Beyond Behavior: Chapter 9

The final chapter of Dr. Delahooke’s book describes the innovative work of New York State’s Center for Discovery.  Clients are fitted with a wristband that is able to measure stress and generate information on stress contributors. This method allows pairing “the physiological state with observable behaviors.”

The National Institutes of Mental Health is now looking into underlying processes instead of only viewing DSM diagnostic categories. They are integrating both behavior and the neuroscience behind it. There is hope for a better way, even if it is slow to come.

What We Can Do Right Now

Since the brain is neuroplastic, it is open to evolve and change.  First, we must begin to view behavior with a new mindset.  We need to remember that behavior is a child’s adaptation to experiences in their lives.  As humans, we are predisposed to a “negativity bias.”  This was an adaption from millions of years surviving from predators.  This is one of the reasons we experience hypervigilance when caring for children and are on high alert to protect them from harmful conditions.

In spite of the negativity bias, we can replace negative thoughts with regular positive experiences.  As the positive begins to out way the negative, we will become more optimistic.

Children need nurturing relationships and experiences to build healthy social emotional skills. 

There are many places where Dr. Delahooke and Dr. Bailey overlap in their teaching.  Dr. Delahooke talks about how teachers can intentionally create positive morning experiences.
This Conscious Discipline chart explains how you can do this.

Here is an example of Conscious Discipline's Brain Smart Start:

Dr. Delahooke ends her book with these reminders for working with children:

• Look at children warmly and lovingly without judgement
• Allow the child to choose the activity he/she would like to do with you
• Take relaxing walks outside
• Sit down together for meals and talk without media or television
• Carve out time for play and fun
• Plan opportunities to move the body
• Bring music into your lives sing and dance

I really enjoyed reading this book and I recommend it to anyone that wants to look deeper into behaviors.  There are many worksheets included in the book for you to use when analyzing what is going on behind the behavior you are seeing.  There are worksheets to help determine individual preferences.

Although, there is overlap between the strategies in this book and Conscious Discipline, this book went deeper into the causes of behavior enabling a person to tailor strategies specifically to the child. It has added more skills to my "teaching tool belt."

Chapter 8: Beyond Behavior

The “adverse childhood experiences” (ACE) study concludes the more trauma a child experiences, the more likely they would be to develop problems with their health, relationships, and behavior.

Check Your ACE Score

Children with a score of four or more are “32.6” times to be diagnosed with learning disabilities and behavior issues. Dr. Burke Harris has studied the effects of high ACE scores on children.
When an MRI was performed on the brains of children who had been victims of extreme stress, it was discovered that these children had a hippocampus that was diminished in size and an enlarged amygdala.  The hippocampus is important to the development of memory and regulation, while the amygdala is in charge of fear responses.

Regular exposure to stress interferes with health brain development.  

Children with behavior problems due to childhood trauma are often put on behavior plans that involve rewards and punishments.  These plans fail because they don’t help the child regulate their responses to stress.  Instead, they retraumatize the child because most of them fail to earn rewards and are most often punished because of their inability to regulate their behavior.  These punishments can lead a child into more stress, only increasing their red pathway behavior. 

These types of discipline are not recommended for children of trauma:

• Physical punishment
• Isolation
• Shaming, blaming, ignoring
• Point systems for behavior
• Yelling, screaming, degrading

Children of trauma many times have bizarre or extreme behavior issues.  This makes it difficult to create relational safety, although this is the only way to retrain the brain’s overreactive stress response.  Supportive environments are filled with predictable routines and opportunities for choice. They are also filled more positive experiences, than negative. They begin with bottom up support to strengthen social emotional development.  

According to Dr. Bailey, the most important influence to help a child build resilience is at least one stable, committed relationship with an adult.

This podcast describes how to connect with a child who is relationship resistant.

The younger the child is when exposed to extreme stress, the more vulnerable they are for having an impaired stress response system.  The youngest children have no way to escape or fight off these threatening situations.

Chapter 7: Beyond Behavior

This chapter begins with a story about an autistic student who had a habit of snapping in class.  As he moved into second grade, the teacher his teacher found his behavior disturbing.  She asked for interventions to diminish the behavior.

This lead Dr. Delahooke to ponder whether the behavior should be corrected or if it was serving a purpose.  Many misunderstand the behavior of autistic students.  They fail to look at the individual differences or respect the way in which these children have adapted to the neurotypical world.

In the case of the child who snapped his fingers, it was discovered that the behavior was a coping strategy for anxiety.

Many autistic children suffer from over-responsivity (which is sensitivity to sensory input).  They also have trouble with anxiety, digestive problems and sleep issues, because they suffer from high stress. Many treatment plans ignore this problem instead focusing on social skills, communication and behavior.  As we know these top down skills will not be mastered until safety and connection are addressed.

“In this case, the message is that diversity of movement and behaviors shouldn’t be automatically judged as negative.” p.207

Using composure and acceptance, we could lovingly say:

• “It looks like you felt something, sweetheart. What might that be?” p.226
• “It seems a bit difficult for you to sit up straight right now. Perhaps you can prop yourself up right next to me with this nice pillow.” p.222
• “It seems that you feel it’s a bit noisy in here.  Feel free to grab your headphones if you need to.” p.223

Click here and here to read stories about people who are on the spectrum and have struggled with sensory issues.

The next story is of an autistic girl who sang during inappropriate times and was not able to keep her hands to herself. After trying reinforcement of desired behavior with disappointing results, it was decided that the child would get three chances to comply.  If she failed on the third attempt, she would be taken to a quiet area with her aid. 

The first time she was taken to the room she returned quietly and seemed calm.  In actuality, she was on the blue pathway as the experience traumatized her.  She began refusing to go to school, became afraid small rooms and locked doors.

Elizabeth Torres, a researcher, has studied autistic behaviors and how they are attempts to deal with bodily difference.  These adjustment and adaptations like “stimming”, lack of eye contact, repeated routines could be coping skills to deal with stimulus in the environment with a sensory system that is wired differently than neurotypical people.

For more information, click here.

Instead of trying to eliminate these behaviors, explaining them to others, such as students or other adults, will generate acceptance and understanding.  Ignoring the behavior is not a good approach as there maybe medical reasons for them.  Ignoring also decreases our connections with others and is very stressful to nonspeaking autistic children.

Helping Neurodiverse Individuals:

1. Realize that the child may understand what is happening, but that they may not be able to show you that they comprehend the situation.
2. Find help for a child that is nonspeaking or not communicating.
3. Build safety and connections with the child to facilitate risk taking.

Chapter 6: Beyond Behavior

Dr. Delahooke begins the chapter reminding us about using IDEA, behavior tracking, and early experiences.

Inquire:  Find out the child’s history and look for behavior patterns.

Determine:  Try to figure out what is distressing the child.

Examine:  look at for causes and triggers

Address: support with interactions developmental problems that are causing behaviors.

In another case study, after tracking and learning the child’s history, it was discovered that a child’s preschool bullying experience had left him on the red pathway when interacting with others.  This trauma had skewed his perception and he interpreted ordinary interactions as threats. The result was that he hit others. This instinct was subconscious and the child could not explain why he hit others. Certain sounds, sights, sensations, and experiences were triggers leading to regular overreactions. 

It is important to note that what causes trauma for one person, may not cause trauma for another. 

The treatment plan was to hire an aid to provide him with a sense of safety when he was moving toward the red pathway.  The teacher also helped provide cues of safety. When the child moved toward the red path, they would move closer, speak calmly, and use reassuring facial cues and body language.

Tracking behavior it was noted that the child was developmentally behind in problem solving with peers. The team decided that “play” would be a natural way to develop this skill.

“Play allows for children to integrate and use bottom-up and top-down functioning in real time.  It’s one of the most therapeutic things we can do with children” (p.176).

Therapeutic Developmental play must:

• Involve an attentive engaging adult (In the case study, the parents played with their child.)
• Be enjoyable and safe
• Have a child driven plan
• Have mutual engagement (no distractions)
• Not include teaching or questioning
• Have an adult embracing their character

The child’s play themes will highlight issues before a child can express these feelings. Play experiences provide safe opportunities to problem solve increasing self-regulation skills.

Dramatic play is not the only beneficial type of play.  Sports, games etc. are also valuable as long as there is engagement, conversation, and a sense of safety.

For more information on using play visit https://www.playproject.org/

Once a child demonstrates the ability to using top-down thinking, we can introduce self-regulation and teach problem solving skills. When teaching a state, it is important to be neutral and show appreciation for how they protect us.  We can help students recognize their own triggers and how they are feeling. We reinforce the idea that experiencing emotions and learning to manage them is a normal part of life. When the child recognizes their state of being, they can then be taught to problem solve and create their own solutions. (There is a sample lesson in the book for teaching children to recognize and name their state.)

Finally, Dr. Delahooke mentions the stigma regarding mental health and recommends as adults we talk about our emotions with acceptance. She recommends looking into the work of Brene’ Brown.

https://brenebrown.com/

Chapter 5: Beyond Behaviors

Dr. Delahooke begins the chapter with a case study about a little boy who had many behavioral challenges.  The four-step process she used to determine strategies to assist the child is IDEA.  This stands for Inquire, Determine, Examine, Address.

Inquire:  Find out the child’s history and look for behavior patterns.

Determine:  Try to figure out what is distressing the child.

Examine:  Look at for causes and triggers.

Address: Support with interactions developmental problems that are causing behaviors.

It is imperative to get a history of the child to gather information about prenatal experiences, the first few month of life, and early childhood.  Some forms you may want to use for this purpose are linked below.  (Dr. Delahooke has her own worksheets included in her book for use.) Developmental History Questionnaire

This is done in addition to keeping a behavior journal and tracking behavior for several weeks.  This should help identify triggers or patterns.  If patterns are not found, ask a wider variety of health questions such as sleep patterns, nutrition/food intake, regularity/toileting.  

In the case study, after history and behavior tracking were gathered no pattern emerged.  However, when general health questions were asked it was discovered that the child had poor sleep.  The first goal was to attempt to get the child to sleep regularly every night.  Then to determine what, if any, benefit that would have on behavior.

However, the daily tracking had to continue to find other patterns. Click here for more about Behavior tracking.

In doing so, the child’s parents recognized that constipation would increase tantrums as it was one of the child's stressors.

The child's plan to help sleep cycles began several hours before actual bedtime.  The plan included soft lighting and soothing music.  Screen time ended earlier and books were read.  Parents monitored their attitudes and voice levels to reduce stress on the child. After solving these physical issues, they then began address the missing foundations for regulation and attention.

Once sensory preferences are identified, they can be used to help a child calm him/herself.  (Food is not a recommended tool, as it is a risk factor for obesity.) Be careful in experimenting with these, as some sensory experiences have an emotional reaction attached, and could set off triggers.  Use of sensory preferences are to be used with an adult helping the child first.  This emotional co-regulation is the prerequisite to emotional self-regulation. 
Click the link to see a Sensory Checklist that might be helpful for you.

In working with a child who is in the middle of a tantrum, be gentle, slow, and provide cues of safety. When the child is more relaxed ask what helps him/her calm down. See Sesame Street's Dealing with Tantrums resources.

Children who are shutdown and withdrawn need to be given cues of connection and love gently.

Some children have an especially difficult time calming their bodies.  Activities such as sports, yoga, meditation etc. can help if the child finds these activities enjoyable. Once children develop the awareness of what their bodies are telling them they can learn self-care techniques.

Mindfulness Exercise for Children
These practices help the child settle and develop an awareness of their bodies. This leads to teaching a child how to care for themselves based on what their body is telling them.

Sending Friendly Wishes
This is a strategy that helps children send good thoughts to others and themselves.  This approach uses body up techniques, such as relaxing and breathing, paired with a top down method like guided imagery.
See more at https://www.susankaisergreenland.com/watch-1/friendly-wishes

Dr. Delahooke's concluding point is that you can use body up approaches to scaffold top down strategies.