“My child needs anger management skills.”

“My child needs to talk to someone.”

“My child needs tools.”

These are common sentiments among caregivers of children who dysregulate. Individual therapy may seem like the right choice. However, most evidence-based protocols for dealing with extreme behaviors in children are parent-based. This is not because parents are to blame! Rather, it’s because parents are their child’s most important relationship. Parents have more influence over their child than anyone else.

Signs of emotion or behavior regulation include:

Tantrums
Meltdowns
Aggression
Destructive behavior
Screaming
Swearing and insults
Threats to harm others
Threats of self-harm or suicide
Self-harm

Parents of kids who dysregulate may experience a sense of walking on eggshells in their own home. There can be a sense of feeling “hostage” by the child’s behavior. Parents may go to great lengths to avoid outbursts by their child. Siblings may be asked to adjust their behavior to further reduce the chances of a child’s dysregulation.

Many children with dysregulation are not great candidates for individual therapy. Individual therapy requires motivation, insight, and the ability to self-reflect. This is asking a lot of kids, many of whom are not developmentally ready to apply “tools.” This is not to say that there may not be a benefit to working directly with a child. Getting to know a child can yield important insights to inform the parenting work. Kids can also learn to better identify and understand their emotions in therapy. We just want to be realistic about what we can accomplish in one-on-one sessions.

Parents can empower themselves immensely by learning protocols and strategies. This will help to regain a sense of peace and security within their own home. Parents can also learn ways to prevent outbursts and respond more effectively when meltdowns happen.

Effective treatment for child emotion dysregulation involves three main categories of intervention.

1) Relationship building: Dysregulation can put a strain on the caregiver-child relationship. It’s common for negative interactions to start overshadowing more positive times. Parent coaching can help with concrete strategies to reduce tension and improve connection.

2) Behavioral strategies: Behavioral strategies offer ways to manage out-of-control behavior. There are decades of reseach to support strategies that fall under this category.

3) Nonviolent Resistance (NVR): NVR, as it applies to parenting, has been around for over 20 years. NVR is grounded in concepts developed by Martin Luther King Jr. and Mahatma Ghandi. Both embodied nonviolent resistance in responding to social-political injustices. Psychologist Haim Omer (at Tel Aviv University) and colleagues have taken NVR concepts and applied them to parenting. NVR involves strategies to resist efforts by others to control us in harmful ways. At the same time, NVR brings attention to how we tend to respond to problems by using control tactics of our own. Efforts to control others are generally counterproductive and tend to make problems worse.

Relationship Building

The Role of Warmth and Acceptance

Regardless of which strategies from this menu that a parent chooses to implement, it is always important to attend to a child’s needs for love and connection, acceptance, understanding, and agency. Without these ingredients, nothing will work to reduce the intensity and impact of child dysregulation. The relationship is foundational to better emotion management. Children do best when they are securely attached and feel accepted and understood by their parents. Conveying warmth, acceptance, and understanding can be challenging after your child has screamed the worst insult ever hurled at you. This is all the more reason for parents to feel fully supported by the adults in their lives. When parents’ needs for understanding and connection are met, then they will be best equipped to be present in a positive way to their children. Many parents find the strategies involving acceptance, attunement, and affirmation to be helpful.

Increase the positives

Caregivers can increase positives in a variety of ways. Praise, compliments, affirmations all help to strengthen the relationship. Positive expressions should outnumber anything negative, such as a criticism or behavior correction. Aim for a ratio of at least five to one positives to any negative communication.

Validation skills

Validation skills provide the foundation for strong connection. Validation extends beyond “emotion coaching” or labeling the child’s emotions. It’s often best to refrain from talking when the child is spiraling into an escalation. Validation skills may be best deployed when a child is calm. They can also be helpful when the child is upset but still in control. In a meltdown state, the child may not be able to process your words. It’s common for parents to have to dig deep to validate their child when the child is being unreasonable. However, well-timed and targeted validation is calming. A great resource for learning validation skills is the book, “What to say when nothing seems to work: A practical guide for parents and caregivers,” by Adele Lafrance and Ashley Miller.

Behavioral Strategies

Contingency Management and Limit Setting

Contingency management goes hand in hand with limit setting. Contingency management is based on principals of “operant” learning. What happens following behavior constitutes a contingency that may or may not reinforce a problem behavior. Many problem behaviors are inadvertently reinforced by others so that the child may learn the following:

“When I scream and yell, my parents back off.”

“When I start to throw things, my parents give in and give me what I want.”

“If my parents are afraid of me, they won’t make so many demands.”

The child may not consciously think these things, but many children learn such associations. If you strategically change the events following problem behavior, the problem behavior may reduce.

Correction, over-correction, and when-then

In a fit of anger, a child kicked the wall and left a hole. This behavior calls for correction and preferably over-correction. A correction would involve the child patching the hole in the wall. An overcorrection would mean patching any wall areas in the room that need sprucing up. You might be thinking, “But my child would never go along with this. I can’t make my child patch the wall!” You are probably right, which is why you also need to blend this with “when-then.” When-then might mean that your child loses tech privileges until the correction or over-correction is complete – even if it takes weeks for your child to step up. Or, for a teen, they might lose car privileges until the repairs are complete. Depending on the corrective action that is needed, it’s okay to provide support. For example, you can provide supplies and offer reasonable assistance to repair a hole in the wall.

It's best to prepare the child ahead of time (preferably also in writing) that this is the new way that you’ll be responding to destructive behavior. If you want to really strengthen this approach, you will also pull in ideas based in NVR. A relevant NVR strategy is to involve a third party (a friend, neighbor, or relative) to work with your child on correcting the destruction that was left by their outburst.

We discourage arbitrary or severe punishments. These can lead to ruptures in the parent-child relationship. And, they do not effect positive change. For example, revoking of screen privileges for a week is not productive. It’s usually more effective to use the when-then paradigm. A work chore designed to fit the child’s offense is a better consequence. ,In this case, the child’s screen privileges are suspended until the work chore is complete.

Adaptations are needed for very young children. Young children may not be developmentally ready to engage in certain corrective actions or chores. Time-outs can be an effective response to misbehavior. Most parents will benefit from detailed guidance and practice on how to use time-outs. Without a clear protocol, time-outs can backfire.

Incentives

Incentives are another common behavior strategy that can be used to boost contingency management. The use of incentives (or rewards) is an extensive topic. We hear from many families that “rewards don’t work.” There is an art and a science to designing an incentive program that your child will care about. You can read tips on how to avoid the pitfalls of rewards and ways to put rewards into action.

Reduce Triggers

We often are asked, “So what do I do when my child is having a meltdown?” Unfortunately, once a child is set off, the meltdown usually needs to run it’s course. There are ways to avoid adding fuel to the fire, but it’s best if you can avoid the outburst all together. However, it best to not to let your child be in control of you just to keep the peace.

A-B-C Baskets

One of our favorite strategies to reducing outbursts involve a concept knows as the A-B-C “baskets.” This paradigm was developed by Ross Greene, author of The Explosive Child. Basket A involves rules set by parents that must be followed, without discussion. Usually, rules in basket A are limited to safety issues (wear a seatbelt, wear a bike helmet, etc.).

Basket C is comprised of issues that should driven by the child’s preferences and agency. Basket C might include whether children choose to eat their carrots, whether they comb their hair, and what they choose to wear.

Basket B involves areas that must be addressed, but the solution need not be unilaterally decided by the parent. Examples include leaving the house on time, completing chores, and brushing teeth. Solutions involve a strategy called “collaborative problem-solving,” which involves coming up with a plan that is acceptable to both the parent and child. Alternatively, issues in may be addressed using contingency management. For example, a teen who sleeps through an alarm may do well with the natural consequence of missing the bus. The specifics of problem-solving or contingency management will vary greatly depending on the issues, child, and family.

A common problem is that parents may put issues that belong in baskets B or C into basket A. When parents treat every challenge as a demand on the child to do things the parent’s way, problems ensue. There are usually better alternatives for handling issues where your child resists your direction.

Parent self-regulation

Another powerful strategy focuses on parents’ ability to keep themselves calm and regulated in the face of problem behavior by their child. We’ve noticed that some of the worst escalations by children occur in response to a breakdown in parent self-regulation. It is completely normal for parents to “lose it” when a child is acting-out, especially when the parent is already stressed out. Everyone has a breaking point! By increasing parents’ skills to effectively disengage from struggles, though, many child escalations can be averted.

Strike While the Iron is Cold

Strike While the Iron is Cold is a NVR strategy, but I’ve included it here because it is such an effective way to avoid triggering an escalation. When a child has misbehaved, attempts to address the behavior in the moment (or soon after) are likely to intensify a child’s rage or distress. Few issues need to be addressed right away. It’s better to wait several hours or more before talking with your child about corrective actions. Ideally, you will have already instructed the child on how you will respond to their misbehavior and there is nothing more that needs to be said. Or, if addressing the issue yourself is unlikely to go well, this is a good time to bring in one of your third party supporters (see below).

NVR Strategies

Resist the child’s unhealthy control over parents

We’ve covered the importance of avoiding efforts to control your child. It’s also critical that parents build awareness of how a child is exerting unhealthy control over parents. The child’s control efforts must not be reinforced. This is difficult, because most parents who are dealing with dysregulated children become habituated to the power their child holds. Parents commonly lose sight of the many concessions and accommodations that they’ve made to “keep the peace.”

Although I’ve stressed the importance of reducing triggers, this does not mean that parents should give up their own freedom (or that of siblings) in order to avert meltdowns. When parents commit to staying the course to live according to their values, there might be a temporary increase in child dysregulation.

Have a clear protocol for responding to meltdowns

Get really, really clear and detailed about what you’ll do when your child escalates. You may decide to call a neighbor to come support you, or call a friend to have on speaker phone while you disentangle yourself from your child’s outburst. You might decide that hanging out in the front yard, in a reverse evaculation, helps to deescalate the situation. The specifics will vary depending on your child, your household, and the nature of your child’s escalations.

Reduce isolation and secrecy

Most violence within the household is maintained by isolation and secrecy. This holds true regardless of whether the perpetrator or enactor of violence (whether emotional, verbal, or physical) is an adult or a child. One of the key NVR strategies is to “break the seal of secrecy.” We’ve found that most families are scared or reluctant to take this step, yet this might be the most powerful action that parents can take to reduce a child’s dysregulated behavior. We commonly see that family isolation keeps children in power with their coecive or dysregulated behavior.

If you let your child know that you will no longer deal with their violence on your own, you will have their attention. Your child may be angered by this announcement, or maybe not take it seriously. When you show, with your actions that any dysregulated behavior will be handled by an adult on your support team, there is likely to be a dramatic and positive shift. The role of the support persons is not to shame or condemn your child. Rather the message should convey that the child is supported, belongs, and will be helped to correct their behavior or make amends.

Summary

Each of the strategies summarized above could be a book in itself. The brief descriptions are not meant to fully equip parents on how to plan for their child’s next outburst. Rather, this summary is intended as an overview and to illustrate how multi-layered effective intervention is when it comes to child emotion dysregulation. I also hope that I’ve communicated why viewing treament as simply child-centered is likely to be inadequate. Families must customize plans according to their own needs and the complexity of the situation involving their child – ideally, with the help of a mental health professional.

A Parent Coach’s Guide to Treatment for Childhood Emotion Dysregulation