Wendy came to my office concerned about her son, Paul. She explained that Paul was frequently dysregulated, and she wanted to know how to support him. I asked Wendy what she meant when she said dysregulated. She looked at me like I had two heads. How could I, a neuropsychologist, not know what dysregulated meant? Of course I was familiar with the term. I just didn’t know what she meant by it.
Emotion regulation is a real and important construct, but understanding a child’s functioning requires much more information than the term dysregulated can provide. To understand how children regulate their emotions, we need to understand how they experience them, and emotional experiences vary along several dimensions.
The first is valence. Is the emotion positive or negative? Excitement, joy, and anticipation can be just as tricky as anger, sadness, and anxiety. A child who is excited about her birthday party might have as much trouble in school as a child who is disappointed about a canceled playdate.
The second is energy. How much energy accompanies the emotion? Some emotions are accompanied by high levels of physiological and behavioral energy, while others are accompanied by relatively low levels. Two children can experience similar emotions but look very different. One child who is upset fidgets, paces, and talks constantly, whereas another becomes inhibited, quiet, and frozen.
The third is intensity. How strong is the emotional experience? Some children experience emotions with high intensity whereas others are relatively muted. Two children can both get angry when their parents tell them to turn off the TV, but one might become furious while the other simply has mild irritation.
The fourth is duration. How long does the emotional experience last? Emotions unfold over time, and they eventually return to baseline. Some children become extremely emotional but recover quickly; others remain emotional for hours. One child cries when she loses a soccer game but happily goes to the playground with her friends five minutes later. Another remains upset for the rest of the afternoon.
The fifth is expression. How does the emotion manifest? Here, we need to distinguish between emotional experience and observable behavior. Internalizing emotional expressions direct inward and include ruminating, avoiding, and shutting down. Externalizing emotional expressions direct outward and include yelling, crying, and throwing things. We tend to notice externalizing behaviors because they can be disruptive, but internalizing can be just as impairing to a child. A child may scream and throw his pencil if he gets a bad grade on a test, whereas another, afraid of sounding stupid, may sit quietly, experiencing just as much distress.
When we describe an emotional experience, we also need to think about whether it is appropriate and adaptive. Three factors are particularly important here: age, context, and goals.
When we think about age, we think about whether the emotional experience is developmentally appropriate. Regulation develops throughout childhood and adolescence, so we consider the emotional expression relative to developmental expectations. We don’t expect young children to express emotions with the control and sophistication of older children and adults. A two-year-old who has a tantrum on the floor looks very different from a fifteen-year-old who does the same thing.
When we think about context, we assess whether the emotional response makes sense. The same response can be appropriate in one context and disproportionate in another. Intense and extended emotional experiences aren’t always pathological; sometimes they are totally appropriate for the situation. Extreme, prolonged sadness after losing a beloved pet looks very different from extreme, prolonged sadness after staining a shirt.
When we think about goals, we determine whether the emotional response is in service of or interfering with what the child wants or needs to do. We shouldn’t try to achieve a constant state of calm or to eliminate unpleasant emotions. Instead, it’s to manage emotions flexibly and deliberately. Anxiety can be adaptive for a kid the night before a test if it motivates them to study; conversely, it can be maladaptive if it interferes with learning, sleeping, or otherwise doing the things they need to do.
So, to sum things up, we need to be precise in our descriptions and thoughtful in our interpretations.
These issues are not specific to conversations about dysregulation. Vague psychological terminology–”therapy speak”--is disrupting lots of conversations about parenting, mental health, and education. Psych jargony terms like dysregulated, overstimulated, and triggered have become part of everyday language. In theory, greater familiarity with psychological concepts should improve our understanding, but in reality, popular usage seems to strip these terms of their specificity and render them meaningless. The conversations become circular: The child is screaming because he’s dysregulated, and we know he’s dysregulated because he’s screaming. We haven’t explained anything; we’ve simply renamed what’s happening.
Also, calling a child dysregulated or some other psychobabble term implies that something is wrong, but we haven’t had a chance to establish that there’s a problem in the first place. Not every intense, unpleasant emotion needs to be regulated away, and not every child who struggles to manage an emotion is disordered.
Back to Wendy: I wasn’t intending to challenge her understanding of her child. I was just asking her to help me understand him. When she uses the word dysregulated, she obscures information and implies pathology–she doesn’t effectively communicate what Paul is experiencing, and it’s difficult to determine whether what’s happening is inappropriate or impairing. So instead of using clinical terminology, I need parents to tell me clearly and concretely what they see, what their kids do and experience. Descriptions provide helpful information about a child; dysregulated provides nothing.
Great post! Using clearer language can help parents (and kids!) reframe their experiences and develop new insights! -From a fellow psychologist