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  • Dr Chris Moore

The Constellation of Regulation: Part 1 of the 3 Rs

At the end of 2020, I wrote a blog about the Arousal Continuum and how a child’s ability to learn and cope with different experiences depends on their physiological state.


https://www.epinsight.com/post/compensate-for-my-brain-state-the-arousal-continuum


Those who have been exposed to chronic stress and traumatic events may be more prone to shifting down the continuum to a state which is governed by the bottom parts of the brain. In Dr Bruce Perry’s Neurosequential Model of Education, he explains how children feel calm when the signals they receive from their body and the outside world do not feel uncomfortable, distressing or threatening.


But to get a child to the point where they can reflect and think abstractly, we need to start from the bottom up. Dr Perry recommends the “3 Rs” of Regulate, Relate and Reason as a physiologically appropriate sequence of engagement. This blog will focus on the first R – Regulate – and look at potential ways that we can provide the patterned, repetitive and rhythmic activities which create a sense of calm and safety.


Breathing


When you deliberately take a few slow, deep breaths, you will notice the effects of the parasympathetic brake on your arousal” – Bessel Van Der Kolk


- We can teach children to take slower and deeper breaths. The “coherent breathing” approach recommends aiming for around 5 to 7 breaths per minute. 5 breaths would mean inhaling for 6 seconds and exhaling for 6 seconds. A child with a longer torso may need an extra second or two added to both. You may want to start with 4 seconds for each if the child needs time to become accustomed to this routine. The key is to unlearn the habit of quick and shallow breaths.


- “Five Finger Breathing” can be a nice way to teach this coherence. Hold out one hand with the fingers and thumb spread out. Starting at the wrist, use a finger from your other hand to move up and down each digit. Inhale as you go up and exhale as you go down. “Square breathing” is another example of this, with 4 seconds for each side of the shape.


- To calm the nervous system, the exhale needs to be longer than the inhale. So if the child breathes in for 4 seconds, they should breathe out for 7 or 8 seconds. Again, go with what feels comfortable for the child in terms of the seconds. You can also visualise this on a shape. With “Rectangle breathing” the child would inhale as they trace their finger around the short sides and exhale for the long sides.


- Breathing through the left nostril, with the child using their finger to keep the right nostril closed, can be calming as it activates the parasympathetic nervous system. if you feel that they are lethargic and need more energy, try right nostril breathing or encouraging them to take a longer inhale and a shorter exhale.


Moving


When one of your children has lost touch with his upstairs brain, a powerful way to help him regain balance is to have him move his body” – Dr Dan Siegel and Dr Tina Payne Bryson


- “The Daily Mile” is a lovely approach which allows whole classes to socialise as they walk around the school environment or neighbourhood. Going out for a walk can be a nice regulating break from remote learning at home. We can also build in quick stretch breaks for the children to tense and relax their shoulders, arms, hands, legs, etc.


- More intensive movement like running and jumping is easier to incorporate during PE lessons, outdoor play and dedicated clubs. But even short bursts of jogging on the spot, star jumps and chair/wall push-ups can boost energy first thing in the morning or provide a relief from an extended period of sitting later in the day. Space hoppers, physio balls and jungle gyms can provide bouncing and hanging sensations. For children who love spinning, have a crash mat for them to land on when they play games like “Pin the tail on the donkey”.


- Consider how to add movement to seated activities. The child may like to have something to fidget with in their hands or the opportunity to scribble while they are listening to an adult speaking. Resistance bands on the legs of chairs can give something for the child to push and pull against with their feet. Wobble cushions and bean bag chairs can also enable the child to receive movement while they’re sitting.


- “Heavy work” or proprioception involves activating the muscles and joints. At home, this can take the form of carrying objects during chores, digging in the garden, brushing up leaves, shovelling snow, etc. In school, the child could be given responsibilities such as handing out books and materials, taking a message to the office and lifting and stacking furniture for special events.


Rhythm


The brain doesn’t just keep one beat; it has many drums” – Dr Bruce Perry


- The breathing and movement ideas above are examples of patterned and repetitive activities which can be very regulating for the brain. There are lots of other activities which allow children to follow rhythmic and predictable sequences. These include dancing to songs, yoga poses, rolling cars, marble runs, domino tracks and ball games.


- Musical beats can have a really powerful effect on the nervous system. Consider how to add tapping, clapping, drumming and stomping to different parts of the day. This might be when children are calling out the answers to a question, taking turns in a game, breaking down the syllables in a word, practising mental maths or even just lining up for a transition.


- Be mindful of the rhythm of your voice. We can really connect with children’s emotional states when we are expressive. Vary the tone and pitch of your voice to match how the child is speaking. Use animated facial expressions and funny noises at regular intervals when telling a story or singing a song. Humming and singing can provide auditory and vibrational input, while chants and raps can be creative ways for children to remember information and express their own feelings.


- We can incorporate rhythm into various play and social scenarios. For younger children, these can be old favourites like Simon Says, musical statues/chairs, hopscotch, skipping, obstacle courses and action songs. Group activities such as “Row Row Row, Your Boat”, “Tug-of-War” and parachute games can provide rocking, swaying and back-and-forth sensations.


Sensory Integration


Knowing the types of activities that a child seeks or enjoys gives us clues to the types of sensory experiences that we can use to help the child find calmness and relaxation in the physical body” – Dr Mona Delahooke


- Going for a listening walk to identify different sounds around the playground, home or neighbourhood allows you to incorporate various sensory inputs, depending on the child’s preference. They can imitate the sound, draw what is making the sound or act it out for others to guess what they are referring to.


- Sand and play dough offer lots of opportunities to engage in different tactile experiences, such as squashing, squeezing and rolling. If the child also enjoys visual and olfactory stimulation, we can add food colouring and pleasing scents. In drawing and colouring activities, we can make these more rhythmic by asking the child to trace around various objects or speed up and slow down their drawing in response to verbal prompts and music.


- For those who crave oral input by mouthing and chewing various objects, we can turn this into a play experience. They could blow bubbles onto different surfaces or play blow football with cotton balls. Some children may find it soothing to watch bubble tubes, lava laps and objects which spin or light up. There are lots of online guides and videos about making glitter jars – involving the child in the creation of the jar can help to personalise this method of regulation and again engages various sensory systems in the process.


- We should also schedule regular opportunities to help children achieve “flow” – that state of complete absorption where they are deeply focused on an activity and less aware of the passing of time. Some may become immersed in jigsaws, puzzles, Lego and other types of construction play. Others may enjoy writing stories or researching favourite topics and making collages/scrapbooks with facts and pictures. Activities such as learning a new song for an instrument or practising a baking recipe not only integrate a variety of sensory experiences, but they also provide a sense of challenge and accomplishment.


Grounding


Being able to be in the moment and appreciate the positive sensory experiences that we have is not simply enjoyable; it also elicits positive emotions that feed into overall well-being” – Dr Tina Rae


- For younger children, it may be as simple as “Say what you see” or tuning into nearby sounds – get them to describe their immediate surroundings in the here-and-now as a means of grounding themselves. With older children, you can pick a sense and apply some kind of pattern or sequence to the questions. For example, they can look for objects that start with each letter of the alphabet or find 5 objects with a particular texture.


- The 5-4-3-2-1 grounding approach is a really nice way for a child (and the adults supporting them!) to cycle through the senses and divert themselves from anxious thoughts about the past or future. This can involve saying, writing or drawing 5 things they can see, 4 things they can feel, 3 things they can hear, 2 things they can smell and 1 thing they can taste.


- Visualising a calm place or a happy time can help to interrupt negative thoughts. There are lots of examples online of visualisation scripts or guided meditation. I would keep in mind that we may interpret the meaning of this place or time differently to the child. Let them take an active role in agreeing the scenario and making the script.


- Practising gratitude can help the child to tune in the good parts of the day. “3 Good Things” can be a quick and simple way of reviewing these. Older children may prefer to write or draw these things in a journal. Gratitude practises within a group or whole class context can deliver fun interactions. Try games such as hangman, 20 questions and charades, where the group have to guess what one of their peers is grateful for.


What a child needs from you


When a flower doesn’t bloom you fix the environment in which it grows, not the flower” –

Alexander Den Heijer


Stress is contextual – there are many factors within the environment and in our own approach which may inadvertently trigger or sustain emotional dysregulation. Here are some things to keep in mind.


- You are the model: Rather than just making suggestions or telling the child what to do, a regulating activity will be more powerful when it is actively demonstrated. Show the child how to breathe in and out. Do some star jumps of your own. Create something with Lego alongside them. We also need to think about our own well-being. Do you need to make a self-care plan of regulating activities? Do you surround yourself with a positive support network? As Dr Bruce Perry says, a dysregulated adult cannot regulate a dysregulated child.


- Structure brings calm: Children will feel safer when they know what is happening now and next. In the school environment, this can involve consistent routines for starting and finishing a task, timers/countdowns to prepare for transitions and clear expectations for group activities. Share visual timetables, checklists, work systems and other successful strategies between home and school during the period of remote learning. Talk to the child about the kind of structure they benefit from in their work – key words highlighted, larger font, samples of the finished product, etc.


- Be proactive: One of the biggest mistakes we can make is waiting until the child has become dysregulated before we try to implement some of the above strategies. This can be futile as they’ve already reached the “point of no return”. Until they calm down, their sense of time, ability to process language and control over their impulses have all been fundamentally altered. Building in lots of “brain breaks” throughout the day will help them to maintain a more regulated state. Whether it’s at home or in the classroom, these only need to a be a few minutes at a time.


- Choice: The reason I refer to a constellation is because of the sheer variety of possibilities. We need to be respectful of individual differences when it comes to what is calming and soothing for a child. One child may love Lego, while another finds it incredibly frustrating. One may like the structure of 5-4-3-2-1 grounding, while another prefers to focus on just one sense. It’s essential that the child’s voice is heard in this process. This is why Louise Bomber’s idea of a personalised “Calm Box” of resources can be so helpful – we can schedule the brain breaks, while the child has control over what activity they do.


- Modify your communication: Once a child has reached a distressed state, we need to resist the urge to “talk them out of it”. It’s easy to jump to the “Reason” part of the 3 Rs sequence, when we actually need to think about whether our verbal and non-verbal communication is dysregulating. You may need to give the child space and sit further away (unless their behaviour poses a safety risk). Slow down your movements and relax your posture, so that you appear less threatening or antagonistic. Use simpler sentences and a softer tone of voice, if you need to speak at all. Just being present can be enough.


- Define the “Safe Space”: If the child benefits from a break in a nearby room, a quiet corner, a pop-up tent or another change in scenery, this shouldn’t just be used when they are anxious or distressed. It should also be a place that the child can go to with a trusted adult during the good times as well – where they can engage in flow activities and other soothing tasks. This means that the safe space is associated with positive memories and it shows that regulating activities aren’t just a reaction to difficult moments.


References and Further Reading


Bomber, L.M. (2020). Know Me to Teach Me: Differentiated Discipline for those recovering from Adverse Childhood Experiences. London: Worth Publishing Ltd.


Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. New York: W.W. Norton & Company.


Delahooke, M. (2019). Beyond Behaviours: Using Brain Science and Compassion to Understand and Solve Children’s Behavioural Challenges. Eau Claire: PESI Publishing & Media.


Hiebert, M., Platt, J., Schpok, K. & Whitesel, J. (2017). Doodles, Dances and Ditties: A Somatosensory Handbook. Denver: Mount Saint Vincent Home.


Perry, B.D. (2020, April 2nd). 4. Regulate, Relate, Reason (Sequence of Engagement): Neurosequential Network Stress & Trauma Series. https://www.youtube.com/watch?v=LNuxy7FxEVk


Perry, B.D. (2020, April 2nd). 5. Understanding Regulation: Neurosequential Network Stress & Trauma Series. https://www.youtube.com/watch?v=L3qIYGwmHYY&t=645s


Perry, B.D. & Szalavitz, M. (2017). The Boy Who Was Raised As A Dog: And Other Stories from a Child Psychiatrist’s Notebook (Revised and Updated Edition). New York: Basic Books.


Rae, T. (2020). A Toolbox of Wellbeing: Helpful strategies & activities for children, teens, their carers & teachers. Banbury: Hinton House Publishers.


Siegel, D.J. & Bryson, T.P. (2012). The Whole-Brain Child: 12 Proven Strategies to Nurture your Child’s Developing Mind. London: Robinson.


Van Der Kolk, B.A. (2014). The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. New York: Penguin Books.


Woodcock, L. & Page, A. (2010). Managing Family Meltdown: The Low Arousal Approach and Autism. London: Jessica Kingsley Publishers.



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