Dysregulation is a big word. Depending on who you talk to, it means different things. The Oxford Dictionary defines dysregulation as an “abnormality or impairment in the regulation of a metabolic, physiological, or psychological process.” This means that something inside the body is imbalanced. If there is an imbalance on the inside, the child shows an imbalance on the outside (an unexpected outcome), which can present as increased emotional reactions, unexpected or inappropriate behaviors, and/or symptoms of anxiety or inattention.
Dysregulation does not mean that the entire brain is processing information inefficiently. We define dysregulation as a breakdown in processing at the level of the lower and/or upper brainstem. Think of the brainstem as the doorman to your building. When he is feeling good, he lets the appropriate number of people (neurochemicals) inside. However, when he is feeling sick, he lets people (neurochemicals) inside either too quickly or too slowly by over-scrutinizing them or by not paying attention. The result of the above scenarios is a dysregulated child who respectively looks either anxious (avoidant) or inattentive (like a tornado).
As occupational therapists, we help children regulate independently (self-regulate) by addressing all of the internal and external factors. The most effective way to do this is to “fix” the internal factors because this “fix” directly “fixes” how the brain processes information, which directly “fixes” behaviors. Internal factors include sleep, nutrition, how the gut processes food, toxin exposure, and structural abnormalities or subluxations of the cervical spine and cranial bones. Making sure that these internal factors are working correctly and effectively ensures that the child has the neurochemicals available for the brainstem to correctly and effectively process the information that enters the brain. Of course, there are external factors as well, but addressing the internal factors first the best place to start.
A less effective way to address dysregulation is to analyze the child’s increased emotional reactions and try to change how the child acts. This approach (a behavioral approach) would be equivalent to a doctor giving you tissues to alleviate a sickness without taking your temperature, looking in your mouth, examining your belly, etc. Although the tissues mediate your runny nose, you are still sick. To “fix” dysregulation, the internal metabolic, physiological, and psychological factors have to work harmoniously.
How do parents help a child regulate? This starts with co-regulation practice between the parent and the baby; regulating in this way helps the child develop strategies for coping and managing stressful events and situations. For any child older than an infant, the job of the parent is to determine whether the child is actually dysregulated. Parents do this by looking for symptoms of anxiety or inattention at consistent times of the day; if this is present and of concern, parents should determine if the autonomic nervous is activated as this indicates that the child is in a dysregulated state (increased heart rate, pupil dilation, flushed ears and/or cheeks, and increased respiration).
The treatment plan for teaching children to self-regulate is straightforward. To start, the parent is in charge of the child’s regulation. More specifically, the parent leads the child in a few exercises that release specific neurochemicals to either “cool off” (for children presenting as symptoms of anxiety) or “heat up” (for children presenting as symptoms of inattention) the brainstem. This gives the brainstem the correct neurochemicals to process information efficiently. Once the child starts to self-regulate in different environments and situations (self-regulation), the parent can decrease the frequency and intensity of these exercises. Over time, the child’s brainstem can process information effectively and thus the child can regulate without assistance from the parent.
As children grow older, they often develop learned behaviors that are associated with their dysregulation. When an older child is no longer dysregulated and is processing information efficiently, that child can continue to act dysregulated by screaming, yelling, and crying for example. Learned behaviors are used by everyone. When we are angry or upset, we turn to our learned behaviors to cope or express ourselves. If the learned behavior is an undesirable one, then it deserves a behavioral response from the parent; this would be a firm “no” approach with the parent acting as he or she does when setting boundaries. It is important to note that children (or anyone for that matter) who are upset or angry for a long enough period of time can make themselves dysregulated.
Your child is probably showing a learned behavior if
1. Your child is able to talk back to you
2. Turn on and off the meltdown
3. Does not show the autonomic nervous signs listed above
It is easy to use dysregulation as an excuse for behavior and/or emotions. When we know a child has a sensory processing issue, parents often assume that negative emotions or reactions are a sign of dysregulation. It is important to remember that everybody has a range of emotions and that it is OK to be upset or angry. What parents do need to keep in mind is that when the range of emotions goes beyond the typical outburst and/or meltdowns and lasts for a long period of time, this behavior can fall into the spectrum of dysregulation. When a child is dysregulated, there is a treatment method we implement and teach that will address the internal factors to improve self-regulation.