A few weeks back, I wrote a post all about “regulation” and we’re back at it again from a slightly different perspective! Before you keep going, if you haven’t already read THIS post and THIS post, now would be a great time to!

There are a few ways to think about the words “regulation.” On one hand, it’s something to achieve- I want to find regulation, I want to be regulated. On the other hand, it’s something that we are actively doing. I am regulating myself or someone else by doing these things.

As a refresher, nervous system regulation or “regulation” for short, refers to the arousal state of the central nervous system- how active or restful our body systems are.

Under-aroused: the body and thoughts are lacking energy. Children may be sleepy, sad or depressed, or bored
Calm: the body, thoughts and emotions are in a restful state
Calm Alert: the body may appear calm or activity is organized and the mental state is ready for learning and engaging. This may be referred to as “baseline”
Over-aroused: the body and thoughts have lots of energy. Children may be moving fast, be in an elevated mood (excited, surprised, nervous, or angry)

Each of these arousal states is important, none are better than the others. Our goal is that children and caregivers can move through these states fluidly and sustain the state that is needed for the task at hand. For example, we want children to transition to a low arousal state for bedtime and stay in this state through the night to allow them to sleep well. We want children to transition to a high arousal state when their name is called loudly and suddenly to alert them to danger. We also want children to reach and maintain an optimal arousal state throughout most of their day so that they can engage in play and learning opportunities that will support their development.

Trauma & The Nervous System

When children have experienced early trauma, often one of the major impacts is to their arousal & regulation systems. When a child experiences something frightening, their stress-response system becomes activated. Their brain and body becomes alert and prepared to respond to danger by releasing various hormones and neurotransmitters. This chemical release triggers a cascade of events in their body and nervous system to prepare them for danger. Some examples of body changes that happen are:

Heart rate and breathing rate increase (or sometimes decrease)
Pupils dilate
Digestion slows
Blood flows to the limbs to prepare for movement and protect the major organs
Sense of time slows or becomes suspended

These changes amount to the fight, flight, freeze response.

One confusing aspect of this is that these changes occur whether the danger is real or perceived! That means there are times when children may become frightened even though we, the adults in the room, know there is no real danger. An everyday example is when the teacher comes and stands over a child, has a slight grimace and uses a strong voice, the child is reminded of their abusive parent and responds as though the teacher will be abusive even though, of course, the teacher never would. We’ll talk a lot more about this in the coming weeks and months but it fits here as we think about why nervous system regulation is so essential for young children, especially those who have experienced trauma or adversity.

When this happens repeatedly, such as for a child who is exposed to ongoing abuse or neglect, their stress response system can become sensitized. Whenever their brain detects, even a small amount of stress, it responds as though the stressor is life threatening. This is the child’s brain attempting to protect them from danger because it has learned that danger could be anywhere.

For example, a child who is not exposed to chronic stress may hear their parent or teacher sternly warn them about something and simply respond to the serious statement by doing what they’re being asked to do. A child with a sensitized stress response might respond to this as though it’s full blown danger and yell back or throw something (fight), run out of the room (flight), or simply stand there looking blankly without responding or following the direction (freeze). If they’re in a group, maybe they’ll run to a preferred teacher or friend for comfort instead of following the direction (flock). These are all examples of a stress response NOT intentional misbehavior.

Strategies to support nervous system regulation

If you’ve read any other posts by me, you know I’m not a “quick tips and tricks” gal. I like to know the why behind what I’m doing and, even more, I like to focus on durable strategies rather than “quick” fixes. The strategies I talk about here are soooo helpful, they just also take a bit of time and practice. I’m always inspired by The Neurosequential Model of Therapeutics (Perry, B.), a model for understanding how the brain is organized and providing intervention that is informed by this organization. When I do trainings on this model, the first thing I talk about is the three basic “parts” of the brain and how we can provide intervention within each of these parts. When we intervene like that, we are doing so in a way that is aligned with how the brain works, making our efforts much more effective.

Basic Brain Architecture

According to the Neurosequential Model, we can think about the brain having three or four general “areas:” the brainstem (bottom), diencephalon, limbic area, and cortex (top). The brain develops from the bottom up (brainstem first, cortex last) and it also functions this way in everyday life.

The brain develops from bottom to top, brainstem to cortex. In day-to-day life, it functions the same way. When we become “dysregulated”, our cortex skills are compromised first, followed by the diencephalon & limbic skills, finally the brainstem skills last. When we want to re-regulate, we have to start from the bottom up!

When we think about intervention, it’s essential to work from the bottom up, or the lowest area first. An easy example to help see the importance of this is- imagine you’re having an asthma attack, your body isn’t getting enough air, you’re worried for your health and safety and it’s an incredibly urgent moment. If someone were to tell you “calm down and tell me the name of your doctor then I’ll grab your inhaler,” it probably wouldn’t be helpful! You might not even register what they were saying, let alone be soothed by the prompt to “calm down” and you might have some trouble remembering the name of your doctor even if you knew them well. If, on the other hand, someone approached with your inhaler and simply offered it to you and sat by you while you used it until you were able to take some deep breaths, then asked, “what’s the name of your doctor, I’d like to call to check in with them,” you’d be more likely to remember the information and feel comforted by their offer of support. In this example, it was all about the timing! The same interventions were offered, but in the order that the brain works in and can make use of.

The same is true for children at home, in school, and in our therapy spaces. Starting with regulating the body & brainstem will help get the feelings regulated. When the body and emotions are regulated, we can start to teach and build learning, memory, and thinking.

Trauma Responsive Strategies for Nervous System Regulation

This is the strategy I use every day in working with kids and families. Like I said, they aren’t quick tips but they are the way that I have found to support meaningful and lasting change rather than relying on entertaining or distracting children into a behavior change.

Step 1: Sensory-based strategies

Why? Working with the body (the sensory system) supports us in moving through arousal states or maintaining the state we want without relying on thinking. When we are dysregulated, we have less access to thinking but we can still access the body for healing & regulation.
How?

Deep pressure & heavy work activities such as pulling or pushing heavy objects or using a weighted blanket or lap pad
Tactile activities such as play with sensory bins filled with water, sand, beans, or rice and other small toys and tools
Movement activities such as walking, dancing, yoga, or swinging
Environmental changes like managing ambient lighting, temperature and smell in the space
Check out this post (https://www.childrensotproject.com/blog/regulationstrategies) with more specific and practical sensory strategies as well!

For caregivers: engage them in these activities in your sessions and also support them in accessing their own sensory-based regulation throughout their days and weeks through education and consultation.

Provide a heavy lap pad or weighted item for them to sit with during meetings
Suggest walking meetings in person or via phone
Provide some small items to fidget with or drawing materials to doodle while you talk
When meeting check- is the lighting and temperature ok? (If these are things you could quickly change in your space)

Step 2: Relational strategies

Why? Once our bodies are regulated, connection is next. This happens in the diencephalon and limbic areas, directly above the brain stem. When we are connected, our regulation can be reinforced and we are more likely to feel safe and included.
How?

Focus on attunement: notice what the child is doing through careful and nonjudgmental observation. Statements like “I can see this block tower getting taller and taller as you build!” allow children to feel seen and not judged.
Being connected is one of the most reliable ways to support regulation. “I’ll sit right here with you while you keep trying this tricky puzzle”
Join the activity and follow the child’s lead instead of focusing on teaching skills or facts
Play without asking questions- use reflective statements to show the child you are involved and interested but not expecting anything from them other than connection in that moment.
Use your affect and facial expression to communicate delight that you are together and enjoyment in what you are doing together. Being gentle by using a deeper and slower tone in your speech instead of overly excited is often helpful in co-regulation.

For caregivers:

Figure out what their important agenda items are and be sure to focus on these. Use reflective listening to ensure that they feel heard throughout your time together. Focusing on attunement and connection is the same with adults. When caregivers feel you are listening and that their concerns are your concerns, you are more likely to be well connected and able to do harder work together.

Step 3: Cognitive strategies

Why? Once we are regulated and connected, we are able to problem solve, learn, and reflect. These skills are essential to developing more skills in any area.
How?

Use visual organizers and schedules to help children know what’s happening now and what’s coming next and what you’ve already finished
Use familiar routines, songs, and language to communicate rules, expectations, and transitions
Talk about what’s happening with language that is appropriate for the child. Once a child is regulated and back to reflecting and thinking, statements like “A little while ago you were feeling so upset that you were crying and threw some of your toys. I think it was because XYZ happened.” Can be helpful in prompting young children to begin to reflect on their experience. At this state of regulation you can also ask questions about their experience.
Tip! If you want children to genuinely reflect, they need to know you won’t judge their answers so do your very best to avoid things like “I know you were mad but….” Or “even though you were sad doesn’t mean you can…” Instead, statements like “I can see why your body would have thrown that toy since you were feeling so upset. We’re working together in this classroom/in our sessions together/in this house to help our bodies be safe even when we are so mad”

For caregivers:

Ask reflective questions about what has worked in the past and what sort of changes they are hoping for in the future. When we are regulated and in a “cortex” place, we are more able to do this type of thoughtful work.
Use handouts, resources, and teaching to ensure that caregivers are learning the content that is helpful in understanding their child’s development and needs.

Thanks for reading! If you’re finding any of my posts helpful, please, please let me know! Then share with your friends and colleagues and sign up for my newsletter if you haven’t already. I really appreciate you being here and the work you do for the little ones in your life.

References & Resources

Perry’s Sequence of Engagement
What Happened to You (Perry & Winfrey) (Link to this book on amazon, note I don’t receive any commission for purchases, this is just for your information!)

Early Childhood Mental Health: How Trauma Impacts the Nervous System & What We Can do About it?