Staying Calm and Composed: Strategies to Help Youth Struggling with Emotional Regulation

Has your child ever lost their cool? 
Made an impulsive decision because emotions were high?
Broke down after having “one of those days?”

We’ve all done it, and as we get older we learn how to better self-regulate. Many youth, including those with Tourette Syndrome, struggle regularly on how to self-regulate. Just like the above, emotional dysregulation takes many forms – yelling, crying, social withdrawals, and inflicting pain to name a few. When someone is struggling to self-regulate, it can not only negatively impact their own well-being, but also create undesired outcomes in their social & family life, school, and extra-curricular activities. So what do we do?

Dr. Graham Hartke is a licensed psychologist (NJ/NY/APIT) in private practice who received his doctorate from the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University. He specializes in the cognitive behavioral treatment of anxiety, obsessive compulsive disorder, depression, tics/Tourette Syndrome, ADHD, oppositional defiant disorder, high functioning Autism Spectrum Disorders, and sport psychology. He has previously served as the director of the Rutgers Tourette Syndrome Clinic and is a certified provider of Comprehensive Behavioral Intervention for Tics (CBIT). In addition to his work, Dr. Hartke is a frequent outreach presenter for the New Jersey Center for Tourette Syndrome & Associated Disorders.



0:04 Okay, good evening and welcome. 0:06 Thank you so much for joining us for tonight’s webinar, Staying Calm and Composed, Strategies to Help Youth Struggling with Emotional Regulation, presented by Dr. Graham Hartke. 0:20 My name is Katie, and I am the Family Medical Outreach Coordinator for the New Jersey Center for Tourette Syndrome and Associated Disorders. 0:27 I will be your facilitator for this evening. 0:31 Before I introduce the presenter, I wanted to go over some housekeeping notes. 0:34 The audience is muted. 0:36 If you’re attending the live webinar, any questions you have can be submitted in the questions box located at the bottom of your screen. 0:42 During the live Q&A, the audience will gain access to and mute themselves. Because of this, we will stop recording right before we start Q&A. 0:50 At the top right of your screen, you’ll see a paperclip icon. 0:54 There you will find a copy of the webinar presentation slides and our upcoming events. 0:59 At the bottom of your screen, you’ll see a react button. To the right of it is an arrow. 1:03 When you click the arrow, you’ll see a few emojis up here, such as a heart, a thumbs up, etc. 1:08 Throughout the webinar, feel free to use this feature to let our presenter know how they’re doing. 1:13 So if you guys want to try using it, maybe giving a thumbs up or a heart. Okay. Awesome. Yeah, we love this feature. Okay. 1:32 And so for those viewing webinar recording, you will not have access to these features. 1:36 However, you will be able to submit your questions for the presenter to answer your questions box is located to the left of your screen. 1:44 Questions submitted will be posted to our Webinar blog for the presenter to answer. 1:48 This blog can be found on our website njcts.org under the program’s tab. This blog will be monitored until Wednesday, May 1st. 1:56 Any personal information will not be included. 1:59 The New Jersey Center for Tourette Syndrome and Associated Disorders, its directors and employees assume no responsibility for the accuracy, completeness, objectivity or usefulness of the information presented on our site. 2:11 We do not endorse any recommendation or opinion made by any member or physician, nor do we advocate any treatment. 2:18 You are responsible for your own medical decisions. 2:22 Now it is my pleasure to introduce our speaker for this evening, Dr. Graham Hartke. 2:27 Dr. 2:27 Hartke, Psy.D, is a licensed psychologist in New Jersey, New York, and AP IT. 2:33 He received his doctorate from the Graduate School of Applied Professional Psychology at Rutgers University. 2:38 He specializes in the cognitive behavioral treatment of anxiety, obsessive compulsive disorder, depression, Tick’s slash Tourette syndrome, ADHD, oppositional defiant disorder, high functioning autism spectrum disorder, and sports psychology. 2:54 With that, I am going to hand the mic over to Dr. Hartke. 3:07 Hello everybody, how are you? 3:09 I’m going to just put the slides up real quick on the screen. 3:15 Okay, can you hear me okay? 3:17 All right, let’s make sure this is, okay. 3:22 All right, good, so I can’t see that part. 3:24 All right, welcome to the webinar 10, everyone. 3:29 This is my, I wanna thank NJCTS for having me on again. 3:33 This, I’m surprised they’re not tired of me yet. 3:35 This is my 10th time doing a webinar for them over the last decade or so. 3:39 So thank you very much for having me on. 3:42 And this is a topic that I think is, really hits home for a lot of people. 3:47 It’s relatively broad topic, because emotional regulation could mean a lot of different types of emotions and different kind of problems. 3:56 But we’re gonna try to tackle it in a way that’s useful today. 3:59 So let’s go through it. 4:00 So today’s outline. 4:02 First, I’m gonna just bring up some situations that kind of get you in the right head space for today. 4:07 I’m not saying these are the only situations. 4:10 Like I said, there’s many different manifestations of emotional regulation becoming a problem, but just some situations to think about. 4:18 We’re gonna do a pretty brief overview of emotional regulation and dysregulation. 4:23 We’ll talk about some strategies. 4:25 This is where we’ll focus on strategies to help you stay calm and composed. 4:30 So strategies for emotional regulation. 4:32 And then we’ll talk about some resources. 4:34 The resources will also be sprinkled into the strategies section as well. 4:39 Okay, so let’s talk about this. 4:42 Actually, this would be a good time, just so you know, tonight there’ll be some poll questions. 4:47 So Katie, maybe you could launch the first poll question before I even put these situations up, if that’s okay with you. 4:54 Of course, so the first poll question is, when you think of emotional dysregulation, which emotional category do you think of first? 5:09 Okay, so just take a minute. 5:11 Do I usually let people wait, Katie, or do we usually move on while they’re doing it? 5:16 It’s totally up to you. 5:17 I usually wait maybe like 30 seconds to a minute, but you can keep going if you want. 5:23 Sure. 5:24 Would I be able to see the poll? 5:27 We’re going to find out. 5:40 So now I’m going to end and share it. 5:45 So can you see that? 5:48 I think if I close my screen, I could see it. 5:50 So let’s just say. 5:50 Don’t worry about it. 5:51 I can read it to you. 5:52 Okay. I can see it. Okay. Right. 5:56 So it seems like most people, very few people put elation, happiness, some sadness, 25% actually is pretty high percentage. 6:04 So sad, sadness, anxiety, and anger are the main categories. And that’s kind of what we’re going to focus on today. All right. 6:15 So here’s some situations to imagine. Okay. Some of these might ring true with you. 6:19 I know these situations might be something you experienced today. 6:23 A child with ADHD explodes with anger when asked calmly by his parents to stop playing Fortnite and join a family dinner. 6:31 The child screams, cries, curses, kicks a hole in the wall and runs out of the house saying he does not want to live anymore. 6:37 Okay, so just kind of envision that situation. 6:40 Another situation, a teen screams when loud music comes on unexpectedly at a restaurant. 6:46 The teen then runs outside, sits on a curb in the parking lot, shaking, rocking, and crying. 6:54 A third situation, a child with Tourette’s syndrome punches a peer during outdoor recess for tagging them out and kickball. 7:01 The child yells at a lunch aid when told to go to the principal’s office. 7:05 The child then refuses to leave the kickball field, resulting in all the other children being asked to go inside. 7:14 And another situation, this is the last one, after meeting someone on the social media app Discord and chatting with them for only a day, a teen falls in love. 7:23 After a week later, the teen is ghosted by the individual. 7:28 The teen is so overwhelmed with sadness, they refuse to get out of bed and they self-harm. 7:34 Okay, now these are just some situations to illustrate what some individuals, particularly on the more intense end, might experience when they’re having trouble regulating their emotions. 7:44 So there are many definitions of emotional regulation that are varied and some are more detailed, But for sake of being concise for a webinar, we’re gonna use a pretty simple definition. 7:57 So emotional regulation today, we’re gonna consider the ability to effectively manage or respond to emotions. 8:03 It’s part of the larger picture of self-regulation, managing your attention and your impulsivity, it’s in that category. 8:12 But for today’s purpose, we’re really focusing on the emotional part. 8:15 So how to effectively manage or respond to your emotions. 8:18 The ability to regulate emotions should not be surprising, but it’s associated with social competency, positive life outcomes, and understanding and awareness of your own emotions, others emotions, causes of emotions, consequences of responses to emotions, and strategies to manage emotions. 8:40 One thing that’s really key to this is ability to regulate emotions really helps someone match the emotional response to the environment. 8:47 right? 8:47 You want to have an appropriate response to the environment and obviously not have self-destructive behaviors. So emotional regulation. 8:58 There’s a model that is out there for the process of how it works by the researcher Gross. 9:06 Originally, I think his paper was in 1998, but he’s been publishing on it up to, you know, the mid 2010s. So it’s still used. 9:15 So I think it’s one look at. 9:17 So one model of emotional regulation is that there’s several components and stages to it. First, we can select a situation, right? 9:26 So we can decide whether or not to, you know, go towards a situation or avoid it. 9:31 Then once we’re in a situation, we can, you know, try to modify that situation to keep ourselves calm. 9:39 And then when we’re in a situation and we’ve modified things it, we can decide what parts of it we want to focus on or pay attention to. 9:48 And then we also can assign meaning to it, right? 9:51 So we’re attending to this thing and then we can assign some kind of meaning to it. 9:55 And then, of course, what most people think about the most regulation is if we start to have a response to it, we manage that response. So we modulate the response. 10:05 So there’s a part of it regarding the environment, your attention, having some kind of say that you could regulate your emotions several ways. 10:16 You could decide to stay home or go to a birthday party. 10:20 Once you’re at the party, you can change the subject from talking about college acceptances if you don’t want to talk about it. 10:26 Say you don’t know where you’re going and it’s making you nervous. 10:29 And then if you do change the subject but then someone does start talking about it, you can distract yourself. 10:34 You can change where you’re paying attention. You look at your phone. 10:36 That’s another way to regulate your emotions. 10:39 If that doesn’t work, you could try to change the meaning of what’s going and say, look, I can’t get away from these conversations and try to use some positive talking. 10:47 It will all work out. 10:48 We’ll get, I’ll get into one college at least. 10:51 And the last part is you can try to suppress the emotion by keeping a straight face, deep breaths, awkward smile. 10:58 So this just kind of shows a process of different areas of emotional regulation. 11:01 And it kind of hints a little bit at some areas of target for intervention. 11:06 So, emotional regulation, I’m not going to get too into all the brain areas, just kind of cover, obviously, for those of you that are aware, the prefrontal cortex plays a large role in executive functioning. 11:18 The limbic system in general is our emotional center, but especially with emotional regulation, the research has really shown that the prefrontal cortex plays a very large role and can even kind of turn down the emotional limbic system. 11:35 Neurotransmitters that are related, serotonin seems to be playing a big role in it. 11:40 Executive functioning, It’s part of executive functioning, right? 11:43 So managing ourselves, having some cognitive flexibility. 11:49 It’s biologically influenced. 11:51 So obviously stages of development, hormones, tiredness, hunger, you know, who hasn’t had been hangry before or something. 12:00 You know, those kind of, having any kind of change to your body can affect how well you can regulate emotions. 12:06 Or if you’ve been delayed at the airport for 10 hours. 12:10 Development is a really important piece, right? 12:12 So younger children have less control of the older children, so there’s, as the prefrontal cortex develops, it definitely helps with having more control. 12:20 That’s why you don’t normally see, in the general population, 20-year-olds having a tantrum as often as maybe three-year-olds. 12:28 Some of you watching might have a 20-year-old that has tantrums a lot, which is fine, but I’m just saying that overall, in general, this happens. 12:35 It also varies by individual. 12:38 And for emotional regulation, a lot of us think about, for clinical interventions, decreasing negative emotions as the goal. 12:46 We have to suppress it, we have to reduce the negative emotions, but emotional regulation could involve either increasing or decreasing positive or negative emotions. 12:57 So I say that, for example, Michael Jordan’s strategy increased the negative. 13:01 So if any of you watched the documentary that was out that a lot of people watched during the pandemic of the Chicago Bulls 1998 run, it was a whole story of Michael Jordan. 13:12 He did talk about one of his really helpful strategies was to get himself really angry at the other opponents and to make him really fuel his planks. 13:21 So there are some advantages in some contexts of increasing energy, or sometimes when people are sad and down, we want to increase positive emotions, right? 13:31 So it’s not always decreasing negative emotions. 13:34 So emotional dysregulation is what we’re focusing on. 13:38 Difficulty in monitoring negative emotions or reactions to them. 13:41 It can happen to anybody and it can be developmentally or situationally appropriate or not situationally appropriate. 13:49 Some common examples which happen day-to-day, toddler tantrums, a trauma or grief response. 13:55 Someone might have a really hard time controlling their emotions. 13:58 Similarly, experiencing a shocking moment, escaping danger in a state of panic, responding to intense pain or sensory stimulation. 14:10 Road rage is something that many people experience every day driving to work. 14:15 Winning the lottery could be an extremely exciting moment. 14:17 Someone could be lost in their emotions in those moments. 14:21 So just kind of highlighting that emotional dysregulation isn’t always abnormal or a problem, but some people struggle on a regular basis. 14:31 So those that struggle on a regular basis, they’re prone to experiencing more anxiety, depression, aggression. 14:38 There’s a low distress tolerance, right, often those individuals where they get triggered more easily by lower levels of a trigger, right? 14:49 So it’s not as intense, you know, something small can turn into a big deal. 14:53 There’s poor social outcomes often, and especially in the case of aggression, it could lead to physical injury, damage of property, legal consequences, or even just long-term impacts and affecting someone’s entire life, you know, work, school. So let’s talk about the symptoms. 15:15 Now I’m just going to list these are these are probably ones that you had in mind when you sign up for this webinar. 15:19 So, explosive anger, meltdowns, impulsive behaviors, inflicting harm to yourself or others, yelling, threats, intimidation, aggression, crying, shutting down, having a flood of negative intrusive thoughts, or in the case of extreme anxiety can be really flood of anxious thoughts, panic and anxiety, loss of rational thinking, loss of control. In some cases, it could be on the on the elation side. 15:52 It can be uncontrollable laughing. 15:54 Someone just really can’t regulate their laughing inappropriately or just uncontrollably. 16:01 So from a parent perspective, for a use that struggle regularly, you hear things like the reactions out of proportion to the trigger. Sometimes way out of proportion. 16:11 People feel like they’re walking eggshells. Go from 0 to 100 or 0 to 60. Feelings of frustration. 16:18 It can be to the entire family. 16:21 It’s taking over, we can’t even function. 16:24 Could instill a sense of helplessness if it happens often. 16:28 And frequent calls to the school, frequent calls to the doctor. 16:31 There are a bunch of associated conditions here that are related. 16:36 Now, one thing I’ll say about this entire webinar is I’m not gonna cover every possible diagnosis that could be associated with it. 16:43 I’m covering just selected ones that are commonly associated. 16:47 And likewise with strategies, I can’t possibly have covered every single possible workbook or intervention, but I’m trying to cover a good amount of them that are useful. 17:03 So if I miss something, you could obviously bring it up in the comments and questions. 17:05 It’s helpful, but I just want you to know I know that there are some things that might be missing because it’s such a broad topic. 17:13 But let’s talk about the associated conditions here. 17:16 So emotional dysregulation is broad in that it can occur across a large group of people with diagnoses and other conditions that are maybe not official diagnoses or they’re associated. 17:29 Substance abuse is a clear one. 17:31 Obviously someone could be dysregulated just even using substances occasionally, you know, while you’re intoxicated. 17:36 that could come up with with teenagers or you know either on the you know the drinking smoking you know marijuana using other drugs even steroids and athletes right some of the ones and why I think this is an important topic for the Jersey Center for Tourette syndrome the cover is it’s a really common for ADHD and Tourette syndrome and and often OCD as well is related and also a lot people with Tourette’s syndrome have comorbid autism spectrum disorders and sensory processing. 18:13 So they all go in that list. 18:16 So something I want to point out here, I’m not going to stay in the slide too long because we’re going to talk a little bit more about ADHD and Tourette’s in these areas. 18:26 But one thing that’s important is, I want to point out there’s two diagnostic criteria in here, intermittent explosive disorder and disruptive mood dysregulation disorder. 18:36 and they seem kind of similar, and they are actually in a lot of ways. 18:40 Basically, they are disorders that where people can go from, you know, pretty calm to pretty upset very quickly. 18:49 One of the main differences is intermittent explosive disorder is usually the person is not usually very irritable very often. 18:57 It’s kind of they can be totally fine and they could just explode. 19:01 Disruptive mood dysregulation disorder usually requires persistent irritability and it’s a little bit more, there’s more of a mood problem going on. 19:09 I think that’s important because there’s, especially with the explosive and anger disorder, there’s a little bit more, there’s obviously a Venn diagram where things overlap, but a lot of times you can look at it if things are a little bit more on the mood side or if they’re a little bit more on an impulse control side of dysregulation. 19:26 So let’s talk a little about ADHD. 19:31 So emotion, this really should be one of the diagnostic criteria for ADHD, or it should be acknowledged more. 19:38 It definitely is the people that work with AHD know about, people that have AHD know about it. 19:42 And even the newest, for example, Connors rating scale, which is a popular rating scale, has a very clear category for emotional regulation. 19:49 But I just want to point out that it occurs in a very large amount of youth and adults with AHD, about 24 to 50% of kids and about 34 to 70% of adults, which is around 10 times to even more than 10 times the in the general population. 20:06 So I think that’s a huge part of this that is not always, I guess, talked about. 20:11 Not that inattention isn’t a key factor of ADHD, but I think emotional dysregulation goes along with it. 20:17 If you think about similar areas, the brain are implicated and it’s part of regulation impulse control. 20:24 It’s really considered, you got to consider the neurobiological aspects of ADHD plus the environment. 20:30 So someone might have executive functioning difficulty, and then other people react to that. 20:35 You know, over time a kid is not listening and people constantly tell a kid to listen and they get in trouble. 20:40 And so other after over time, over years of kind of experiencing, you know, bringing to the table trouble, focusing, paying attention, controlling your behavior, and having constant reactions from other people that are negative or consistent, it develops a sense over time as that, you know, people can be critical, rejecting, or even unjust, right? 21:02 And it can affect someone’s confidence, mood, sensitivity. 21:05 So it’s not that it’s always because of that that someone gets upset, but this is why over time we see something that comes up in EHC a lot, which is rejection sensitivity, right? 21:15 So this isn’t a diagnosis. 21:17 It’s kind of a newer way of categorizing or describing symptoms that online, some people make it sound like it’s an official diagnosis, but it’s really more a description of symptoms. 21:27 But the idea is that a good amount of people with AHE, especially adults, and even youth, and especially as youth age and it seems to increase, experience intense mood shifts when they feel any kind of real or perceived social rejection, abandonment, criticism, or failure. 21:46 And if you think about the model I talked about before, where over time it builds up, you could see how that sensitivity would develop. 21:52 And people describe it as a very severe, unpleasant, emotional, and sometimes physically painful experience. 22:00 So this is an important thing to know about people with AHE, and sometimes it can be very sensitive. 22:03 So you might have a kid who seems to have a very strong reaction to losing a board game or something. 22:09 It’s just way out of proportion. You know, sometimes these things occur. 22:14 And it could happen in the general population too, but these things sometimes might seem really out of proportion to what you’d expect normally. 22:21 Let’s just talk for a minute about the TS rage attacks. 22:24 I know, I think someone else had a webinar on collaborative problem solving, might have talked about this recently. 22:31 So intermittent explosive outbursts or rage attacks that occur with Tourette syndrome. 22:36 They’re sudden, dramatic, repetitive, verbal aggressive episodes that are not appropriate and disproportionate to the trigger. 22:43 So they just explode. 22:45 It happens in about 20 to 70% of people. 22:47 The numbers range. 22:50 And, you know, some characteristics of it, usually it doesn’t have any kind of goal-oriented expression. 22:57 It just kind of happens and someone is really dysregulated. 23:01 And it happens a lot with ADHD, if you have the combination. 23:05 It can be very scary. 23:07 So here’s just an example of a rage example looking at from intensity, frequency, duration. 23:11 It might start with a routine problem, someone responds with extreme frustration, just kind example I gave in the beginning, all we have to losing total control, reactions at a proportion. 23:28 Sometimes they can be frequent and they’re severe, sometimes predictable, sometimes the intensity is not. You don’t always know how strong it will be. 23:38 Duration varies but often resolves in about within a half hour, at least the worst of it. 23:45 And oftentimes children feel very remorseful and parents feel very scared. So people, it ends with not good pleasant feelings. 23:53 You know, people are feeling bad and it’s obviously different for different people, but I just want to point that out. 24:00 So like I said, we’re covering a wide range of emotional regulation. 24:03 I just thought these were two good examples to bring up for a Tourette Association based webinar. 24:10 Okay, so let’s get to the All right, so we’re going to, I thought there’s a, oh, sorry. I don’t know why that happened. Okay. 24:23 So I tried to find a way to structure this that would make sense for this talk. 24:28 So here’s what we’re going to cover. 24:29 We’re going to cover a general strategy development framework because it’s a broad area of emotional regulation and interventions really need to be the right amount. 24:38 You know, you don’t want to overdo it. 24:39 You don’t want to underdo it and you want to make sure you cover, you know, the right elements. 24:44 So having a good strategy development, a framework to use as a guide is helpful. So we’re going to go through that. 24:51 So medical interventions, health interventions, the big areas, we’ll talk about social emotional skills toolbox. 24:57 These are probably the skills you’re all thinking about. 25:00 We’ll talk about crisis intervention, which is important, a really important piece. 25:04 Collaborative problem solving, functional behavior interventions, parent and home interventions, school interventions, co-regulation, so how adults around the individual who’s dysregulated can help, and tech interventions, which people are always excited to talk about. 25:22 But sometimes the promise is greater than what it actually offers. 25:27 So we’ll get to that. 25:28 So strategy, development, framework, I’m not going to go too much into this, but sometimes when an individual comes to you and they’re really struggling, so let’s say a kid has a meltdown once in a while, developmentally appropriate, you’re not going to intervene. 25:40 But these are all strategies for people to have trouble regularly. 25:44 So using a framework, like a program planning framework, it’s good to kind of consider all those areas. 25:49 So first we want to clarify the needs of the individual, the environment, and the problem behavior. 25:55 Then you want to plan an intervention, you want to have a purpose for it, and goals. 26:01 The goals are usually increased or decreased behavior, depending if it’s positive or negative, and have some kind of way to measure it. 26:07 Methods is what most people focus on, what’s the strategy, but having a strategy without really having it match the need is really not good. 26:16 And a really key part is delineating who’s responsible for what and what the timelines are when you’re doing these interventions. 26:24 Implementation and evaluation of interventions is also important once you get it going, you need to kind of monitor it and change. 26:31 because for anyone that’s done a behavior chart knows sometimes it falls apart after a few weeks. 26:38 You know, if you tell a kid to do some deep breathing, they might forget to do it. 26:42 You have to kind of add new things into it, review, refresh, and keep it going. 26:48 This is used as a guide, involves multiple stakeholders. 26:52 Okay, so I just want to talk about the clarification phase really quick. 26:56 This is kind of breaking down the assessment in a different way. 26:59 Obviously, it can be a parent considering these things. 27:02 It could be a physician, a psychologist, anybody, but generally you want to consider neurobiology. 27:09 You want to experience the life experiences, so the environment component, social learning, family, cultural, historical information. 27:19 Cognitive skills, it’s good to kind of review what areas might be lagging or problems, right? 27:25 So lagging skills, and we’ll talk about that as an example. 27:28 I’m not talking about doing, you could do it, but I’m not talking about doing a whisk or a waste cognitive assessment. 27:35 This is more for kind of helping us develop a emotional regulation response strategy. 27:42 Perspectives, this is kind of important. 27:44 You really want to know, kind of consider, what’s this person really that’s really getting upset? 27:52 What’s important to them? 27:53 What are their values? 27:55 What do they want to do? 27:56 kind of who they are as a person, right? 27:58 So I think sometimes that’s not considered. 28:00 You know, sometimes people, it’s important to kind of take that into consideration. 28:05 And obviously the clinical considerations, if there’s any diagnosis or clinical assessments and severity level. 28:13 And characters of the problem behavior, these are things that anyone that’s familiar with behavioral interventions knows about. 28:19 So, FBA aspects, you want to describe the emotional experience, you want to define the behavior, look at intensity, frequency, duration, antecedents, and get some examples of the problem. 28:32 Okay, so we’re gonna, I’m gonna show you an example of this later on, but, and we talk about collaborative problem-solving. 28:37 There’s a nice resource that’s free online from Ross Green, who does collaborative problem-solving. 28:44 Now he changed the title to something slightly different because of legal reasons, but still collaborative problem solving. 28:50 But one of the things that he has this one pager, which you can kind of look at to kind of consider different aspects of how he delineates executive functioning skills, language processing, and et cetera, and consider if any of them are difficult for the child you’re looking at, right? 29:06 Also helps you kind of delineate what some unsolved problems are. 29:10 And really it’s a nice kind of way to kind of help you conceptualize what might be going on and some areas to work on. 29:17 For the next part, we talk about skills. 29:20 Health intervention is really key. 29:23 There could be a lot of reasons, especially if, you know, and a lot of health-based reasons that are related to emotional dysregulation. 29:30 So obviously, you want to address any acute or chronic medical conditions. 29:36 There might be medication, medical procedures, therapy, alternative treatments. 29:40 You know, sometimes you just do blood work and you find there’s something going on. 29:43 Anyone that’s dealt with pans or pandas knows that could be you could see kind of a dramatic change in behavior sometimes from from that If a kid’s not sleeping you might that might be where you address. 29:54 I mean the whole intervention might be on sleep If the kid has a lot of difficulty when they’re Hungry, you know having food might be so these these are just one bullet point But anything on here could be the main part of your intervention with a kid Sensory considerations, if something is triggering or something can be soothing for a child, it’s good to know. 30:18 And medications, there’s a lot that can be given for emotional dysregulation. It really covers a wide range. 30:25 Antidepressants, beta blockers, anything to calm an individual down. 30:33 They have the atypical and atypical antipsychotics, mood stabilizers. 30:37 But sometimes people don’t realize that some, in severe cases, some doctors will prescribe an as-needed or they call PRN medication, which can be any of these listed above, but suddenly given the moment if someone’s in a real, real bad spot, you know, it depends on the case, right? 30:55 In a hospital it could be a shot, and in a school it might be, you know, a prescription to give a kid something, usually in therapeutic settings, people are more familiar with that. 31:05 And just finding doctors can be tough. Sorry. 31:10 Side effects, adherence, that kind of thing. All right, so let’s get to the tools. 31:15 It’s what everyone’s probably been waiting for. 31:18 And some of these you’re going to probably know because they’re not all brand new. 31:22 But these are the skills that are more, this section is more geared towards the individual. 31:27 So what you’re going to teach her, reinforce the child. 31:30 Typically based on cognitive therapy, you know, focus around thoughts, feelings, behavior. 31:38 Evidence-based strategies, most of these, there aren’t really a lot of brand new ideas. 31:42 A lot of times when you buy a workbook, it’s they’re using evidence-based means that we have established research that these are effective techniques and someone has maybe adapted a new visual way to describe something or use it, but these are more evidence-based strategies. 32:00 Not one size fits all, you have to select skills, work for individual change over time and you know it can be any way. 32:06 I mean some people might have an online way to teach these skills. 32:10 They might watch YouTube videos. 32:11 A lot of kids today will tell you I learned how to do something just from YouTube. 32:14 But direct instruction, working with a counselor, teacher, parent, modeling, role-playing, you know all these things. And don’t forget the modalities. 32:22 Sometimes kids really learn some of these skills while they’re playing video games or performing you know in sports or visual arts. 32:30 So I think it’s It’s important to not just see this as like, all right, I’m gonna give a kid a worksheet. 32:34 That’s the only way they can learn how to do this. 32:36 There’s lots of modalities and visual, auditory, kinesthetic ways of learning. 32:45 So one of the very first things of CVT in general is education. 32:50 So when you’re working with a kid or a teen, educate about emotions. 32:55 Some kids need a lot more. 32:56 People on the autistic spectrum, for example, sometimes do a lot more work on that than maybe an older teen. 33:01 but you never want to underestimate. 33:03 Sometimes it’s good just to get better at talking about and approaching your emotions. 33:07 Also learning about the relationship between situations, triggers, thoughts, feelings, behaviors, so that kind of, you know, the way they kind of influence each other. 33:17 And for particular problems, behaviors, you can kind of map them out for people and show like, here’s your typical situations, here’s what triggers you, here’s your thought, like automatic thoughts. 33:27 And so really learning is important. 33:29 And also learning about the specific problem, so educating kids about feeling about anger or depression or self-harm or anxiety, you know, so they get to be their own mini experts in those areas. Okay. 33:43 All right, so a lot of you have seen like a feelings thermometer or an anger thermometer, so I just found a generic one online. 33:49 There’s hundreds of them out there in books and online, but this is an So here’s some cognitive behavioral techniques. 33:58 So the cognitive techniques of cognitive restructuring like reframing, reappraising, thinking about a situation differently in a more positive light or a different way, challenging your thoughts, these are really powerful tools but they take practice, right? 34:15 So we know that and a lot of times we use other aspects of Externalizing thoughts, like pretend the thoughts outside of you so you’re talking back to it, you’re talking back to your OCD, you’re talking back to your anger. 34:29 Self-talk is a really key component, especially with anger control, telling yourself to stay cool, I control my anger. 34:36 And then relatedly, using some kind of monitoring or thought tracking can be really helpful, writing down what you’re thinking, tracking patterns. 34:46 There’s a program that I forgot to include in here, which I’ll mention at the end, that is good for schools for self-monitoring. 34:52 I’m blanking on it now, but I’ll make a note to bring that up or add it later. 34:57 But you can even have that in school. Positive thoughts are really important. Don’t forget that. 35:03 Sometimes we forget that is a really good intervention. 35:07 Also, goal setting can be very important for, you know, having a goal to work on, you know, improving certain behaviors. 35:15 A lot of people are not always as motivated as we like them to be to work on these things. 35:20 Journaling is also another, you know, way to get your thoughts out and kind of work through it, talk about your emotions. Stop and think is a strategy that is pretty straightforward. 35:31 People have different ways of writing this out, stop, opt, you know, think, go, all those kind of different words there. 35:38 But the basic idea is that you kind of visualize something or think to yourself, stop, to kind of in the moment kind of stop your thought. You might want to count or something to three. 35:48 You could add different different aspects to that, but it’s a good a good thing for an in the moment reminder for someone to kind of pause, even though it’s very hard to And then some behavioral techniques if it’s especially anxiety or other areas that someone’s really upset about you can work on exposure to face fears or desensitization. 36:05 Sometimes with sensory processing that’s also helpful to get more and more use of something so you don’t have a strong of a response, right? 36:12 You decrease the sensitivity to something. 36:18 Activity scheduling especially for depressive or lower mood where you focus on someone getting active and busy and moving along and having some kind of scheduled reminders to calm down or prompts, practices every day, that can also be helpful and visual aids. 36:36 So examples, using a thermometer, a stop sign, posters. 36:40 A kid recently told me he does not like the posters in his counselor’s office because they’re too positive. 36:46 So I don’t know, I mean, you can’t win sometimes, but it’s good to have posters, kids do look at them. 36:53 So this is still cognitive behavioral techniques, but I just divide this next tier into relaxation strategies because these are more for in the moment or calming strategies, so they’re under that category. 37:04 So the classic ones that most of you know about but are really essential is practicing some kind of slow breathing, a belly breath, diaphragmatic breathing, rhythmic breathing. 37:13 There are countless ways that people talk about doing this. 37:17 Everyone seems to think that the way they learn is the way, but it’s whatever works for you, right? 37:21 So the main idea is that by breathing more slowly and rhythmically, and often, if you can, if you have time, breathing more than just once slowly, like taking a minute or more, you can activate your parasympathetic nervous system. 37:38 So that’s the whole idea is you have a voluntary response to calm a more involuntary response in your body. 37:46 So when we’re anxious or upset, it activates the sympathetic nervous system, we wanna kind of decrease that. 37:51 So whether it’s box breathing or breathing, looking at a picture of a triangle or belly breathing or holding your breath. 38:00 I also, I don’t really think you need to hold your breath for 12 seconds or more. 38:04 Usually I like a five, breathe in for five, hold for two, breathe out for five. 38:09 Young kids turn blue sometimes if you have them hold their breath for too long. 38:13 Progressive muscle relaxation and you’re progressively tensing and releasing your muscles to relax your body. 38:19 That’s another relaxation technique that doesn’t involve breathing. 38:21 That’s been around for maybe a century now, I think since the 1930s. 38:26 So it’s a pretty old technique that’s been around for a while. 38:29 Using calming sensory items. 38:31 So fidget items or, you know, any kind of calming object or, you know, some schools have sensory rooms. 38:41 Could be a smell, could be tactile, could be something with temperature. 38:45 I know someone was telling me when they’re angry, their suggested technique was to get an ice cube and hold it, and the coldness of the ice cube would remind them to cool off, and they liked holding it. 38:59 Enjoyable activities is also a common one, and these seem pretty obvious, but these are what most people do, right? 39:07 They might color if they’re feeling depressed, or they might listen to music, play games, video games, go for a walk, look at their phone. 39:16 So they’re important to not underestimate how those activities can be helpful. 39:19 Sometimes hard to do in a school, but if someone really is having a tough time, you know, that’s something you consider. 39:26 Positive self-talk and imagery, mindfulness in yoga, some kind of distraction is really also commonly used. 39:34 Sometimes trying to actively ignore, count backwards or to 10, and then sometimes people use apps. 39:43 But also a really common strategy is talking to a support person like the school counselor. Social-emotional skills. 39:51 This is an important, really important piece for emotional regulation is teaching and reinforcing these skills. 39:56 So feelings identification, developing some kind of keep calm plan using these strategies, developing empathy, perspective taking, an awareness of others and self, communication skills, relationships skills, social problem solving. 40:10 And some people like to use social stories to kind of put these strategies into action to kind of talk about. 40:19 So social story involves writing out a story where you have, and there’s a whole model for it, but the general sense is you’re putting the skill into the story and reading the story and working on the story with the child. 40:33 I’m doing a real injustice to that, but we have so many skills to get to today, so I’m not gonna focus on that. 40:37 Here’s some examples. 40:38 if you’re looking for concrete items to take home or get to help with this. 40:45 So here’s a few evidence-based CBT tree packages. 40:48 These are more for the anger and challenging behavior area, and some of them you might know about. 40:53 I really like the manual called Cognitive Behavioral Therapy for Anger and Aggression in Children. 41:00 It uses an evidence-based, it’s evidence-based and especially anger control training, which has been around for a while, which involves a lot of the we just talked about kind of put into a package, monitoring emotions, relaxation, responding to anger provocation, and it involves social skills training and problem solving training. 41:22 So those are some key aspects. Anger control program, which is similar. 41:26 This one’s probably more designed for groups, but it can be adapted for individual. 41:30 Similar, it has goal setting, the anger management strategies and problem-solving skills. 41:38 Aggression replacement training, for schools, groups, you could use it for individuals if you adapted it. 41:44 This is for very challenging youth, so people that might, kids that might’ve been sent to jail or really having problems with conduct, but you can adapt it. 41:54 So this includes those components of skills, and also, sorry, there’s a typo here, guys, moral reasoning. 42:02 So there’s a component to where they really talk about the morals of their behavior in that training. 42:07 And then there’s Coping Power. It’s been out for a while. They’ve really expanded. 42:12 It was more of a 37-week, multi-year kind of program that was put out in a manual, but now it seems like they have a whole website and program. 42:20 But this has social competence, self-regulation, and parental involvement components. 42:26 And you can pick and choose. You could just use certain aspects. 42:30 You could use it in individual sessions, for groups, but if you’re looking for a program for a school or something, that’s a good one to use. 42:37 It has a lot of elements to it. 42:39 Like I said, we’re not gonna get super in detail on anything, I’m just giving you the overview. 42:44 And also, people think about the third wave cognitive behavioral therapies, so DBT, and accept as a commitment therapy. 42:51 DBT, I would say, is probably the default for a very, very large majority of therapists out there for treating lots of conditions. 43:03 It’s really packaged nicely in workbook format to work on very concrete defined skill categories. 43:12 So you can just kind of pick and choose, or you can go through the whole program and use different skills. 43:17 So they do have a category for emotional regulation skills, even though the whole program can help with emotional regulation. 43:23 One that I like to use, I put a picture up on here, a lot for kids in the moment is the stop skill to think about stop, take a step back, observe, and proceed, right? 43:34 So I know there’s schools and programs that use this all the time. 43:40 Also, opposite action is a skill that is used a lot for DBT, where you focus on noticing your emotion that might not be helpful for you and focusing on an opposite action of what you want to do. 43:53 So if you’re feeling sad to become active, if you’re feeling scared to face your fear, if you feel like you want to fight, walk away, those kind of opposite actions. 44:03 So it’s very helpful. 44:04 And I’ll give you some, there’s a workbook I like for kids for that in the back. 44:10 And acceptance of command therapy also includes some mindfulness in those aspects, but especially for teens, it can be helpful as a way to kind of add some acceptance to their feelings and appreciation, and also has a good section with looking at your values and kind of having committed actions, so kind of moving forward. 44:30 Like I said, I’m just putting these tools out there to consider, and we’re not going to get super into them, but if you have questions, I can answer them later. 44:39 So let’s talk about in the moment strategies. 44:41 This is what people think about a lot with the most regulation. What do I do when my kid I’m with is having a total meltdown? 44:47 The main goal is de-escalation. The main goal is to stabilize. 44:53 You need to realize that it’s not the time to air grievances. It’s not Festivus airing grievances. You’re not solving problems. 45:01 You want to just stabilize the situation by having everyone calm down. 45:06 Very simple, easy to remember keywords. If a kid knows a keep calm plan, you say, let’s use our keep calm plan. 45:12 Or if it’s a self-injurious behavior, let’s safety plan right now. 45:15 If you’re doing DBT, stop opposite action are really great skills to kind of point out right there. 45:22 And often includes encouraging someone to talk, self-talk, calm down, think positive thoughts, distract, count, some relaxation, some action steps, walking away, going to a quiet room. 45:36 Sometimes there’s physical release, punching a pillow. I would say use sparingly. 45:40 You don’t want to encourage getting violent, but if someone really is going to always put a hole in the wall and you want to have a punching bag or something, it’s like you got to decide if that’s worth it. 45:52 So I don’t always put that one out there as a strategy unless it’s already an issue and we want to kind of gradually move till not hitting things. 46:00 We might move to something soft first. 46:04 And then co-regulation is the biggest part. 46:06 It’s, you know, one of the biggest parts is as the adult, you need to keep calm and be a calm present in the room. 46:11 We’ll talk about that in a few slides. 46:13 These are just, this is just something I use a lot with kids For in the moment management, sometimes you just got to break it down into key areas. 46:21 This isn’t make a nice word, but it wasn’t like an acronym, but really want to motivate yourself to manage your emotions. 46:29 Why do we want to behave? 46:30 Why do kids sometimes behave great in school, but not at home? 46:32 Maybe they’re motivated to not get in trouble in school, right? 46:35 So it’s important to work on that. 46:37 That’s an issue. 46:38 I really need to keep my cool. 46:41 Being better at being aware of yourself, so the early warning signs that you’re starting to have trouble in your environment, right? 46:47 What’s going on around you so you can kind of, you know, know what to do. Obviously reappraisal and suppression of emotions. 46:53 So in the moment, these are two things we want to do. 46:57 We want to think differently about it, give ourselves some time to think if we can. 47:01 And if we need to suppress, we need to calm ourselves down, walk away and breathe. 47:05 And then social problem solving, because a lot of times, if you can solve the problems, then you might not have, you might have less triggers. Crisis intervention. 47:13 This is key. The goal is to deescalate. 47:16 We talked about crisis here is more of an individual mental health, not school-wide like active shooter. We’re talking about individual here. 47:24 It’s good for everyone to be trained. 47:26 The main idea is that people lose rationality as they become more highly emotional. 47:33 As they lose rationality, you want to use more simple levels of communication, less words, less talking, just setting limits, right? 47:42 And this, it really is important you pay attention to your nonverbal communication, your listening, and you give simple instructions. 47:48 So, a really good model for those of you who have done CPI training, Crisis Prevention Institute, you know this, you’ve probably been drilled in it many times, but I think this is a really nice model, simple. 47:58 When people are starting to get mostly dysregulated, you know, the first stage of call is anxiety stage, you’re starting to get, show those warning signs, you still have control. 48:07 You want to have a supportive response. You go ask someone like, hey, what’s up? 48:10 Are you okay? You can have more of a defensive response. 48:15 When someone gets defensive, it’s the next stage. They start verbally acting out. 48:19 At that stage, they start losing rational control. 48:21 You want to set limits and have a very clear response. Like, stay here. We’re just staying here. 48:28 We’re just keeping calm. Sit down. You don’t really need to get into a big discussion. 48:32 You’re setting limits. 48:34 When someone’s physically acting out, that’s where you may want to get safety or restraint training, and then you want to kind of re-establish rapport once the tension reduces and they start to calm down. 48:50 This is not, you know, just to cover this here because of emotional regulation, this comes up. Obviously suicide assessment, safety plan, safety contract. 48:56 I have a resource I’ll show you at the end, Columbia Suicide Severity Scale. 49:01 Free Evidence-based, really good. 49:03 You can get trained on it. 49:04 Anyone can access it. 49:07 That’s a good one. 49:08 Really focuses on the key areas, having obviously the history and then getting a sense of the ideation, active and passive, a method, intent, plan and behavior. 49:18 Safety plan, I have on here aspects that if you wanna make a safety plan with somebody, you wanna indicate the warning signs, some internal coping strategies, some social situations that people can distract you if you want other people around, people I can ask for help from, agencies to contact, 9-8-8, 9-1-1, making environment safe and regular check-ins. 49:44 I think it’s important to have, most therapists have this template for that. 49:50 Safety contract, I was commenting on, it’s not always recommended. 49:55 So sometimes verbal might be better. 49:57 Writing it down doesn’t always mean someone’s not gonna act on it. 50:01 It doesn’t really have, there’s not a lot of evidence to support it and it doesn’t really provide much liability. 50:08 So, you know, it’s usually not, usually it’s okay, but it’s just something to consider that I don’t think it’s, it’s sometimes talked about as a major thing, but it’s just not always needed. 50:19 Sometimes verbally just saying, are you going to be okay? 50:21 You promise you’ll call, that’s better than having them sign something. 50:25 But a lot of people like to do the signing. 50:28 Okay, collaborative problem sign, there’s a whole webinar on this, but it is important for emotional regulation is to cover the basics. 50:35 The whole premise is when an expectation or demands place on a child and the child does not meet them, adult has three choices. 50:42 Plan A, you do what the adult says or else. 50:44 Plan B, collaborative problem solving. 50:47 Plan C, the adult lets it go. 50:50 So plan A is like, adult imposes their will, like this picture, because I say so. 50:56 Plan C, permissive, you just let the kid do what they want. 50:58 Plan B, you do some kind of collaborative problem solving. 51:00 and the model is that kids do well if they can, not if they want to. 51:03 So it’s not that the kids are just doing well because they’re motivated to, it’s that these kids have lagging skills and they have a lot of trouble, so they need help. 51:10 So we’re gonna collaborate with them and model for them how to do this. 51:14 So I put on here the collaborative problem solving steps. 51:16 I’m not gonna go through all of them right now, but I’ll just highlight the first one, empathy, right? 51:21 Where you really wanna, when a kid’s really sticking, they’re not totally losing control, but they’re really having a tough time, you could ask them like, what’s up? 51:29 Instead of saying, you should do what I say, you could take a sidestep and say, what’s up? 51:33 Can we talk about something? 51:35 I’ve noticed, right? 51:36 So you’re non-threatening, you’re trying to calm them down and trying to talk it through. 51:41 Clarity problem solving is usually best done after an event happens, when it’s calm, but you start off with kind of a non-threatening empathy. 51:50 After the kid talks, you drill down with them, define the problem, the adult says their concern, and then you brainstorm solutions together. 52:00 Function-based interventions are really, really, really important. 52:04 Often times people do ABC data collection as a standard, you know, protocol to just, I want to see what the current, the usual patterns are and what’s going on, what are the usual antecedents, and you could, sometimes interventions really show themselves to you when you collect a little data, you go, okay, well this, you know, if we don’t turn the TV on at 5 o’clock, then there’s never meltdowns, you know, something like that might just pop out at you. 52:30 But really you want to, you develop interventions based on the before, during, and after, right? 52:35 The antecedents, you might want to change the environment, change triggers, you target certain behavioral skills and teach them, and then you modify consequences. 52:45 So you could have some kind of behavioral plan, you know, charts, modifications to teach, reinforced skills. So parent interventions. 52:59 So parent interventions are really key, and they can be involved in a lot of the interventions we really talked about. 53:03 So these are just more specific. But parent self-care is really important. I want to point that out. Burnout is really real. 53:10 And getting a team together could be helpful for parents, right? Their own support. 53:15 Learning about your child’s condition is also really key, especially if there’s ADHD or other conditions like that can give you some kind of empathy or because it can be, even if you know, it can be very frustrating that you’re, you know, 70 year olds still not getting it, you know, and they’re still having a hard time. 53:31 Parent management training is, is, is a, you know, longstanding treatment that for parents where it kind of goes over some key aspects of behavioral management of kids. 53:43 So, you know, active ignoring effective commands and timeouts, consequences that are logical with younger kids using play. 53:53 And then for some, for younger kids, parent-child interaction therapy can be very helpful because it directly involves the parent and the child, you know, working together and the therapist kind of directs the parent. 54:08 And there’s like a child-directed phase where the parent just learns to kind of follow the child’s in the parent-directed phase of the child, they practice setting limits. 54:19 And so that is really good for also working on co-regulation, so how a parent will respond to those moments. 54:26 They have modified it for younger and older than that, but that’s kind of like the key age for parent-child interaction therapy. I know we’re running short on time. 54:35 Did you want to do any, I don’t know how much, Katie, I think I went over, so did you want to do any polls or Yeah, so I mean, it’s 7.56 right now. We can do another poll. We don’t have to. 54:46 I just want to make sure that we have time for Q&A. 54:50 I’m going to just blow through the next couple slides and then we’ll do Q&A. 54:53 Is that all right? 54:54 Of course. 54:54 Okay. School interventions. 54:56 I know there’s a bunch of school people on here and a lot of the things I talked about already could be done in schools. 55:01 And I’m going to give some resources. 55:03 But for parents, especially it’s probably more, you know, you want to sure that if a kid needs some kind of accommodations, they’re getting them, you know, an iron arrest, 504 IEP, if there needs to be some kind of behavioral intervention plan, some kind of modification system, counseling, training staff on safety if the kids are really getting dysregulated can be really key. 55:26 If your school does not have that and you have getting hit by kids, make sure you have some kind of CPI or handle with care training for your own safety and liability. 55:37 Some schools will have a quiet room, a quiet corner, a reset room, sensory rooms are becoming more common in schools. 55:45 For more severe cases, obviously kids might need to go to a more therapeutic school or setting where there’s more staff and resources to handle them. 55:51 The environment, at some point you need to change the environment, right, to really help kids that are really struggling. And regular communication with parents. 55:58 I do want to point out sports and extracurricular activities because this is important. 56:02 This is often a major source of dysregulation for kids. 56:07 Having really poor sportsmanship, having a difficult time handling a loss, or striking out in baseball or something like that, you know, having a bad basketball game. 56:18 So a lot of kids struggle in the sports field. 56:20 They might even struggle that much in school or at home, but sports might be a trigger for them. 56:25 So it’s really important that the players, the coaches, and parents really help the kids. 56:32 Coaches sometimes are not, you know, not always thinking about the mental side of it, but it’s important for parents to kind of let coaches know and work with them. 56:41 But helpful strategies could be things like using positive self talk, visualization, having kids kind of talk themselves through, having some kind of minds in the moment or relaxation strategies for the kids to practice during their sports, looking at triggers. 56:59 All the other skills we about could be important here, but these are some that are more commonly used for sports. 57:06 But obviously it also involves regulating motions for optimal performance. 57:10 So sometimes people are not assertive enough in certain sports, so you might need to kind of do the other end where you need to get a kid to be more aggressive or assertive in a sport, and that’s another aspect as well. 57:22 So co-regulation, we talked about this a little bit. It focuses on de-escalation and support. 57:28 You want to empathize but set limits, you know, you’re not going to let you do whatever they want, but you want to kind of be there and be a calm presence. 57:35 Remember, just you being calm, if you’re physically calm, it helps cool the room. 57:39 Think about it like an ice cube going into a hot cup of tea, like you just being there is helping cool the room down. 57:46 So you want to listen and set limits. 57:49 This is important, is manage your nonverbal, paraverbal, which is how you say what you say. 57:55 so your tone, volume, cadence, and your proximity, like don’t stand in someone’s face if they’re really upset, like give them the right, so just some of this really at the bottom, it takes finesse, right? 58:08 You just kind of have to know, and sometimes it might take some coaching or help, or one parent might need to tag out for another parent to come in. 58:15 Sometimes this is something that you can work on with siblings who are older or even younger is to teach them at least, even if you’re not going to be co-regulators responsibility, but how do you respond when your sibling is really acting out and how do you keep calm? So this is an area that’s really important to focus on. 58:31 Okay, and there’s a lot of strategy in here, but I threw it into a chart. 58:35 Sometimes if it’s really complicated, you might need to see where everyone’s, what’s going on. 58:40 So you know, if you look down the center, it’s okay, what do we do when someone is deescalating or they’re escalating and we want to deescalate and get to safety? What happens when they’re really upset? 58:51 Okay, What are we doing when they’re not? 58:53 What are the things we’re doing medically and in school at home? 58:57 So it’s important sometimes that someone’s really having trouble to think about all the different aspects of before, during, and after, and the different areas for intervention. 59:07 I’ll just put this up here at the end for tech and then we’ll get to questions. 59:10 So a lot of people are using tech. 59:13 Many people use it, and the most common is just to distract themselves, right? 59:16 How many kids just get through a tough thing by looking at their phone, right? 59:20 adults, too. Neurofeedback and biofeedback. The research is generally inconclusive. 59:27 Some people find it helpful. Monitors, brainwaves, heart rate, other internal indicators. 59:32 There’s a game I’m going to show you a resource to called The Mightier Game that was developed by I think Harvard. 59:39 It’s online, it costs money, but there’s a video game that kids can play with a heart monitor strapped on them and the game helps them regulate their as they are playing. 59:48 It’s part of the game. 59:50 There’s some wearable devices. 59:52 I just want to point out Monarch is out there. 59:55 There’s really not much research on this. 59:56 I’m not saying it’s bad or good. 59:58 It’s just, it’s much easier to get a medical device of FDA approved than medication approved. 1:00:03 So sometimes if you see a device and it says it’s approved, doesn’t mean it’s had the level of research done on it. 1:00:10 So just always kind of use it with caution. 1:00:12 Talk to your doctor about it. 1:00:14 And I’m not really sure if Monarch is really making that much of a difference. 1:00:18 I don’t think there were that many studies, but it might be worth a try. 1:00:23 Mental health apps, MH apps, there isn’t a lot of research on it, but a lot of people use them. 1:00:28 It seems like the mindfulness exercises are particularly helpful and CBT. 1:00:34 Now, I could have done a whole thing on mindfulness. 1:00:36 I know I didn’t do mindfulness justice in this talk, but it’s in here. 1:00:40 I just had to put a lot in here. 1:00:42 So resources, I’m going to put these up here and I’m going to show you a really quick thing on with the computer browser of a couple things and we’ll move to questions. 1:00:52 So I just put a collection of them. 1:00:54 So there’s a children’s book, a self-regulation workbook for kids, The Explosive Child, which is the collaborative problem-solving, a really nice CBT activities book for kids. 1:01:06 It’s a nice workbook. 1:01:07 A card game called Mad Dragon that’s like Uno. 1:01:10 This is that CBT manual for anger. It’s really good. Another CBT manual. 1:01:18 There’s a little spot emotional regulation box set, which has all these little stuffies in it, and it can be a nice kit to have in a school. 1:01:26 And then some people buy things for a calm corner, right? 1:01:28 So companies like Amazon or Lakeshore have, and you can go, you can spend like $1,000 on a beanbag chair and things to hang in the room. 1:01:37 So some programs, zones of regulation is a really program. It covers all these areas. It has some sensory components as well. 1:01:45 I love Social Decision Making, Solve Problem Solving. It’s the Maurice Elias program. 1:01:49 The Nurtured Heart, which a lot of schools, some therapeutic schools use. 1:01:55 It has, it takes an approach where they really work on how they are, what they’re attending to. 1:02:01 It’s kind of like planned ignoring of the negative behaviors, There’s really reinforcing positive behaviors and setting clear limits and goals. 1:02:09 There’s DBT programs and groups which are used very often in coping power. 1:02:14 Some other resources, the Calm App, Headspace, Moshi Kids, Ninja Kids, Cosmic Kids, Yoga, these are all some things. 1:02:24 So I’m just gonna show you some links. 1:02:26 You can look at these later and we’ll do questions. 1:02:30 Just really quick, can you see my screen? 1:02:34 Hopefully you can see it This is the also we talked about Cloud or proms line is the newest one. 1:02:41 You could just check the boxes if there’s different skills you’re working on This is the suicide assessment the Columbia Protocol There’s lots of different versions of it, but it’s really straightforward. There’s research. 1:02:56 There’s ways to get trained on here and This is a good one. 1:03:05 Cosmic Kids Yoga. 1:03:07 You can see this. 1:03:14 So it’s just kind of a free video series, which is just relaxation and makes it fun for kids. 1:03:21 And the Zones of Regulation, they had a book out, but they’re actually launching a digital version with a subscription, which is really exciting because these are some pictures of it. 1:03:29 They were, you know, they’re gonna, you can basically kind of do it on the computer or a tablet and kids can kind of answer questions. 1:03:36 The zones really include, you know, blue zones where you’re not very activated. 1:03:42 Green, where you’re kind of feeling normal. 1:03:44 Yellow, a little bit more activated. 1:03:46 Red, very activated. 1:03:48 So this one is something I think it’ll be really good to have in schools once it comes out. 1:03:52 I know a lot of people have the physical book. 1:03:54 And this is the video game, Mightier, that you can look at. 1:03:58 Everything costs money, but they kind of have kids kind of visualize their emotions with technology. 1:04:05 They learn different calming skills, and you could practice and apply. Okay, so sorry about the long talk. 1:04:12 Hopefully people are still here for questions and yeah, do you want me to not share my screen? 1:04:19 Yeah, you can end that. 1:04:22 Okay, so real quick, I know we’re running a little late. 1:04:27 For those that need to hop off, thank you so so much for attending our next presentation, Navigating Parenthood Practical Guidance for Supporting Your TS Child is presented by Jeremy Lickman, and it’s scheduled for Wednesday, May 22nd at 7 PM. We have more information on that on our website. 1:04:48 This webinar will be archived to our website at njcts.org under the Programs tab, and we’re going to hop into Q&A, and I’m going to stop the recording.


  1. Alexandra says:

    Do you have any recommended resources for parents on de-escalation in general?

  2. LaFerne says:

    how would you modify some of the strategies to accommodate developmental stage of preschoolers?