Clinical psychologist and DIR Expert Training Leader, Ira Glovinsky returns this week to discuss factors affecting self-regulation, the development of it, and a number of things we can do about it. This follows our discussion from last time on The Foundation for Regulation and highlights some points Dr. Glovinsky made during a presentation at the STAR Institute in Colorado. So, what is regulation? What factors affect our child’s regulation and what can we do about it? Let’s see what Dr. Glovinsky has to say…

Focusing on Regulation with Dr. Ira Glovinsky

by Affect Autism

It’s not just about the child

As we’ve discussed with Dr. Glovinsky before, when our children get dysregulated, we tend to focus on their behaviour, which causes us to be more rigid in how we deal with situations. When someone’s having difficulty regulating themselves, it’s their physiology, not them being ‘difficult’ or ‘misbehaving’. We need to focus on the Relationship to remedy the situation. We need to look at how we focus on regulation. What do care providers and parents do? We have to include the adults who are with the children in the moment when we discuss regulation.

Regulation begins in utero and the context from the very beginning is a we context. We talk about self-regulation down the road, but self-regulation really emerges from what goes on in co-regulatory experiences. Infants have a difficult time regulating themselves. 

There are rudimentary ways they can regulate when they are overstimulated. They may avert gaze, close their eyes, hiccup, or sneeze. But they need caregivers around them to develop the capacity for regulation.

Self-regulation is not a category, it’s a dimension. You can’t just look at the child, but have to consider the care providers and the context.

Dr. Ira Glovinsky

So self-regulation develops dynamically. It’s really dependent on the adults with the infants, along with the context, to develop inner self-regulation. As we think about treatment and interventions, we can’t partial out the adults who are with the children, and we can’t partial out the context. It all has to be considered.

Optimal regulation

Regulation is either when there’s not enough going on internally and externally, and we need to increase the amount of stimulation in order to activate the child into an optimal zone of arousal. When a child is over-aroused, we try to lower that stimulation level into that same optimal zone of arousal, or ‘window of tolerance’. A main characteristic of what we mean by regulation is a person being in a state of ‘alert inactivity’: we’re attentive to our surroundings and we’re able to take in stimulation, process stimulation, and problem-solve. 

Regulation is an individual difference

Self-regulation is not a category, it’s a dimension. You can’t just look at the child, but have to consider the care providers and the context.

Dr. Ira Glovinsky

Dr. Glovinsky did a study looking at children who presented with A.D.D. symptoms. The results were interesting. When they looked at brain activity, there were three distinct groups that emerged. 

The first group of kids had the classic definition of A.D.D. with hyperactivity. These kids were bouncing off the walls. A second group could be diagnosed with ADD without the hyperactivity. These kids were quiet but internally and distracted, but not very active. 

But the third group had activity levels that were very high but they had wonderful attention levels. They cannot function well without the high level of stimulation that activates their movements. They were very regulated kids, but just needed more activity to regulate.

Regulation is a dimension, not a category. We have to be aware of this when intervening and focus on the Individual differences of the children–and of the parents, too–and individualize the recommendations. 

There are some people who regulate by being in a state of alert activity. Ironically, these kids often get a diagnosis of hyperactivity or attention deficit disorder (ADD).

Dr. Ira Glovinsky

Different cultures have different regulating strategies as well. The prescription is going to be different for every single child and family with regard to regulation.

Gaining an awareness of inner sensations

Dr. Glovinsky also points out that many kids are often misdiagnosed. One factor that contributes to this is interoception, which we referred to in our last podcast with him. We also need to pay attention to a child’s interoceptive system: the sensations going on inside their bodies. Some children and adults don’t have awareness of the experiences going on inside their bodies, which has strong implications for regulation.

Dr. Glovinsky told us about interventions he’s heard of from clients where they ask the child to “Catch your angry feelings at the very beginning by taking deep breaths“, but Dr. Glovinsky learned that some children don’t have the feeling of anger until the moment they explodes. When they are told to use these techniques, they sound good, but they don’t tend to work. Other children tell Dr. Glovinsky that they register feelings in their bodies but they don’t know what to label them.

We need to figure out what’s going on on the inside, and what’s going on on the outside. Some children and adolescents don’t even know when they are hungry or tired. If you don’t have those inner experiences, how do you regulate yourself? Kids have to learn about their bodies first, Dr. Glovinsky believes. Then they can attach those sensations that they have an awareness of. Then we can talk about emotions, then we can talk about what to do about it.

Mentalization

We’ve discussed mentalization with Dr. Glovinsky briefly before and today Dr. Glovinsky talked about how it can factor in to regulation. Mentalization is about holding concepts in our mind, which requires the capacity for symbolic thinking. When you can hold a symbol in your mind, you can use this to self-regulate, such as when a child understands that his mother has left the house, but will return later. 

Adult-child co-regulation

Dr. Glovinsky stresses that when adults see this overwhelmed behaviour in a child, we want to watch, wait, wonder and be curious about it rather than rushing in and focusing on the particular task in the moment. See the child as being dysregulated: their heart rate and blood pressure has increased and their breathing is shallow and rapid, so you want to focus on the child breathing from their belly and slowing down. Focus on helping the child get regulated rather than teaching them a lesson, or getting compliance. 

Focusing on behaviour creates a ‘reactivity dance’ where a parent moves in which increases the child’s reactivity, which increases the parent’s reactivity, which causes someone to explode before they can regulate. Rather, let’s focus on a ‘we’ project where the adult is supportive, nurturing and helpful which helps develop secure attachments, synchrony and attunement, creating a sense of safety and security which has longterm effects, rather than being punitive and ‘teaching the child a lesson’ in the moment.

Dr. Glovinsky finds that often, parents use disciplinary methods that their own parents used on them, which they believe will, in turn, work on their child. But your child is not you, and what may have worked for you won’t work for your child, Dr. Glovinsky says. Support, scaffolding, and help rather than reactivity can help more kids than not–even with kids who have been referred for very serious mood disorders and being ‘out of control’.

There isn’t a toolbox

I provided Dr. Glovinsky with an example or my son’s latest dysregulated behaviour of dumping bins of toys or clearing off book shelves. He responded that there isn’t a toolbox and every child is different. If you function from the toolbox technique, by the time you use the toolbox, the child shifts and is into something else. We have to think of us instead of tools. We have to feel comfortable and regulated to help the child.

What does this mean? ‘Dr. G’ gave us some examples. A child in his office started dumping toy bins and Dr. Glovinsky felt that if he tried to stop it, he was going to get a tantrum, so Dr. Glovinsky joined him and dumped another toy bin then said “Oh no, what are we going to do?” He and the boy were laughing together. Dr. Glovinsky suggested to the boy that he would clean up the space toys and asked if the child would clean up the others. It worked.

Another child was dumping bins and Dr. Glovinsky asked the child to hold out the emptied bin and said he wanted to see if he could throw the toy into the box. Within a short period of time, they were in a turn-taking game with him, the boy, and the boy’s mother, throwing the toys into the box. As a classroom teacher years ago, Dr. Glovinsky had a child who kept falling out of his chair, which would set off the other kids. So Dr. Glovinsky went over and asked the child how he did that and got on the floor crawling. Then he got all the kids crawling to get their ‘sillies’ out.

The main point

Can you feel comfortable being with a child who is dysregulated and feel that it’s going to be OK? Can you think to yourself:

What can I do with this child at this time of day that is playful rather than rigid to get the child on my side to work together?

This is our challenge as the adult with a dysregulated child. 

So in his examples above, Dr. Glovinsky did a few very important things:

He JOINED the child. He was PLAYFUL and CALM. He was regulated. He got a CONNECTION with the child. 

It’s more about understanding the child’s capacity in that minute, even though the child cognitively knows, if he were in a calmer moment, that he shouldn’t behave that way. Later on when everyone is calm you can reflect by normalizing the situation, “You had a hard time stopping yourself from dumping those toys.

Dr. Glovinsky points out the importance of being PRESENT in the moment as well. You can be happily playing trains or struggling putting on a coat while in a hurry to get out the door. He suggests not to think positively or negatively about the situation you’re in, but simply that this is what you’re doing now, in this moment. You have to be just as creative in the ‘putting-on-the-coat’ activity as in the playing trains activity.

Dr. Glovinsky might say “Oooo! Oooo! Let me help you put on the coat!” and put the arm’s coat on the child’s leg (being silly/using nonsense) or put his own coat on inside out to help the child SHIFT. Taking the time for a little humour can be helpful. Would you rather have a 40-minute tantrum or take 10 minutes to help get the coat on with a happy child?

What we CAN do

I pointed out that my son would get dysregulated if I put his coat on the wrong way. He might yell, “No, Mama! It goes here!” Dr. Glovinsky said that he might respond with, “Oh can you show me?” I usually say, “Oh silly Mama! What was I thinking?” As the adults, we need to work on our reactions to our children and why they don’t work. Our work is not working with our child in the moment, but realizing that we get dysregulated very quickly when our child does these things.

Parents vary in the amount of patience they have with their children’s behaviour. And parents say, “I can’t. I don’t have time. I’m tired. I’m rushed.” Practice when you actually HAVE time in Floortime play with your child, so when it happens in the moment, you feel a little more prepared to handle it. We can do wonderful training in calm moments, but we need to act in harder moments, so in Floortime, you can practice tolerating frustration playfully.

It can be overwhelming to think about many things at once. We can start with baby steps. We can pick something to focus on for the next two weeks, for example. Figure out, “What can I do to calm myself down when I notice myself getting dysregulated when my child gets dysregulated?” Then focus on how to co-regulate with your child.

Self-reflection

In the moments when you do have time to think, reflect. Think about this morning when you lost your patience, and wonder where it came from. Dr. Glovinsky says there’s a history of how we react to problems. It’s related to our history and as adults and parents we need to think about our histories. After explosions of emotion or tantrums, going over what happened and thinking about what we could do next time is helpful.

As parents, we often don’t get to see how other parents react during dysregulation in the privacy of their own homes. Video taping helps us reflect on the outcome of how we were in the moment. We can see how we reacted and the effect it had on the child, and how the child reacts. We might pick up things we did not notice about ourselves.

Dr. Glovinsky says that he has heard from children that after they finally calmed down the teacher or parent wanted to talk about what happened and that puts them right back in the crummy mood. Dr. Glovinsky suggests that when reflecting about what happened and the child eventually getting regulated, instead ask “How did you do that? You are so calm now but you weren’t before. How did you do that?” This plants a seed to talk about and develop strengths, and to build the capacity to self-regulate in the future. 

Keep in mind what's important

How can I nurture the Relationship: A sense of safety and trust, and being able to rest in the attachment.

Affect Autism was selected by Feedspot as one of the Top 20 Autism Podcasts on the web!

Thank you to Dr. Glovinsky for taking the time to speak with us! If you enjoyed this podcast and found it helpful, please consider sharing it on Facebook or Twitter and feel free to offer Comments in the section below. Next time, Speech and Language Pathologist, Amanda Binns will return to discuss her latest publication, a review of Developmental Social Pragmatic (DSP) approaches to autism.

Until next time, here’s to affecting autism through play!

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