“Self-regulation” has become a buzz phrase to help children manage stress, become resilient, and stave off depression, anxiety, and post-traumatic stress disorder. To gain a better understanding of this concept, we interviewed Stuart Shanker, PhD, founder and CEO of the MEHRIT Centre (https://self-reg.ca). Dr. Shanker sets up self-regulation programs in school districts across Canada. He is the author of Self-Reg: How to Help Your Child (and You) Break the Stress Cycle and Successfully Engage With Life (Viking Press).

CCPR: Dr. Shanker, how do you define self-regulation?
Dr. Shanker: Self-regulation is the broad set of responses to stress—some helpful, some counterproductive—that clinicians need to step back and assess in each child before planning treatment. There are two extremes for stress responses: fight, flight, or freeze; or responding thoughtfully. The issue is, when a child reacts to a routine homework assignment with an emergency response, will we set up a reward system to eliminate tantrums, or will we build the child’s ability to take on challenges?

CCPR: Got some examples?
Dr. Shanker: Sure. Children often use electronic devices to escape into a trancelike state. They don’t know what calm feels like. When you turn the device off, it’s aversive coming back to reality. We have to help children and teens shift to functional, growth modes of self-regulation such as physical or social activities. Another example is children with autism, who often find eye contact stressful and shut down. This limits their ability to engage with others. If we merely train the child to look at us, the child experiences more stress and may act out. Instead, we can reduce the stress of social interactions so that the child can use those interactions to gain skills.

CCPR: What does the research say about building self-regulation and stress tolerance in children?
Dr. Shanker: Studies at York University and University of Michigan looked at patterns of stress responses in children with autism spectrum disorders, who typically have trouble regulating themselves (Casenhiser DM et al, J Autism Dev Disord 2015;45(3):846–857; Solomon R et al, J Dev Beh Pediatrics 2014;35(8):475–485). They looked at how the children managed sensorimotor, communication, visual, and executive function, and used relationship-based interventions. The children became more regulated, connected with others, and communicative.

CCPR: How does this apply to the usual patient and family we see?
Dr. Shanker: These approaches come from general child development and are even more useful with children who are less rigid in their thinking. When caregivers adjust for children’s patterns of strengths and challenges, they do a better job of connecting and communicating, and the children become more confident in meeting daily challenges.

CCPR: How do you assess self-regulation?
Dr. Shanker: Catalog the child’s responses to situations at home, school, and activities, including cognitive, communicative, and social demands. This shows you where you can build on good function and where to reduce stress to build more gradually on harder situations. Both tantrums and withdrawal indicate that a child has developed a sensitivity to stress, a negative bias. If you explain the behavior as making poor choices and punish the child, all you’re doing is increasing the stress. In your office, if you show a child a neutral photo, the child will tend to see it in a negative light.

CCPR: How do you help the child?
Dr. Shanker: Help caregivers distinguish between misbehavior and stress behavior and not treat misbehavior as volitional. As they reframe their child’s behavior, their own distress drops. Then help them become stress detectives. Maybe smell is a huge stress for this kid. Are the things the child is doing to self-regulate also hidden stresses? The third step is to reduce the stresses. We had a little girl who experienced sitting at a separate chair and desk as very stressful. But a connected chair-desk worked great for her.

CCPR: Then what?
Dr. Shanker: Help the child learn what calm really feels like, to identify the signs of becoming overstressed and get back to calm. Finally, help caregivers to be reflective, always asking “Why am I reacting this way?” “Why is my child reacting this way?” and “How might I respond?”

CCPR: Thank you for your time, Dr. Shanker.