FREQUENTLY ASKED QUESTIONS

What percent of kids suffer from emotional dysregulation?

This is a tricky question to answer, because it is determined by how emotional dysregulation is defined. Studies show that about 3% of kids suffer from pediatric irritability. One study found that 9% of school age children present with symptoms of irritable-angry mood and temper outbursts. I think the answer lies somewhere in between as several diagnoses have symptoms of dysregulation, including ADHD, anxiety, mood disorders and autism spectrum disorder.

UNDERSTANDING What Causes Dysregulation?

There are several possible causes for a child’s inability to regulate their emotional systems and behave appropriately. Dr. Delahooke has a short youtube video that encapsulate the first question to ask:

Is your child intentionally misbehaving OR is the behavior representative of a stress response?

WATCH THE VIDEO:“The Most Important Question to ask about Children's Behavioral Challenges”

Unfortunately, many professionals assume that children who are acting out are doing so intentionally when they don’t respond to traditional behavior management. Professionals also assume that the parenting needs to be addressed and teach parents traditional parenting skills. However, when children are NOT intentionally acting out, traditional rewards and consequences can make the behavior worse.

Physicians and psychologists will also appropriately ask if the child has a history of trauma. If so, it makes a lot more sense why they may be behaving with a stress response. HOWEVER, some kids will dysregulate without a history of trauma, leaving professionals once again to question whether or not the parenting isn’t solid enough. If your child has no history of trauma and consistent parenting responses aren’t effective, it may be time to consider if BIOLOGY is playing a role in your child’s inability to control their emotions.

What mental health diagnoses may be causing my child’s emotional dysregulation?

There are several diagnoses associated with dysregulation, which is why it is important to have a mental health professional (experienced in this area) evaluate your child.

There are 2 types or disruptive behavior disorders that kids who dysregulate often get diagnosed with:

Disruptive Mood Dysregulation Disorder (DMDD) is classified in the DSM-V as a type of depressive disorder, as children diagnosed with DMDD struggle to regulate their moods and emotions in an age-appropriate way. As a result, they exhibit frequent temper outbursts in response to frustration, either verbally or behaviorally. In between outbursts, they experience chronic, persistent irritability. This is a relatively new diagnosis; one study found between .8% and 3.3% of children 2-17 years old meet criteria.

Oppositional Defiant Disorder (ODD) is defined as a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness. This behavior is usually targeted toward peers, parents, teachers, and other authority figures. Studies vary but in studies with large samples of the general population, about 3% of children meet criteria.

Personally, I don’t find either one of these diagnoses to be very helpful. While they tell us that children are struggling with disruptive behaviors, they don’t tell us WHY. DMDD was included in the DSM-V to try to better account for all the kids who were mistakenly getting diagnosed with bipolar disorder. While it does encompass the symptoms of a lot of kids who are dysregulated, it doesn’t help determine what is CAUSING the behaviors. Not only do I believe ODD is an unhelpful diagnosis, but is also a potentially harmful one. It labels kids (often from a very young age) as “bad” or “problematic”. Once again, this diagnosis does nothing to help adults understand what is causing the defiant behaviors.

The following diagnoses in children all have symptoms of emotional dysregulation AND help determine what type of treatment is beneficial:

● ADHD (with or without hyperactivity)
● Anxiety
● Bipolar Disorder
This is often what parents think is causing their child’s behavior. In fact, this is usually not the case. Unless there is a family history of clear bipolar, it is unlikely this will be diagnosed.
● Autism Spectrum Disorder
These kids can be tricky to identify if symptoms are mild. It is important to talk to a child professional who treats autism if you think there is even a remote chance your child could be on the spectrum.

What does biology or family history have to do with my child’s behavior?

The research is inconclusive as to whether or not genes CAUSE emotional dysregulating behaviors. However, like most illnesses or medical conditions, there is likely a combination of genes plus environment that result in symptom presentation. DNA/ Family history influences our propensity to become ill- mentally and physically. Providing therapists and physicians with what type of mental illnesses or suspect behaviors exist in siblings, parents, grandparents and extended family is important in helping providers determine an accurate diagnosis/ diagnoses.

What does brain wiring and the Nervous System have to do with it?

Well, the short answer is “EVERYTHING”! First, a quick tutorial on how the brain is wired to manage emotions and problem solve:

WATCH THE VIDEO: “Why Do We Lose Control of Our Emotions”?

This video describes what happens to all of us when our emotions get too intense. What it doesn’t mention is that for some kids (and adults), emotions can get so big and so out of control so fast that there isn’t time for other parts of the brain to take over. For these individuals, the wiring is a little faulty. This can be a result of DNA, trauma, lack of access to calm, nurturing adults- or a combination of these factors.

Child psychologist, Mona Delahooke, PhD has written a cutting edge book that explains the neuroscience behind emotionally dysregulated behavior. In “Beyond Behaviors,” she explains that these kids are not acting out purposefully, but rather are responding to how their bodies perceive stress and threat. Dr. Delahooke’s article in “Psychotherapy Networker” offers a great introduction into understanding how the brain-body highway, known as the autonomic nervous system (ANS) affects children’s behaviors.

READ THE ARTICLE: “How I Came To Rethink Children’s Challenging Behaviors”

Understanding Stephen Porges, MD work on the Polyvagal system is key to understanding what can influence behaviors. Dr. Porges notes the importance of neuroception, which is how our nervous system evaluates risk without requiring awareness. To understand what is causing a child’s misbehavior, it is imperative you understand the unique aspects of your child’s nervous system.

Here is a helpful tutorial for understanding Stephen Porges’ Polyvagal Theory:

WATCH THE VIDEO: “The Polyvagal Theory: How Your Body Makes The Decision” **

** MAKE SURE YOU GET PAST THE FIRST 5 MINUTES, THE LAST 5 ARE EASIER TO UNDERSTAND