person in the environment because I know what they do. And so that really allows a child to manage the stress that they’re probably coping with in other areas as well, potentially, to to not have to worry about those things from a neurological perspective.

Sophie Guy [00:19:13] Any other examples?

Ben Rogers [00:19:15] For practitioners that are listening and thinking, gosh, there’s lots of information in this podcast and I’m not sure where to start. I just come back to the therapeutic use of self and how you use yourself in the interactions. That’s a key thing to take away from potentially this podcast.

Sophie Guy [00:19:31] Yeah, and maybe I could just pick something up. Could you talk a bit more about why is that therapeutic and what is it about our voice and our facial expressions that’s important for regulation and for calming the nervous system?

Ben Rogers [00:19:43] Yeah, so the other day I had a meeting with a colleague and I walked in and I was wondering if they were frustrated with me or upset with me. And I wasn’t getting the reciprocity so that I was smiling. I wasn’t getting smiling back. My tone of voice, my intonation was kind of used a lot of different range, but theirs was really flat and their expression was quite flat. And so as we were talking over, you know, a couple of minutes, they said to me that they’d actually been to the dentist and they’d their, half their face was numb. And so I think that’s a really key example, because in that first two minutes, I noticed that my level of alertness slightly increased and there was a bit of a stress response as I interacted with them. And so that’s a really, you know, good practical example of the importance of reciprocity and what Stephen Porges talks about, safety cues. And so just by using the full range of our facial expressions, we can resonate. We can send a message to the nervous system of someone that we’re, you know, working with and can support them to feel a bit more regulated. Obviously, part of that is trying to attune and meet a child or parent where they are in the moment. If it’s not congruent, then it can have an opposing effect. But if we’re meeting them in that kind of social engagement space, it can allow them to to convey safety. And I found that prosody and rhythm as being a really effective tool in supporting regulation as well. I don’t have an amazing kind of singing voice, but if you can use the intonation of your voice in a way that conveys safety, that’s not low frequency sounds or high pitched frequency sounds, but is that kind of nice kind of prosody in the voice, it can really support the nervous system as well to feel calm. And so that’s something you can play around with, with your kids, with your nieces or nephews, or potentially in sessions with children and families as well. It’s something that I definitely enjoy. And now that we’ve got this deeper level of understanding through Stephen Porges polyvagal theory it really validates that approach in many ways.

Sophie Guy [00:21:43] Well, I think that there’s been a really rich and interesting conversation, Ben, I think we’ll wrap it up here. And thank you so much for joining me on the podcast today.

Ben Rogers [00:21:53] Thanks, Sophie.

Narrator [00:21:56] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.