Before the Meltdown: Recognizing and Responding to Early Signs of Nervous System Overload in Children

[music] Welcome to Episode 267, before the meltdown, recognizing and responding to early signs of nervous system overload in children, featuring Dr. Roseanne Kapanahage, licensed professional counselor. Make sure to subscribe to be alerted about future episodes by clearly clinical, learn, grow, shine. [music] If you only take one thing away from this training, let it be this. Children never go from calm to chaos without warning. Their nervous system always tells us first. Most adults simply have not been trained to recognize the signs. Hello and welcome. I'm Dr. Roseanne Kapanahage, I'm a licensed therapist, certified school psychologist and an author with more than 30 years of experience working with children, adolescents, and family struggling with emotional and behavioral dysregulation that feels intense, unpredictable, and overwhelming. Across these decades of clinical work, one pattern has become increasingly clear. We are seeing more children with more overlapping diagnoses than ever before. While our diagnostic systems have expanded, our interventions have not always kept peace with what's actually happening in children's brains and nervous systems. Let's ground this in what we know what is happening right now in the world. Current national data shows us that approximately one in five children in the US have a diagnosed mental health, emotional or behavioral condition, rates of anxiety and depression in children, as well as adolescents have increased dramatically over the past decade, and as we all know, particularly during this pandemic period. And some estimates show increases of more than 40 to 60% in adolescents alone. ADHD now affects roughly one in nine children, and the majority of these children experience co-occurring, emotional dysregulation, anxiety, and behavioral challenges. We are also seeing a rise in complex presentations that don't fit neatly into a single diagnostic category, and children are being referred for emotional outburst, school refusal, aggression, shutdown, chronic irritability, and moodiness, sudden personality changes. Conditions like pants and pandas, if you haven't listened to that episode that I did with Elizabeth, please do, because it's awesome. Conditions like pants and pandas, while still unrecognize affect a significant number of children, often present with abrupt severe dysregulation that leaves families and clinicians shaking their heads, and wondering what's happening they're looking for answers. These are no longer fringe cases. These are the children and adolescents that are filling their offices, classrooms, and increasingly emergency rooms. What this tells us clinically is not just that children are struggling more, it tells us that their nervous systems are under unprecedented strain. Yet most clinical models still train us to intervene after behavior escalates. We wait for the meltdown, we wait for the school refusal, the terrible grades, the shutdown, and then we respond with consequences, skill building, insight oriented talk therapy, or behavioral plans. By the time we're doing that, it's already too late, because by the time dysregulated behaviors appear, the nervous system has already crossed over that threshold of activation. One of the biggest gaps in child and adolescent mental health care right now is night diagnosis, it's timing. We often ask children to regulate, reflect, comply or problem-solve after their nervous system has shifted into that flight, flight or freeze survival mode. And at that point, the parts of the brain responsible for executive functioning, emotional regulation, impulse control, and flexible thinking are no longer biologically fully accessible. And that's why so many well-designed interventions fail with dysregulated kids, not because the child is resistant, not because the parents are inconsistent, but because the brain is simply offline. This training is designed to help you intervene earlier at the level where change is actually biologically possible. So regulation first parenting is not a parenting trend, it's not permissive care, it's a neurobiologically informed clinical orientation, so that we're clear on the order of how we support kids. The core principle is simple but powerful because it's based in science. No learning insight or behavior change can occur unless the nervous system is regulated enough to support it, not perfect regulation, but regulated enough. Regulation is not a reward for good behavior, regulation is the foundation that makes good learning possible. When we adopt a regulation first lens, we stop asking what's wrong with this kid, and instead we ask what's happening with their child's nervous system right now. This single shift changes everything about assessment, intervention, and outcomes. Behavior becomes information, not evidence, like often how we are trained, emotion becomes a signal, not a problem, and dysregulation becomes something to respond to, not control. So why does early recognition matter so much? Children do not suddenly become dysregulated most of the time. When they are, we really do have to think about what it could be, right, trauma, victimization, pants pandas, something sudden we have to look at. But most of the time it creeps in over time. Nervous system collapse is a process, not an event. Before a meltdown shut down or explosive episode, the nervous system sends warning signals. These signals typically show up as overstimulated or under stimulated behaviors. Over stimulation may look like increasing irritability, impulsivity, sensory needs, emotional intensity to small things, escalating silliness even. Under stimulation may look like withdrawal, fatigue, disengagement, zoning out, or even emotional flatness. When the cues are missed or misinterpreted, the child moves closer to that collapse. And once collapse occurs, recovery takes significantly longer, because right, that nervous system isn't regulated enough to respond. That's why early intervention must happen before behavior explodes, not during it, right? And we get caught up in that trap as parents, as clinicians, because we're not seeing those signs of early dysregulation. So I want to say this, that nervous system first framework is also ethically and culturally important. Behavior-based interpretations are vulnerable to bias. Cultural norms around emotion, communication, authority, and expressiveness very widely. And what may be labeled as defiance, disengagement, or emotional dysregulation in one context may be culturally normative in another. And I think we know that, but it bears, you know, it's really worth repeating. Physiology is not subjective. When clinicians focus on nervous system signals, such as breathing, peace, tone, muscle tension, or recovery time, we reduce the risk of labeling kids with clinical diagnoses, or over-path-ilogizing children, particularly from those from marginalized communities, and communities where there is a lot of trauma. A regulation first lens moves us away from judgment towards a clearer path of attunement to what is actually happening in the nervous system. So here's what we're going to cover in this training. We're going to focus on five core learning objections. It's really identifying those early warning signs of nervous system overload in children and adolescents before over-disregulated behavior appears. We're going to differentiate between typical developmental stress and nervous system collapse using clinical indicators and context clues. I'm going to explain how nervous system dysregulation contributes to behavioral presentations that we commonly say ADHD, ODD, and so on. And we're going to apply the principles of regulation first parenting to guide early intervention strategies for families. I'm going to walk you through what it looks like and we'll integrate co-regulation techniques that clinicians can teach parents to stabilize the nervous system before that escalation cycle really just starts spiraling out of control for both a child and the family. And throughout this session, I'm going to share clinical examples, case instructions, therapist language and practical strategies you can immediately use in your work. Disregulated behavior is not a failure of motivation character or parenting. The physiological signal that the nervous system is overwhelmed and when we intervene earlier at the level of regulation, we change that entire trajectory of care and how people respond to care. And to do this effectively, we must first understand the science. So we are going to explore the neurobiology of regulation, emotional hijacking. And what happens to the brain when stress takes over that prefrontal cortex? This is a science that is the foundation of regulation first parenting. So to intervene early, we must first understand what's actually happening in a child's brain and the nervous system under stress. And remember, stress can be real or imagined. It's what that nervous system perceives as a stressor. We forget that. And we have to teach that to parents. So we're going to focus on three core scientific concepts that form the foundation of regulation first parenting. First, how the autonomic nervous system organizes behavior around safety and threat. Second, what emotional hijacking is and how it shuts down learning. And third, what happens when the prefrontal cortex goes offline during stress? Together, these concepts explain why behavior changes so dramatically when children are dysregulated. And why timing is so much an clinical intervention in and of itself. So let's talk a little bit about the autonomic nervous system and neuroception. So at all times, a nervous system is asking one central question, am I safe? This question is answered through the process called neuroception. And neuroception refers to the nervous system's unconscious scanning of the environment for cues of safety, danger, or life threat. And it happens below conscious awareness. A child does not choose to feel and safe. Their nervous system detects threat automatically based on sensory input, past experiences, internal states, and relationship, relational cues, I should say. When safety is detected, the nervous system supports regulation, connection, and learning. And when threat is detected, the nervous system shifts into survival mode. And this happens in a very fast automatic and involuntary way. And this is why a lot of times we often think kids are doing things on purpose because we can see them shift and we don't really understand why. And that's because their nervous system is determining is this safe or not. It doesn't have to be logical to us. It is how their nervous system is interpreting their environment. This is why interventions will work well in calm moments and fail completely during dysregulation. And that's also why you see the lack of generalization depending on their state. So the child is not unwilling. It's rather, I want you to think, is the nervous system available or not? So emotional hijacking is a really important concept for clinicians to understand. I think we see this. I think we see this with parents. I think we clearly can see this with kids. And it occurs when the amygdala detects threat and rapidly activates the stress response before the cortex has time to process the information. The amygdala is fast, the cortex is slow. When the amygdala perceives danger, it sends a signal to the hypothythalmus to activate the sympathetic nervous system, a release stress hormones such as cortisol and adrenaline. What's that happen? Which happens in milliseconds? The brain prioritizes survival over reasoning. This isn't just a metaphor that people are talking about. All these quote and quote, quote, coaches out in the world. And AI heads out there talking on the internet. This is really a biological shift that happens when the body that really prevents our kids from absorbing all these beautiful therapeutic interventions or teaching them and even good parenting. So the prefrontal cortex is that third component that really you need to understand. So it's responsible for executive functioning. That's the job manager of the brain. It does everything from working memory to integrating information from different parts of the brain, moral reasoning, decision making. And when we are under stress, that blood flow and neural resources are redirected away from the prefrontal cortex toward survival circuits. And that means that kids are not going to be able to problem solve thing through consequences. Use maybe those coping skills that you know last week, you taught them. And they really can't shift their perspective. Asking a dysregulated child to calm down, use your words, make better choices, assumes that the brain state is regulated, but that's not what they're in, right? And that's why regulation first is so critical because we're going to talk more about how simple it is and why it is the missing stuff. But stress itself is not the problem. Moderate time limited stress can enhance focus in learning. The problem arises when stress load exceeds your regulatory capacity. I'm going to talk a lot about capacity because I want you to really start thinking about that with kids and parents. So they have the capacity, right? So today kids, their capacity is just completely overloaded with regular demands. Academics, I mean, holy cow, three decades of working with kids. I used to do neuropsych testing. I can't believe what kids have to do in school. They don't have downtime. They have constant sensory stimulation, constant device dysregulation. They don't have unstructured downtime. They don't have boredom to just regulate. And we also have inconsistent adult regulation supporting kids who are dysregulated themselves. And so this adds to the load of the nervous system. And when it accumulates without sufficient regulation periods, micro regulation periods throughout the day, the nervous system shifts more quickly into survival states. And it's then going to take a much longer time to recover. This was why some children appear to overreact to small triggers. The trigger is not the cause. It's the final drop in an already full stress cup. OK? That's that capacity. And this is why regulation first is a neurobiological necessity. And we must regulate first because a nervous system must feel safe before learning can occur. The prefrontal cortex must be online before skills can be accessed. And co-regulation is required before self-regulation develops. It is a necessary component. We need the bar of the safety of our parents. When kids don't have that, we have a lot of issues. So this isn't a parenting philosophy, even though this is something that I am so heartily behind, it's really how the brain works. And when clinicians align intervention timing with nervous system state, outcomes improve across diagnosis. It doesn't matter what the diagnosis is. That is, I hope, something that's really going to stick with you today, because so many of us were working sometimes feels harder than our clients. So understanding this sequence allows clinicians to intervene earlier more accurately and more capacially. So now that we understand the science of regulation and dysregulation, we're going to identify next what is nervous system overload. How does it show up? And we're going to talk about over stimulation. Then we're going to talk about under stimulation as early warning signs of nervous system collapse, which again, we're seeing more and more and more of. And then kids are getting labeled, right? So we understand how the nervous system organizes behavior around safety and threat. I gave you super cursory information. Bessel Vander Kolk has a lot of great information just about trauma. So we have to identify those early signs of over stimulation, because over stimulation is a physiological signal that the nervous system is carrying too much of a load. And when we miss these early signs, we actually often intervene late or and/or we often miss label kids with clinical diagnoses. And it is because our stress cups of the trial and the parent are full. So let's talk about what happens in the nervous system, right? Stress adds up in our cup. It can become chronic. And a place where a child is not getting relief. And the nervous system can't downshift without that support. It's offline because it's agitated. So what are some of those common signs? Things that make sense, increasing irritability, emotional intensity, reactivity to small things, heightened sensitivity to noise, touch transitions. Transitions is a big one. Impulsive behavior differs. difficulty waiting, escalating silliness that feels dysregulated rather than playful. And these are things that happen with frequency. Rapid speech or pressure talking, physical restlessness or pacing, rigidity, difficulty shifting between tasks. And again, those emotional reactions that seem disproportionate as well as poor recovery. And these kids are, you know, they're labeled a lot of things, particularly ADHD, but you're going to see attention seeking, oppositional out of control. And again, what we're seeing is a child that is struggling to discharge excess activation. And, you know, why do we miss kids? A child may be, you know, over stimulation is frequently missed because at first it might be productive. You might see them being more talkative or energetic or funny or highly verbal. And then it can shift into some of these other escalating behaviors where there's a lack of regulation at the right time, the intensity frequency and duration of these behaviors really start piling up, right? And, you know, in young children, overstimulation may show up as running, crashing into things, emotional volatility, those difficulty transitioning, which, again, I want to have put a little bit of a caveat on that because that's developmentally normal. So it's, do you teach them and does it stick? How often are you having to re-instruct and in comparison to their peers? What's happening? Sensory dispensiveness. For school age kids, we might see more of that impulsivity, difficulty sitting, emotional outbursts. Perfectionism starts showing up at this point because the pressure of school increased defiance particularly at home. And then in adolescence, again, we want to say what's normal in developmental, but is the intensity frequency and duration so outside of the norm, irritability, emotional overreactions, rigidity, anxiety, mass, disengar, and increased conflict with caregivers and people in their lives. So when, without a nervous system, lens, these patterns are often interpreted as willful behavior rather than physiological overload. And over stimulation can also be highly context dependent. So a kid may be peer-regulated in a classroom, but melting down and really a hot mess at home. And this doesn't mean their behavior is manipulative. We know this as clinicians. We spend a lot of time explaining this. But what it does mean is that their nervous system is being held together at school, often because of the structure, often because of the fear of looking dysregulated at school, but then they shift with those demands that happen at home. And when we miss things, I want to talk to you a little bit about a case I had with an eight-year-old, who was becoming increasingly silly and loud during a therapy session. And this is somebody I was doing clinical supervision with. And the therapist initially engaged with humor, really kind of doing some rapport building. And as the session continued, the child began to interrupt, ignore, bound, raise, knack over things, really start to get physically out of control. And then the clinician really said, this is an impulsive kid. And we weren't seeing this across the board. I think that's important to really understand. But from a nervous system perspective, the early signs of over-stimulation were already present. And that what was happening is that he was needing some time to downshift, not additional engagement. The therapist was actually trying to engage instead of providing a commerce base, which is hard for therapists because we want to go in and fix. But we actually have to teach regulation. And when we intervene too much by trying to provide relief, we can make things worse, right? So common clinical mistakes that people make when we see these kind of bigger behaviors, moving is increasing verbal input when the nervous system needs quiet, adding consequences instead of regulation, escalating demands, and interpreting behavior as intentional. So each of these increases the threat and pushes a nervous system closer to collapse. Over-stimulation is a nervous system warning, not a behavior problem. And when we recognize those cues early, we can shift earlier and we can reduce escalation and support the nervous system before it collapses. So now let's talk about early warning signs of under-stimulation and shutdown. So most people think of dysregulation they picture chaos. They picture all those big behaviors. But we also have to think that nervous system class can be far quieter and easier to miss because it can be shutdown as well. And what you can see is all of those early behaviors where flat-affect, low energy, low speech, zoning out, emotional numbness or detachment, heavy reliance on screen and solitary activities. And in simple terms, a nervous system is deciding, I can't fight this and I can't run away from this, so I'm just gonna shut down. It detaches and those signs of under-stimulation can be misinterpreted as lazy, depressed, defiant, unmotivated. And it doesn't mean there isn't a clinical issue there. We're really talking about what are the nervous system signs and how can we help get kids back online? You can have dysregulation with clinical issues, but I often see these under and overstimulated behaviors with kids that really don't have a clinical issue. They have a nervous system issue. So I hope that's an aha moment for you. So why is it often misinterpreted? Because we can see these behaviors across developmental stages. For example, in young children, under-stimulation may look like disengagement from play, passivity, maybe minimal emotional expression because they're overloaded or difficulty initiating interaction. As school kids, it could be task avoidance, low frustration with withdrawal, not anger, because that would be overstimulation. And with adolescents, we can see social withdrawal, school refusal, excessive sleep, disengagement masked as apathy, I don't care, right? And these patterns are often misdiagnosis, depression, defiance, lack of motivation. And again, under-stimulation is very dependent on the situation you're in. So we may have environments where it's quieter, and you might start to see that they're more regulated. And on the opposite, they might be less regulated and loud environments and vice versa. It really depends on that person. So for example, if a 14-year-old who becomes silent when asked about school stress, the therapist interprets the silence as a resistance or avoidance to increase in questions, but from a nervous system perspective, the adolescent has already crossed into shutdown. Continued verbal demands increases threat rather than engagement. The appropriate intervention is not more processing, it's regulation and presence, right? So common clinical mistakes we make when kids are shut down is interpreting withdrawal as non-compliance, talking too much, increasing those verbal demands, pushing for insight before regulation and assuming a kid doesn't care. And this is just a nervous system response because it's the safest option it really has. So let's talk about how do we differentiate between typical developmental stress and nervous system collapse and how to make that distinction clinically without pathologizing normal behavior. So one of the most important clinical skills that I have learned to develop because I have such complex layered cases in these three decades of working with kids and families, but that ability to distinguish between normal developmental stress and nervous system collapse is something I don't think we talk enough about, especially in a time when kids feel like I just see kids shut down, shut down, shut down. And there's so much behind it, right? Parents personalize their behavior. We can have teachers, personalize behavior, and then we're unsure how to best help because we're dealing with people who think kids are doing this on purpose. This is a nervous system saying, I don't know what else to do, so I'm just gonna turn off. And we tend to push skills, expectations, and consequences, a lot with kids in this world, and all that does is increase dysregulation. And that's not to say we don't hold the bar for kids. What I'm saying and all of this and we've gotta regulate first before we do those things and soon to be end of clients as I retire from clinical care. And when we make mistake normal stress for pathology, we risk over intervening and undermining resilience. But let me slow this down and make it clinically clear because stress is not the enemy. Stress is not harmful. In fact, manageable stress is essential for development. It helps children build frustration talents, tolerance, problem solve, and as I mentioned earlier, build that all-important emotional resilience, which is something they're gonna need now in the future. soon future and for the rest of their life. Because if we don't have resilience, we are walking around with a cup that is always overflowing and that nervous system is going to react to everything. And then we develop clinical issues if you don't have them already. So moderate stress activates the nervous system without overwhelming it. The child may feel challenged, frustrated upset, but they retain access to executive functioning and recovery. And in these moments, kids can tolerate discomfort, recover with minimal support, maybe even, you know, some support or none at all, they can still remain flexible, access language and breathing and use previously learned coping skills. This is stress, not dysregulation. And that's an important distinction. And when you see kids who are beginning to not be able to use those skills, you know they're in a dysregulated state. That is the answer. And there has to be a constancy in it. We're not talking one off. So we all have time to we're very overloaded, right? I think everyone can agree. So what changes when stress becomes collapse? Nervous system collapse occurs when stress exceeds the child's regulatory capacity, right? That's that word I want you to remember capacity. And the nervous system can no longer maintain balance. At this point, the nervous system shifts into survival mode that prefrontal cortex goes offline and behavior becomes driven by an autonomic response rather than choice. Clinically, collapse looks different from stress and several key ways. So when evaluating a child, listen, observe for the following markers, the child cannot recover without adult intervention. Emotional reactions are disproportionate to the trigger. And this occurs with some consistency. Flexibility is lost. Language becomes limited or unavailable. Reasoning fails. Behavior escalates or shuts down quickly. The pattern repeats across different contexts and situations. There must be an intensity, frequency, and duration here. These are not one-offs. If they're one-offs and we have a highly just stress trial, please figure out what that is, right? I think we're help our parents to figure that out, right? And that's not typically what we're seeing. We're seeing kids as therapists that have the pattern. A simple and powerful clinical question is simply this. Can the child return to baseline independently or do they require co-regulation to recover consistently? When recovery consistently requires adult nervous system support, we're no longer dealing with typical stress. So I love to talk about my stress cup model all the time because it's such a great visual and it's also a great way to talk about regulation first and stress and how it overloads the system with your clients. Every child has that stress cup. Every demand adds to the cup. Academic demands, sensory, emotional, social pressure, food pressures, transition, illness, all of it, fill your cup. Regulation empties the cup. When the cup is moderately full, children can tolerate stress and recover. When the cup is closed over filling or overflows, collapse occurs. The behavior you see at collapse is not about the final trigger. It's a cumulative load. That is so important because we as clinicians, I did hundreds of evaluations and did hundreds or thousands of evaluations, hundreds of school observations and they would always be looking for the trigger. The set the waste stress works. And yes, we can look at triggers and we can try to control the environment so that there is capacity for the child to learn the skills, not constantly dampen. That's a big shift in our culture because we're moving to constantly dampening things and then kids don't have skills. But it moves away from that single incident explanation in toward pattern recognition. I often would describe myself as neo in the matrix and I would look at all this data and all these patterns. Of course, I had the luxury of brain maps, but even just in behaviors and listening, you really start to get a sense of this kid has a cup that's just too full. Everything's hitting it. Stop looking for the one thing. What can we do to help them regulate in those moments in between dysregulation? That's what the nervous system wants. Developmental considerations are always really, really important. Young children have smaller stress cups and fewer internal regulation tools. Adolescents have greater capacity, but often face much higher stress loads, particularly with academics and behavior that represents typical stress in one developmental stage may represent collapse than another. That's why we always must have age appropriate expectations. And as clinicians, we got to help our parents have age level expectations because holy cow, I feel that we've really have these expectations for kids. They're so unrealistic. And so we take those expectations and we pair it with nervous system capacity and teach about that. So one of the things I love about regulation first, having worked in many environments with people all over the world and all over the United States is that it differ. It has a cultural and contextual sensitivity because it differentiates stress from collapse, but also requires cultural humility. So expressions of emotions, frustration, tolerance, communication styles, expectations vary across cultures. We know that, but then does every parenting, does every technique, does it follow that? I think not. That's why I always went to the brain first. But what is defiance in one context? Maybe self-advocacy in another. What is withdrawal in one context? Maybe respect in another. So when we focus on physiological cues, like breathing changes, muscle tension, pacing, recovery time, impulse control, there's so much more reliable indicators than the behavior alone. A nervous system lends reduces bias by shifting from interpretation to observation. That's important because we don't want to over pathologize kids because to me, clinical diagnoses are buckets of understanding. I'll talk a little bit about that. But here's what we often make mistakes when we're looking at collapse and when it's mistaken, just for stress, right? Stress escalating consequences, increasing cognitive demands, pushing for insight, framing as intentional. We can't make those mistakes. So each of these increases perceive threat and deepens dysregulation when collapse is recognized accurately. Intervention is shifted towards stabilization rather than correction, which happens an awful, awful, awful lot. So I'm going to talk for a little bit about rethinking common clinical issues as dysregulation. It's something that I see again a lot. And we do, I think there are sometimes we don't diagnose enough or properly. And I think a lot of times we over pathologize kids. I feel that the majority of kids I have have a shopping cart full of diagnoses, summer accurate, summer not, based on clinical data from a brain map, but also just great clinical intakes. Having such complex cases, and that is the bulk of what I do. I have a lot to say about intakes. And so much of what we do has to rule out and we forget that. It's a differential diagnosis. We don't always give diagnoses. And you also can wait. Sometimes parents or schools can pressure us to give a diagnosis. And some of these need a little time to really understand what's going on. One meeting isn't going to do it. And maybe sometimes one meeting will do it. Certainly has happened to me where I'm like, what's going on? Right? So why does nervous system dysregulation so often show up as ADHD, anxiety, oppositional behavior, mood instability? And you know, we know that there is such an increase in clinical diagnosis as I mentioned at the top, particularly since the pandemic. Okay. We know right before the pandemic suicide rates increased, but anxiety, depression, medication use, just a skyrocketed. I have never seen, I've had more OCD cases in the last six years than I had the previous 20 years combined. I mean, probably times two, to be honest. And that's not to say we're getting better at diagnosing ADHD, which I OCD, which I think is somewhat true. I think there are just higher levels of dysregulation. And we're just seeing more complex clinical cases. Right? So across diagnoses, right, doesn't matter if it's ADHD, anxiety, oppositional behavior, OCD, panspandas, we're frequently seeing the same underlying mechanism, nervous system that can't reliably regulate when the nervous system is chronically overstimulated, right? That stress cup is full. Children may appear impulsive, emotionally reactive, anxious, oppositional, and that attention becomes inconsistent. Flexibility drops, emotional responses, escalate quickly, typically, its anxiety, it could be a learning problem, they have an attention problem because their nervous system is too dysregulated to allow them to think. That is a real shift in your thinking. We are struggling to support these highly dysregulated kids and families because I don't want to exclude their families. But when these behaviors are interpreted as problems with self-control and motivation, when the reality is your system is just stuck in a hyperarousal. And when the nervous system shifts towards that under stimulation, that presentation looks different, but it's still stemming from the same overload. Children may show those withdrawn, disengaged, unmotivated, depressed behaviors. In these cases, a nervous system has moved to conservation mode because mobilization no longer feels safe or effective. So many kids and families I see just shut down because they've done this, they've done that, and they're really pretty hopeless, which makes me deeply sad and big part of what I'm doing. But from a regulation first perspective, these are not separate problems. These are different nervous system strategies for managing stress. Healthy or unhealthy, it's still the nervous system's way of responding to stress. We know as therapists we can support that and we can change that. We can really bring people to a place of regulation and hope and health. And I really want to implore that because we've got to turn on the hope meter peeps for our family. But this is also explaining as I talk about the shopping cart diagnoses, why so many kids carry those multiple diagnoses. Sometimes they're just layered on, sometimes they shift from one to another. When the underlying dysregulation is not addressed, system shift rather than resolve. What begins as anxiety may later look like oppositional behavior or OCD, what appears as ADHD may look like mood disorder or shutdown later. In conditions like pans and pandas, a relationship becomes especially clear. Sudden neurological changes can rapidly disrupt regulation, leading to dramatic behavioral and emotional shifts. These cases remind us that behavior follows brain and nervous system function. And that's not to say there is an infection or toxin trigger. What that's to say is that that nervous system in these shutdown or overloaded states does not prevent the body from moving forward and healing. And I've seen that time and again and also seen that when we regulate, we create huge changes in regulation and then learning new ways to manage stress and whatever is going on. So viewing the behavior through a nervous system lens reduces diagnostic and cultural bias. Instead of interpreting behavior through those assumptions about intent, compliance and characters, clinicians are really going to assess these theological state. So you want you to ask, is the nervous system overstimulated or shutdown? Can the child recover independently? What increases regulation? What overwhelms it? How long is it taking them to recover? How frequently are these episodes? These are the questions that really help you to understand what is going on. It moves us away from judgment, which most therapists aren't doing, but we're constantly dealing with people that are judging and really towards attunement and of course guiding our clients to a path of reducing dysregulation so that they can feel happier, less anxious, all those clinical things that are bringing them to the table start to reduce. That is incredibly important. So just to understand, you really have to digest that different diagnosis often reflect the same underlying issue, a nervous system under strain. Now, the nervous system under strain can produce similar look-alike issues, but they also can really exacerbate a clinical issue that is there. So I don't want to say that it's a replacement for diagnosis. It's just to understand this is part of why some of these cases are treatment resistant and don't resolve. I love to talk more about that, but that's a whole other topic. So let's talk about co-regulation, how regulation is learned. So if a nervous system dysregulation is driving behavior, the next critical question is this, how does regulation actually develop? And I don't think we talk so much about this. I remember this as like a blip in my learning in the mid to early, no, no, the early to mid 90s into the late 90s. We didn't talk too much about this. This sort of became independent learning and this is why you're here and I really hope this is, you know, not the first time you're hearing it, but maybe the first time you're hearing it and understanding how useful this can be and how much you can integrate this into your already the work you're doing. So the answer is this, it's not through insight, instruction, or consequences. Regulation develops through co-regulation. It's a neurobiological process that's not a parenting style before children can regulate themselves or their nervous system relies on the presence of a more regulated adult nervous system to stabilize it. It's really that emotional anchor and it's how the brain develops. I mean, we know that remember, remember the Reese's monkey experiment where they could choose food over a soft monkey. And if they chose a soft monkey, the little baby monkeys would pass, that's because we need that softness, we need that there. And that's how important work than comfort is for our own nervous system. So what is co-regulation biologically? So from a nervous system perspective, it occurs when a regulated adult provides cues of safety, that the child's nervous system can downshift out of survival mode. And it includes cues like vocal tone, predictable pacing, non-threatening body language, emotional steadiness, physical and relational presence. And through these signals, the child's autonomic nervous system detects safety and begins to move at a fight, flight, or shutdown in response to everyday stressors. In simple terms, the adult nervous system leads and the child's nervous system follows. And this is why co-regulation has become sort of a term, disorder, and parents worry they misunderstand it. They think it reinforces bad behavior or kids dependent on it, prevents learning self-control. But the neuroscience tells us the exact opposite. So it develops through repeated co-regulatory experiences, children internalized regulation by first experiencing it. Without co-regulation, a child does not become independent. They remain dysregulated. And effective co-regulation must match the child's nervous system state. When a child is overstimulated, co-regulation means reducing language, slowing movement, lowering pace, increasing predictability. When it's overstimulated, it means that it needs very gentle engagement, warmth and presence, like movement or sensory input, and minimizing verbal pressure. Using the wrong strategy for the wrong state increases dysregulation and reduces your ability to regulate. And that's why some well-intent interventions actually backfire. I see this a lot in educational environments, but also see really regulated teachers doing beautiful things. So clinicians play a critical role. And they can help parents better understand. And they can help reframe dysregulation as biological, model regulation in session, really show parents roleplay it out and coaching parents on timing rather than control. Getting rid of those ideas that kids are acting like this on purpose, but it's so prevalent. I don't care what ethnicity, where your background is. We are still the number one way we parent is from our parents. And those messages still get sent down. And regulation versus a way to break that, because we focus on science. There's no personalization in it. And I found it to just be incredibly effective and really helps parents to get on board quick. And we have to help parents regulate themselves first. They have become so overwhelmed, right? The American Psychological Stress in America Survey, 2024 says 50% 48% of parents are overwhelmed. 41 are so overwhelmed they're almost immobilized. I mean, I'm not surprised by that, but it's a reality is affecting our kids. When it's applied out of order, right? Parents will say it doesn't work when it's applied early consistently. And, you know, just keeping it real simple, starting with that whole regulation and getting parents to regulate themselves so that they have capacity in their cop. It's pretty dramatic. What can happen? I can't emphasize that enough. We often look for big event interventions like medications and neuropsych testing and neurofeedback. I mean, you know, all these things that we've all recommended are even done with our own kids. We have to regulate nothing's going to stick. So, you know, in terms of, you know, how we actually apply this, right? You know, I have a case study for you. So I have Ellie and after school, homework refusal, out of control behaviors, highly overstimulated, and this is how we use the comms protocol. So instead of correcting behavior, Ellie's parents were taught to slow the environment down, lower their voice reduce the stumble of doing community auto trafficking and mortgages reduction language. Stop the demands and instead saying you need to calm down they started using tools to register when they were away for themselves and and them because otherwise we were going to be stuck. So then A avoiding lighter saying, they had to stop watching this or disrespected. This was a major initial system. So there's a nervous system just regulation without saying she's doing this on purpose. This is where the magic happened and they had capacity in their nervous system because they're regulating themselves to be able to do this. Then L we started to look for root causes. What overwhelmed her nervous system today? So then you started to see okay, here's here's these are the triggers and they started sprinkling in more regulation activities in advance, not waiting for the blow up and then the M the modeling. So they practice regulation activities along with her. So they say go do your breath work. Let's go for a walk or pause. Pause is my favorite. They started doing this with her and that's when again starting to change, reinforce, breaking the shame cycle and then the S support and reinforce. You got to practice some more and had to really teach the parents like you don't do this one time when you really need to unlearn and learn something out. You know, learn something new. This takes time and the meltdown started to get less intense than fewer and then eventually extinguish. And Ellie was much better able to manage these things on their own, right? So common pitfalls that therapists make with the comms protocol, right? So they skip co-regulation and go start to explain. They expect immediate change. They return to consequences or allow the parents to return to consequences too quickly. Now that's a whole controversial thing we can talk about it, but it works best when parents when you're emphasizing timing and repetition, not perfection. I talk about 80% perfection. I don't want parents to be perfect because they're going to be afraid to do anything. They're also going to really think the child needs to be fixed. This is a system issue. We have to help parents move away from co-disregulation to co-regulation. So this is just the comms protocol is just a framework, this teachable repeatable and grounded in this neuroscience. That is where we need to really help parents. For sure. So at this point, most clinicians are asking, what do I do differently in the session tomorrow? And this is not you're not doing a whole new treatment model. It's a shift in sequencing observation and coaching. So the most important thing, right, is that when a child is dysregulated, the goal is not insight problem solving or skill acquisition. It is stabilization. And there's one critical internal question you need to ask before you work with a kid in your office. Is this child regulated enough right now to benefit from what I'm asking them to do? If the answer is no, then you need to work on regulation first. And therapists, you know how to model regulation, but you can add in regular regulation, activities, sensory activities, breathwork, heart math. There is a list of things. So, Mattics, you know, as much as I'd love to share everyone with you, I'm trying to give you the basics. But there are so many amazing things. And we have to teach parents regulation first language. We got a show in my brain, teaching about the nervous system. I love to make a little A n s with the parasympathetic at the bottom. And I want to make a little A n s with the parasympathetic at the bottom. And it's sympathetic at the dominant at the top. And really just explaining like here, here, or given the cup analogy and really help them. And then assigning regulation based homework. Literally writing out. Here's what I need you to do. Okay. I might get out your phone. I want you to put in five times during the day for two minutes. Whatever you want to do. And then you're going to have to do a little A. And then just do a little A. And then troubleshooting common challenges. Right. So regulation is being attempted too late. They're going to say it didn't work. It's the strategies didn't match the nervous system state. The adults are too regulated themselves. They need to be much more refocus in your sessions on the parents or they need their own therapy. And that's incredibly interesting. We need to be able to see them and understand your path. Throughout this training, we're consistently returned to one central truth behavior is a signal of the nervous system state. Not a measure of will, motivation or character. When we intervene at the behavior alone, we often intervene too late. When we intervene at the level of regulation, we actually change the whole system. We're working with receiving. Right. So what we have to do when we acknowledge rate that the reality that you all are facing rates of clinical and behavioral issues are rising. Presentations are more complex. Families are overwhelmed to say to put it mildly. And many children are entering care already operating near the edge of nervous system capacity. And when we explore the science behind this regulation, first, you're really looking at how the autonomic nervous system organizes behavior around safety and threat, how emotional hijacking shuts down the prefrontal cortex, and why children can't access skills when they're already dysregulated. And from there, right, we talked about the over and understimulated nervous system and the signs of nervous system under load. And what we do before behavior escalates and how they're often misinterpreted and misunderstood and lead to clinical diagnoses, which may or may not be appropriate. And we always have to consider what's their nervous system state, what's the developmental level, what tools do we have? We often focus on the tools before we say what's their nervous system. So let how regulated are they? What do we need to do to support co-regulation through the teacher, through grandparents, through caregivers, through the people that are supporting and hopefully loving this kid, no matter what age. And why this matters more than ever is because we're in a dysregulated world. People are on edge. It's kind of scary out there in the world. And there's an intensity and our kids are absorbing that and parents are getting better and better. And it's kind of scary out there because it's kind of scary out there. And it's kind of scary out there. that nervous system to regulate. It works. So I just want to say thank you for the work that you're doing commitment to seeing children and parents through a nervous system first lens. And I hope you're as excited as I am about this. And I know that when you implement nervous system first work and regulation first parenting, we really are going to change mental health. You've just finished listening to another exclusive continuing ed podcast by Clearly Clinical. If you like what you just heard and you need continuing ed credits, please visit us at clearlyclinical.com to check out our one year membership where you'll have access to our growing library of continuing ed podcast courses. Clearly clinical where our goal is to help you learn, grow and shine.