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104: How to help a child to overcome anxiety
26th January 2020 • Your Parenting Mojo - Respectful, research-based parenting ideas to help kids thrive • Jen Lumanlan
00:00:00 00:52:38

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Listeners have been asking me for an episode on supporting anxious children for a loooooong time, but I was really struggling to find anyone who didn't take a behaviorist-based approach (where behaviors are reinforced using the parent's attention (or stickers) or the withdrawal of the parent's attention or other 'privileges.').

Long-time listeners will see that these approaches don't really fit with how we usually view behavior on the show, which is an expression of a need - if you just focus on extinguishing 'undesirable' behavior, you haven't really done anything about the child's need and - even worse - you've sent a message to the child that they can't express their true feelings and needs to you.

Listener Jamie sent me a link a book called Beyond Behaviors written by today's guest, Dr. Mona Delahooke, and I immediately knew that Dr. Delahooke was the right person to guide us through this. Listener Jamie comes onto the show for the first time as well to co-interview Dr. Delahooke so we can really deeply understand our children's feelings and support them in meeting their true needs - and overcome their anxiety as well.

Also a reminder that the Your Child's Learning Mojo membership closes to new members on January 31 2020 - click here to learn more!


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Jen:                                     01:28 Hello and welcome to the Your Parenting Mojo podcast. Today, we're talking about a topic that parents have been asking me about for ages and that is how to support children who are experiencing anxiety. Now, it's not super hard to find research on anxiety and on treatments for anxiety, but the hard part is finding someone who doesn't just see anxiety as an unwanted behavior that we need to extinguish using reinforcements and who actually sees anxiety as a potential cause for behaviors like having a bad attitude or lacking impulse control that we might typically think of as bad behavior rather than being caused by anxiety. So, we have a special guest today who's going to help us move beyond this view of anxiety and that's Dr. Mona Delahooke. Dr. Delahooke is a licensed clinical psychologist with more than 30 years of experience caring for children in their families. She's a member of the American Psychological Association and holds the highest level of endorsement in the field of infant and toddler mental health in California, as a Reflective Practice Mentor. She has dedicated her career to promoting compassionate relationship-based neurodevelopmental interventions for children with developmental, behavioral, emotional and learning difficulties and has written a book called Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children's Behavioral Challenges. Welcome Dr. Delahooke.

Dr. Delahooke:                02:43 Thank you so much. I'm so happy to be here.

Jen:                                     02:45 Thank you. And we have another special guest here today as well. We've heard about her, we've heard her words and now we're going to hear her very own voice. Today, we have with us listener, Jamie. She's not listener Jamie to us. She's Jamie Ramirez in real life and she and her wife are the proud parents of now 11-month-old daughter Elliot. Jamie struggled with anxiety for a good deal of her life and has also read on this topic a lot. And she was the one who suggested that I read Dr. Delahooke’s book and so when Dr. Delahooke agreed to an interview, it was only natural to ask Jamie to join me as a co-interviewer and she enthusiastically agreed. Welcome Jamie.

Jamie:                                03:22 Hi.

Jen:                                     03:23 Yey, you’re here. All right, so let's start kind of at the beginning I guess by talking about how Dr. Delahooke’s thinking about anxiety is different from the way that most researchers and psychologists think about it and treat anxiety and children. So Jamie, I wonder if you could start by reading one of your favorite passages from Dr. Delahooke’s book and then perhaps we can contrast this with the more common view on anxiety. So do you want to go ahead and do that?

Jamie:                                03:48 Yeah.

Jen:                                     03:49 Okay.

Jamie:                                03:50 “The truth is that we scrutinized children's behavior from the time that they're born. “She's such a good baby”, we might say of a newborn who is easy to care for, doesn't cry too much, sleeps through the night and whose moods are predictable and easy to read. Without realizing it, we are betraying our cultures understandable bias toward valuing behaviors that we can easily understand and that make our own lives easier as caregivers, teachers, or other providers. As children reach school age, we lavished praise in good grades on those who are good listeners, follow directions and can sit still and perform well on tests. We often reward these good behaviors with positive recognition, not realizing the messages we are sending to children whose natural tendencies fall outside of the easy child profile, particularly in the educational arena e.g. those who can sit still are better than those who cannot. Quiet is better than loud. While these messages may well serve the purposes of group education, they ignore the importance of understanding and appreciating and not judging the range of children's individual differences demonstrated through their behaviors.”

Jen:                                     04:57 That's such a powerful passage. I can see where it resonated with you. Yeah. And so Dr. Delahooke, I wonder if you can contrast that as sort of the way that you view anxiety with the way most psychologists think about anxiety. What do most psychologists think anxiety is?

Dr. Delahooke:                05:13 Well, the way I was trained and really I think the predominant thought still amongst most psychologists is that anxiety is understood as a disorder. And maybe we can understand that through understanding that the DSM, are you familiar with the DSM?

Jen:                                     05:35 Yeah. The Diagnostic and Statistical Manual. Just for listeners.

Dr. Delahooke:                05:38 Yes. For listeners, it's kind of the dictionary, so to speak, for labeling and diagnosing individuals along a set of criteria. So one shift that's happened in the last kind of less than a decade starting in 2013 was that the DSM that Tom Insel, who was the head of the National Institutes of Mental Health announced that the national institutes were going to be diverting funding away from straight DSM criteria and more towards looking at underlying causality. So the short answer to your question, the way many of my colleagues, I believe view anxiety is as a DSM disorder and the American Psychological Association defines anxiety as an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. So anxiety is defined kind of loosely in a way as something that if you have a certain amount of characteristics or symptoms, then you have anxiety.

Dr. Delahooke:                06:51 And that's kind of how it's viewed now as a thing, as an actual like, oh, your child has anxiety. Well, there is no blood test for anxiety. Right? So it's not exactly like your child has diabetes, you know, your child's blood sugar level is above 105 or whatever. Anxiety, the way I was trained, I was really in my education in the 80s was that it seemed like anxiety was this thing that you treat with a certain protocol such as cognitive behavioral therapy and medication if needed. And that was what would help it go away. But what I wasn't taught was what's underlying all sorts of anxiety. Well, there's all these different subtypes and so it's really exciting to me that the shift is now not just looking at a symptom checklist, but looking at the brain circuitry and the domains, the dimensions of functions rather than these categories. And it's a really exciting shift.

Jen:                                     08:04 Yeah. And I just want to delve a little deeper into a couple of things you mentioned, you mentioned medication and cognitive behavioral therapy, and from the research that I've done, it seems as though each of those are effective in about half of the children that are treated. Is that right?

Dr. Delahooke:                08:19 Well this, yeah, generally speaking with the research you might find different percentages, but some percentages are about a third. Some go up to a half.

Jen:                                     08:29 Okay.

Dr. Delahooke:                08:31 But you think about half, that still leaves another half.

Jen:                                     08:35 Yes, it does. Yeah. And so what are some of the challenges of treating this anxiety in children?

Dr. Delahooke:                08:42 Well, now that I have a different protocol, I'm finding much way fewer challenges that I think that early in my career when I was using the standard protocols is that I found that for example, cognitive behavioral therapy, trying to talk to a child and help a child actively change their thoughts and their cognitions come up with the ways that their brain can help them shift their thinking and feel better. Right? Which are great ideas, super great ideas. But I've found that for many children that fall fell flat on its face. And that's when I went to look for answers as to why. Why would some children be able to shift their thoughts? And why would others just not have that capacity, especially in the heat of the moment? And that became one of my biggest clinical questions.

Jen:                                     09:39 Okay. And so just before we get to that, I want to briefly mention the study that came out of the Yale Child Study Center that got a lot of press, I think it was about within the last year or so and it found that a new program that teaches parents how to use reinforcements to treat their child's anxiety was as effective as traditional cognitive behavioral therapy. So again, it's working for about the third to a half of the people who are being studied. And so I'm just curious about what you make of that particular approach just because it's something that parents have probably heard of recently.

Dr. Delahooke:                10:10 Right. Well, first of all, parent involvement is fantastic. We know that parent involvement, parent-based treatment is really makes most sense from a neurodevelopmental perspective because the way human beings regulate their emotions and eventually their behaviors is through co-regulation, meaning other human beings who attuned to them and we develop our emotional capacities in our ability to self-regulate emotions through relationships. So, parent involvement is great. Now, I glanced at this study yesterday, but I think you said Jen, that it uses a behavioral paradigm.

Jen:                                    10:54 Yup. Yup.

Dr. Delahooke:                10:56 Okay. Okay, so here's where I think the research coming out of the lab of Jonathan Green is way more impactful and will have more efficacious results and that is because it's not based on the paradigm of behavioral reinforcement essentially. Now the idea of reinforcing behaviors we want to see and ignoring or punishing behaviors we don't want to see is a paradigm that was developed in the last century.

Dr. Delahooke:                11:28 And it started with studying animals, you know, in the lab. And it was exciting back then because you could figure out how to alter rats and dogs behaviors through reinforcement schedules. This was picked up to work with humans. And specifically one population that it was picked up on was for individuals, children and teens who are self-injuring at the University of Washington and later on at UCLA with Ivar Løvaas. So the science then was to protect and to try to of course try to help children improve their behaviors. But what is missing in my opinion and perhaps why the Yale study didn't get more than a 50% improvement rate so it equaled cognitive behavioral, is that it involved the paradigm, the older paradigm of reinforcing surface behaviors. And we now know that behaviors aren't the tip of the iceberg. So once you locate what is happening underneath the child's behavior, then you have a pathway to really helping them gain behavioral control and deal with their anxiety or their worries or their, whatever concerns they have that is much more natural and much more sympathetic with brain development. So essentially what this study apparently did not, it had--okay, the good part was that it was parent-based, but it was still along the lines of cognitive behavioral therapy because it involved the assumption that children's behaviors are deliberate and purposeful. We might think of that as willful and we can talk to them about it or put them on a reinforcement schedule for it. But to me that's the problem because not all behaviors are due to reinforcement.

Jen:                                     13:31 Yeah. I love this ‘cause it's a bridge from where we've been to where we're going. So what I'm hearing you say is that the reason the study was as successful as it was was because of the involvement of parents. And maybe this helped parents to attune to their children a little better than they were before, which helped them to better support their child. And the reason it didn't work better is because we were using reinforcement.

Dr. Delahooke:                13:54 That's a yes. Again, I'm not a researcher, but I'm going to go back and read that study. Yeah, I think that's a good guess because once you involve parents and especially if the parents have a gentle way with the child and look how were the parents doing the reinforcement, right? Was it gentle? Was it soothing? Was it calming the autonomic nervous system? Likely the artifacts of the study and the variables that they didn't measure may have been just as important as the reinforcements.

Jen:                                     14:27 Yeah. Okay. All right, so now I understand a bit about where we've been. Jamie, do you want to kind of take us forward from here and delve into some of Dr. Delahooke’s ideas a little bit?

Jamie:                                14:35 Yeah, sure. I wanted to spend a good chunk of time drawing out your thinking on the idea that when we see behavior that is problematic or confusing, the first question we should ask isn't how do we get rid of it, but rather what is this telling us about the child? And I'd like to do this using a case study from your book of a child named Matthew.

Jamie:                                14:54 So to summarize, Matthew was late to start speaking and was diagnosed with autism. You observed him in a session in school when he was trying to get the attention of his aide who was next to him. When she didn't respond, he touched her arm and then she followed his IEP or individualized educational plan, which says she wasn't supposed to respond to non-preferred behaviors. So she moved away from him. He continued to try to get her attention. So she moved behind him and when he leaned back in his chair to see her, he fell over. So then the aide took Matthew to the calm down room, which was a small closet with a padded floor and you watched him through the one way window looking really flattened sad with his aide ignoring any interaction with him. So let's talk about what's going on here. What do you think that the teacher and the aide are seeing in this situation? And do you think that they see Matthew as being in conscious, volitional control of his actions?

Dr. Delahooke:                15:48 Thank you for reading that Jamie. And it just brings, every time I hear it or listen to it, it brings me back to that moment to that classroom where I was sitting in the back of the room and using the lens that I now use. It felt like I was watching a slow moving car crash. So the answer to your question, did I think that they saw Matthew as being conscious and having volitional control of his actions? Absolutely. And let me just say that I have so much compassion for the teachers. I did and I do. And if anyone's listening today and you've heard me talk before, you know that this is a no blame, no shame space for me. I don't intend to have anyone feel bad about what they have done or the ways they approach children because it's in our cultural DNA to view behaviors on the surface.

Dr. Delahooke:                16:47 So I'll just say that out front I don't mean to offend anybody with what I'm saying. I just need to add a layer of understanding to our current approaches. So when I looked around the room, when I saw that Matthew, his initial bid for attention, which was to try to grab the arm of his aide, that was viewed as a bad behavior because she was wanting him to listen to the teacher who was giving the lesson. But this was a child who had individual differences that compromised his ability to easily ask for things he did not have the words to do that and his motor system was also kind of roughly connected to his intention system, so the very best he could do was swat at his aide. And I saw that as a brilliant adaptation to him letting her know he needed something.

Dr. Delahooke:                17:47 He either needed help or he was feeling uncomfortable or he needed to move. And when she moved away so that he couldn't touch her, I just thought, Oh wow, there we go, the behavior is being viewed as bad because it's noncompliant or because it's poorly understood. And what I wanted to do with that moment is say, let's celebrate that behavior. He needs you. Let's find out what this child needs at this moment. Anyway, as you read, when he started to increase his ability to grab her, then he's trying to grab her, which meant to me that his nervous system, his fight or flight system was engaged and he was actively trying to seek social engagement to feel better. She moved where he could not see her or touch her and he fell over and then they brought him to, it was called the calm down room, but it was really a timeout room.

Dr. Delahooke:                18:45 There was nothing soothing about that room. So when I looked around the room I expected to see, or I guess I hoped to see adults in distress going, Oh my gosh, this poor child who can take him out and see what he needs. And instead what I saw was everybody ignoring the situation, which was how they were trained. It was on the child's IEP to ignore non-preferred behaviors. And so I believe they absolutely saw Matthew’s behaviors as volitional and that he had control over them. And what I saw was a stress response that started off slow, what I call the light green zone like he was still in social engagement. He was looking at her, he was trying to touch her and the aide was trained to understand that as a noncompliant behavior and it went south very fast and he ended up being punished for trying to reach out and that's why I put that story in the book.

Jamie:                                20:01 So, you wanna share a little bit about how things improved with him after your intervention?

Dr. Delahooke:                20:08 Yes. I hope I can now bring everyone up. Now that I've brought everyone into the room as it was powerful moment, I'll never forget it and it's actually when I decided that I was going to write Beyond Behaviors. So when we got together, my approach with teams mirrors my approach with parents and children and that is that we connect first. So we held a team meeting with the parents and the providers. Unfortunately, the aide was not allowed in the meeting. We have some weird rules here in California. Sometimes aides aren't allowed into an IEP meetings. But anyway, when we met, I respectfully explained that I had done an analysis of an evaluation of Matthew’s individual differences in his sensory processing, which were causing him to not be able to say, help me please, but rather grab somebody.

Dr. Delahooke:                21:10 So I reframed the grabbing as an adaptive behavior due to the way his brain was wired, his body-brain connection. And I invited the team to all look at his behaviors through the lens of compassion and his brain wiring rather than misbehavior. And it was amazing. There was an OT on the team and the teacher was very open to a new lens. In fact, she welcomed it because everyone knew Matthew was a sweet guy as a really gentle soul. And when we understood him better, when we understood that there was a reason. So we took out the iceberg and I actually have a blank one, so I wrote on top what his behaviors were and then on the bottom I filled in what I thought was contributing to his behaviors. So there were the motor system, his sensory system, and most of all, his feeling of not feeling interpersonally safe.

Dr. Delahooke:                22:16 He needed an adult to help him feel better. And once we put this all together, miraculously or not, he found ways to connect and the aide started to move closer to him. So over time it took several months, but over time the aide leaned in. She didn't lean away, she leaned in, everybody leaned in to this child, and all of a sudden there wasn't the need for him to have these behaviors because he had his relational and his physical needs met. We basically accommodated to what the child's individual needs were with a lot of warmth and human engagement and the behaviors that they were so concerned about went away.

Jamie:                                22:59 That's amazing. So the proponents of the classic approach to treating anxiety where you reinforce behaviors you want and ignore behaviors you don't, say, oh, if you respond to Matthew when he seeks attention in a non-preferred way, he's just going to do it more. A lot of parents and teachers might feel a real tension between their desire to respond compassionately to a child like Matthew and what the experts say about encouraging his “bad behavior”. So can you share some thoughts on whether we should ever worry about reinforcing non-preferred behaviors by giving them our attention?

Dr. Delahooke:                23:33 And just another great question. I understand that question myself from a parenting perspective. I wondered about that too and I know there were times that I ignored things that my kids were doing because I just didn't want to reinforce them. So I think this way of thinking is kind of, there's some logic to it. And so I get that. I get the question. I guess my response to that question would be, we have to understand what we're giving our attention to and where we focus our attention. So I want us to focus our attention on not on the behavior, but what the behavior signifies. So if a child is, say a toddler, is asking over and over again for something and we've said no, and we don't know what to do about it, we don't necessarily have to ignore the child and nor do we have to necessarily give in to that sixth cookie.

Dr. Delahooke:                24:42 We can very much still give our attention, but say no, we can provide a loving for boundary and still maintain our authority. So I just think that ignoring behaviors, if you think about the last time someone you love or someone you don't love it, anyone ignored you. How that felt inside?

Jamie:                                25:05 Awful.

Dr. Delahooke:                25:06 Awful, right? When someone that you are talking to or trying to communicate with you ignores you, it goes against this basic human need for social engagement and it feels awful. So, I really think we can improve. There are ways to improve without worrying about if we're going to make the behavior worse.

Jamie:                                25:29 That's awesome. So you just a little bit earlier mentioned the iceberg idea. Can you kind of describe that a little bit more for the listeners and kinda describe one as related to anxiety?

Dr. Delahooke:                25:44 Sure, absolutely. The iceberg, you know, the term the tip of the iceberg, that's a commonly used phrase. And I use it as just a good visual for thinking about behaviors because the tip of the iceberg that's above the waterline, it's usually 10 or 12% of that big chunk of ice, so I use it to show us that behaviors are what we see. And then what we don't see, 90% of that big chunk of ice is underneath the waterline. So those are the things that are more invisible and that we can look for to find out what's actually going on. So in my developmental iceberg, we have the kind of what's going on on top? What we can see with the behavioral challenges? What the child's doing? The obvious, we can see that. But underneath we have the causes, the triggers, the internal processes in the child. So those could be things like sensations that are processed in the brain and body, emotions, the ability for motor planning and executing actions, subconscious memories, Oh, that's a big one like triggers to things like smells or sounds and developmental capacities and processes. So the richness comes from really looking at what could be contributing to this child's behavior.

Jen:                                     27:09                  I love that approach and it takes me back to thinking about parents. And when I think about interactions that I have with other people, I see that I get triggered sometimes and I see some of the causes of those triggers. And I think of myself as a sort of a full rich human person. But I think there's this real tendency to look at our children and think, well, it's only about the behavior, right? We're sort of applying this double standard. And another way I think that can happen is, we didn't actually mention this in the setup, but in the book you tell us that Matthew has autism. And so as we were reading the book, we might think, Oh well, you know, the kid has autism, we're going to give him a bit of a pass, but my child doesn't have autism. And so maybe I'm not going to be as lenient with her and she should know better. And we sort of seem to have this idea in our minds that our children should be able to do certain things by certain ages and that what they need when they can't do this is some tough love parenting or maybe some teaching to prepare them for what's going to be a harsh world out there. So do you agree with this?

Dr. Delahooke:                28:08 First of all, I can say as a parent, I can relate to it ‘cause that is one of the first things I thought when I was disciplining my children before I had the paradigm shift is, honey, this is a tough world.

Jen:                                     28:21 And I'm not the toughest person in it.

Dr. Delahooke:                28:25 Yeah. I'm not going to be doing my job unless I get you ready to be in the world. And if you do that behavior out there, you know, good luck. So I have a lot of compassion for that belief and it's pervasive. I really believe that the worst a child's behaviors get the more adults feel pressured to step it up. And again, I experienced that myself. And I think that our culture, does it. Think about the, well, I think it's one of the causes for the school to present pipeline because oftentimes some of our children who have had a rough history, like our foster children who've had trauma histories, they get stepped up in the behavioral approach and get more and more isolated and more and more disconnected from other humans because their behaviors, which were adaptations to survival have been demonized. So a couple of thoughts as to what you just said.

Dr. Delahooke:                29:21                  I purposefully don't always use labels. So for Matthew, yes, he was diagnosed on the autism spectrum. But the principles we talk about about behaviors cut across any sort of individual difference. At any moment, a child who have no obvious differences in terms of being neuro-typical or whatever that is, if there is such a word, could experience a traumatic moment and have a behavior that is a big explosion that we really need to understand. So the idea that we need to set up a child for success in the world by containing their behaviors and teaching them how to do better. Yes, that is true. But we have to wait until a child is ready to be taught and a child isn't ready to be taught until they have emotional and behavioral control in their brain-body development.

Jen:                                     30:22 Yeah. And it seems as though a way that we try and get around that is using rewards. And I interviewed Alfie Kohn last year and he hates rewards, but even he can see is that you can sometimes get temporary compliancies in rewards. So why does this work? I mean the behaviors approach essentially says that children probably don't care that much about our values and goals. So if we want them to follow us in our values and goals, we have to give them something that they do value like candy and stickers and praise. But I mean the whole of human society managed to integrate children into the way we operate. Before there was candy and stickers, which implies that children you kinda do want to do this and can become functional members of our society if we can support them in the right way. So I'm wondering what you think about where is the support lacking today that makes it seem as though we have to go in with the stickers and the candy and the praise to fill that gap?

Dr. Delahooke:                31:15 That's just such a great question. And we are so obsessed with stickers, candy and praise. I mean, okay, let's separate them. Praise can be a connector, right? And candy and stickers are things. So I think what is missing, what is lacking today when you said, what is lacking? Here's what I think is really lacking. It's the understanding that social engagement is the most magnificent reinforcer in the world. And I don't mean by faking it. I mean by when we are in a flow of a loving back and forth with the child or with another, with our partners, nothing feels better to humans than the love and connection that you get from being in a joyful, playful flow. So here's where the, again, where the approaches to managing human behaviors kind of got hijacked by the excitement of reinforcement schedules. Again, I understand that was really big news in the 50s and 60s and on, but what we know now is that the main engine that drives human social and emotional development is relational joy and play actually, and play happened millions of years ago. Right? And before all this happened with toys and reinforcement schedules was that animals played together, children, humans, we play together, we go back and forth and that is the best way both to build the health of what we would call executive function, the ability to have cognitive control over our behaviors and emotions. And that's what we consider a neurodevelopmental or a bottom up approach that we build the skills through engagement rather than we try to artificially manipulate, incentivize little humans to cooperate. Does that make sense?

Jen:                                     33:29 Yeah, it really does and I think it's sort of setting us up for Jamie's next question about how we actually move forward to use some of these tools that you recommend. But just before we do that, I want to close out this loop by one more thing that parents may have heard or may have thought to themselves that I should do if my child is experiencing anxiety, is to reassure the child that the thing that they are fearing isn't really a threat. Does that work?

Jamie:                                33:52 What do you think?

Jen:                                     33:55 Well, you know, I have my suspicions, but isn't it tempting? Right? There's a plane going overhead and your child's afraid of it and the chances of it falling out of the sky in that moment are fairly slim and you feel as though you can safely reassure your child that nothing's going to happen.

Dr. Delahooke:                34:08 Yes, yes, and it's kind of a default. It's our natural way of reassuring. Right?

Jen:                                     34:13 Right.

Dr. Delahooke:                34:13 But let me give you an example of two different ways we can reassure a child. I was talking to a parent yesterday whose child has extreme difficulties when the parent's driving the car and the child is thinking that the car is going to crash, and so the child would be saying things like, Oh no, you're getting too close, there’s another car, you're getting too close and start to have these really worried thoughts and starting to fuss and cry and distract the driver, which was the dad and the dad's solution, he was, of course, trying to keep everybody safe and he's so nice and logical, but he was saying things like, “it's okay, we're not gonna crash. Everything is okay. We’re not gonna crash. It’s okay.” And so we played with it a little bit and I kind of modeled for him that we can add something to that because it's really not for a child who's upset like that, it really isn't our words.

Dr. Delahooke:                35:05 It is our connection, our emotional co-regulation. So I kind of, here's another way of doing it. The child saying, Oh no, I think we're going to crash, the car is too close, Oh no, no. And daddy would be go like, “Oh my goodness, this is, Oh, you're scared again. Oh my goodness. Here honey, I hear you. I hear you. Here, get a little bit closer or I'm right here, let’s try to work through this together. I'm going to start to dah, dah, dah, dah, dah.” The difference, hopefully you heard, was that there was inflection in the voice, there was a connection with the child. It wasn't saying just okay, we're safe. And of course the dad flustered of hearing the child say this over and over again.

Jen:                                     35:46 But instead of discounting the fear and saying it's not real.

Dr. Delahooke:                35:52 He kind of join the child and we can say it’s not real but the two things that are super important, one is the prosody of our voice because before we register actual words, our neuroception registers safety. So the tone of the human voice, oftentimes the tone, the prosody, the rhythm of a voice can help a child calm their anxiety. So remember that your voice matters. And number two, your facial expression. So these two things, our facial expression and our tone of voice are nonverbal ways to help our children feel safe. And that's where I think we're going with a lot of treatment for anxiety, in my opinion, is once a child is ready, we go to talking to them about their fears, but there's so much backfill we need to do before we can do that. And that's probably why 50% of the time, cognitive behavioral therapy doesn't work. It's because the child's not ready for it yet.

Jen:                                     36:55 All right, Jamie, you want to move us forward?

Jamie:                                36:57 Yeah. So I wanted to go back and talk a bit more about emotional co-regulation because it seems like your approach is rooted in this relationship based model of co-regulation. I think it's easy for parents to grasp when their child is an infant. We're told that our calm presence is what helps a child to calm themselves when they're a big ball of screechy mess. But it seems like pretty early on, perhaps before they're ready, we see our presence as a crutch that we want to pull out as quickly as possible so the child doesn't become dependent on it. Can you share your perspective on whether this is the right way to think about helping children, not just in responding during moments of high anxiety, but also reducing the likelihood of the child's brain and body resorting to anxiety for the rest of their life?

Dr. Delahooke:                37:41 Yes. And that question kind of goes back to the other question about if we reinforce something will this kind of create a pattern for our child of dependence or of using strategies that aren't helpful for them in life. So I think it's absolutely worthwhile talking about. So one, this idea of co-regulation, maybe I can just explain what that is because it sounds kind of like jargon and basically when a person is self-regulated, it means that I can stay calm in my mind and in my body through strategies, either consciously or subconsciously where I am able to maintain, learn, be alert and calm and all those good things that teachers would love to have for all of their students. And we forget that what's important is that self-regulation is built through co-regulation and that is just as we talked about with Matthew, babies, toddlers, young children, and depending on your own timeline, we need that loving attunement whereby our emotions are seen by our caregivers to start to develop our own self-regulation.

Dr. Delahooke:                39:08 So that's why co-regulation is important. Now when we pull that too soon, we may see challenging behaviors. We may see what we would think about as anxiety. I like to think of anxiety as a stress response. So we may see stress in the child for example. Sometimes we see this with toddlers who are going to daycare for the first time or going to preschool, you know, you'll see that. And then we go back. So the answer is to go back and do the emotional co-regulation that the child needs and then pull that slowly, pull that away as the child is comfortable. So I don't think we need to worry about overdoing co-regulation. Now there's another piece to this though and I think it's really important also to think about how do we develop hardiness in our children. Hardy like H-A-R-D-Y, you know, like strength and resilience and hardiness.

Dr. Delahooke:                40:10 And so we want to make sure we have a lot of awareness of our own regulation because sometimes if we're a little anxious ourselves as parents, we don't realize that we are using our child to co-regulate ourselves. And then we may hang on a little too long. So that's why I talk about a lot in the book I talk on, I think it's chapter four. I really talk a lot about our own taking care of, our own emotional house of emotional development. And if we're taking good care of our own emotional house, we can help develop our children to experience resilience and hardiness on their own because that's really our goal, right? One day we want our children to be able to be successful out there in the world without us.

Jen:                                     40:55 It reminds me of a workshop that I just finished running a few weeks ago. It called Taming Your Triggers and it helps parents to uncover the true sources of their triggers. And surprise, you might think it's your child behavior, but it's not your child's behavior that's triggering you.

Dr. Delahooke:                41:08 Oh, that’s wonderful, Jen. Yes, that’s great.

Jen:                                     41:11 And so the whole workshop is about managing those triggers and using tools like nonviolent communication to find solutions to problems. And so what you're saying there about being so important that parents kind of have their own house in order first makes me think, okay, well, I mean there are so many parents going through that workshop who have so many triggers and years of anxiety experiences of their own. What support, what advice, what information can we offer to those parents or maybe some reassurance that, you know, you're going to be able to raise a child who is not crippled by anxiety here?

Dr. Delahooke:                41:44 Yes. Well, hope is the key and sometimes in my field, if we go back to why I'm glad we're moving away from the DSM labeling and medical disorder model, which I call disorderism, is that it takes away hope and when we have a relationship-based strength lens to look from, we can assure parents that there is so much hope. And so I've worked with parents who have their own trauma histories for example, and there's always something to do. I have been so impressed with, I'm sure you're familiar with the massive amount of research on mindfulness and mindful self-compassion work of Kristin Neff and Chris Germer and others that they've done work with PTSD, with war veterans and with parents of children with many, many needs who suffer a lot and who are burdened with lack of sleep and the constant demands. But once we realize that there are things that each of us can do as a parent to calm our own nervous system down and to be there for their kids, there’s a lot of hope.

Dr. Delahooke:                43:02 So you know it's not easy and it takes a little bit of time, but I think I described many different pathways starting from mindful awareness, just this moment of mindfulness when you can actually pause, take a breath. If you need to take a longer exhale, just take a breath and if you're able to label what you are feeling in the moment, you know, it can just make all the difference in the world. It can prevent us from doing something to our child or saying something to our child that would dysregulate them even further.

Jen:                                     43:38 Wow. It's like you're giving a little infomercial for the Tame Your Triggers workshop. These are exactly the things that we worked through.

Dr. Delahooke:                43:46 Fantastic. Thank you. And I need the information so I can send my [Inaudible] [43:50].

Jamie:                                43:53 Awesome.

Jen:                                     43:54 Jamie did you want to ask another question?

Jamie:                                43:55 Yeah, sure. Okay. So, you know, obviously some anxiety is caused by things that happen, interactions with parents, school environment, etc. But sometimes anxiety just seems to exist in the child. I can definitely say for myself, I have, I describe it as having a hairpin trigger for anxiety like I'm startled easily, things like that. So as parents it can feel beyond our control, especially if we're that way and maybe our child got that from us. So how can we support children who have this experience and prevent it from becoming chronic toxic stress?

Dr. Delahooke:                44:33 What a beautiful question. And that speaks to really the idea that some of how we experience the world is in our constitution, right? And some of this is in our genetic makeup or in our constitution, how the way our sensory system understood the world as a child was met with our relational environment. So it sounds like from what you were describing, that you are one who has extraordinary contact with the world and experiences it deeply. And so I think that once we have this lens on not demonizing these startle responses that we may see coming up in a young child, for example, and it may be similar to our own especially if you share the same genetics, maybe it's coming up, that this compassionate lens of understanding that there is a way to view our sensitivity to the world and begin to explain it to the child and experience it with them as not as threatening as we did it as parents.

Dr. Delahooke:                45:48 So, I'll put myself into the equation. I was a very anxious kindergartener and my mother described like when I went to school, I would just stop talking and at home I was a motor mouth, but at school I would not talk to anybody and it would have been so wonderful for an adult to come alongside me and just, you know, cozy up and start chatting with me a lot, you know, on the side, I know I would've probably opened up and felt more comfortable because I had some social anxiety, but now I know that's a label. It wasn't social anxiety. I was very sensitively wired to being in a large space with a lot of people. And there's no shame in that. But instead what happened is that I got sent for psychological testing as a kindergartner.

Dr. Delahooke:                46:41 So what we can do for our children I think is to model that these differences aren't something we need to necessarily be afraid of. We can embrace them and we can nurture ourselves. We can develop our children's ability to get what they need from the adults around them as early as toddlerhood. And so I think there's a lot of opportunity to shift the lens from a negative kind of slant to a very self-compassionate, loving, nurturing stance. Whereby we build our strength and we see ourselves as strong and sensitive and not as anxious and weak.

Jen:                                     47:21 Wow. What a powerful perspective. Really locates the power with the parent and the child. And I know we're almost out of time here. One thing just came up for me as you were talking and I remembered a listener who had emailed me asking, you know, should we avoid triggers of anxiety? If it's something like going to the beach and all of a sudden your toddler is afraid of the water should we just not go to the beach for a while or should we go to the beach and try and do the self-regulation there or the co-regulation?

Dr. Delahooke:                47:48 Yeah, great question. I get that all the time too and my general answer to that is I don't think it's necessarily in the child's best interest if we avoid things like that because the world is filled with opportunities to get dysregulated. And if we start to narrow our world, but the most important key to remember is that co-regulation piece so that we would do very low and slow. We would titrate it to what the child can manage. Even if, say if it was going to the beach and the child would sit in the car and then you'd play with a little bit of sand right outside the car. I mean it would be the idea of exposure and just throwing a child into it. That's another technique that psychologists use that I personally go, is that we could do it through co-regulation. So I say to parents, generally, of course you have to make up your own mind for that situation, but if it's somewhere that you enjoy and you think your child would enjoy doing or going to, or experiencing that if you go super slow with emotional co-regulation, oftentimes that helps just expand a child's horizons rather than avoiding it, which at some point kind of narrows the child's world.

Jen:                                     49:04 Yeah, that makes a lot of sense.

Dr. Delahooke:                49:06 Is that what you do?

Jen:                                     49:07 Yeah, we're lucky that she's not currently experiencing a lot of anxiety, but yeah, I think in general we do try to not avoid things because we're experiencing this. So yeah, I appreciate that perspective. And as we wrap up, I'm just wondering, are there any books that you recommend for reading with children that can really better help them understand what's going on in their own minds as we work on helping them to manage this?

Dr. Delahooke:                49:29 Ah, yes. Let me think here. I have a--there's a book--a children's books you’re talking about?

Jen:                                     49:35 Yeah. Yeah. But we have your book for the parents, right?

Dr. Delahooke:                49:38 Yeah, I would recommend my book for the parents. That's why I wrote it. There's a precious book that I just read. It's called Listening to My Body and it's by Gabi Garcia. Oh, it's beautiful. It's about sensations and listening and getting in touch with my body's sensations. And I really feel that the way children and adults get in touch with their emotions is by starting to begin to be mindful of sensations. So that's one book I recommend. And then there's another one that's just came out, I’ll look here on my bookshelf and it's a mindfulness and gratitude and self-compassion book by Jennifer Cohen Harper, and it's called Thank You Body, Thank You Heart. And it's just lovely for all different age ranges, but it's lovely and it just allows the child to notice different parts of their bodies and be thankful for them. And I think that for anxious children, for children who have a lot of stress responses, if we can help them recognize when the stress starts coming on and what it’s like, that is a great pathway to helping them develop coping skills early in life so that they will be able to maybe even reduce the likelihood of later on having strong anxiety and shifted into something that they can manage.

Jen:                                     51:11 That's fantastic. I know we're out of time here and Dr. Delahooke I just want to say thank you for sharing this with us. I think this is going to have such a profound impact on so many families that are listening to this. Thank you so much.

Dr. Delahooke:                51:21 Oh, I'm so thrilled to be here and yes, stay in touch. I'm Mona Delahooke on Twitter and Instagram and on Facebook. I love to hear from families and I'm just so grateful that you had me on.

Jen:                                     51:33 Awesome and thanks so much Jamie for the introduction and for coming on the show today as well.

Jamie:                                51:37 Thanks for having me.

Dr. Delahooke:                51:39 Thank you so much Jamie.

Jen:                                     51:42 And so Dr. Delahooke’s book Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children's Behavioral Challenges, there's a link to that in the references for today's episode as well as the children's books that she had mentioned and the other studies that we've talked about today and you can find all of at


Beesdo, K., Knappe, S., & Pine, D.S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. Psychiatric Clinics of North America 32, 483-524.

Delahooke, M. (2019). Beyond Behaviors: Using brain science and compassion to understand and solve children’s behavioral challenges. Eau Claire, WI: PESI.

Lebowitz, E.R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W.K. (2019). Parent-based treatment as efficacious as Cognitive Behavioral Therapy for childhood anxiety: A randomized noninferiority study of supportive parenting for anxious childhood emotions. Journal of the American Academy of Child & Adolescent Psychiatry.

Porges, S.W. (2007). The polyvagal perspective. Biological Psychology 74(2), 116-143.

Wood, J.J. (2006). Parental intrusiveness and children’s separation anxiety in a clinical sample. Child Psychiatry & Human Development 37, 73-87.