Expert and author Terri Duncan explains the importance of emotional regulation, and offers was to support those with emotional disregulation.
Terri Duncan is a Speech Language Pathologist and has worked with Autistic children and a broad range of developmental delays. She is also author of the book Why Emotional Regulation Might Mean EVERYTHING. Terri has her B.A. in Psychology and Linguistics from the University of Ottawa and her Master’s Degree in Speech Language Pathology from the University of Alberta. She has been consulting in schools, homes and communities for more than 20 years, an interest that began when she worked as an aide with a four-year-old boy with autism in a family’s home. Since that time she has been fascinated by the complexity of autism and the resilience of families dealing with the challenges they face on a daily basis. Terri founded Children’s Autism Services of Edmonton in 2004 and since that time, the organization has become one of the largest service providers in Western Canada serving more than 500 families every year.
For more about Terri’s work, visit: https://childrensautism.ca/
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Note: the following transcription was automatically generated. Some imperfections may exist.
HACKIE REITMAN, MD (HR):
Hi, Dr Hackie Reitman, welcome to another episode of Exploring Different Brains, and today I’m excited. We’re going all the way up to Canada, where we’re going to talk to Terri Duncan, who’s an expert in something I need to know about emotional regulation. Terri, welcome. Thanks for being here.
TERRI DUNCAN (TD):
Thanks for having me. I appreciate it.
HR:
Tell us about your book, “Why Emotional Regulation Might Mean Everything”.
TD:
Thanks so much. I am excited to be here to talk about this book, and the title really says it all. It’s something that I’ve learned over the years. I’m a practicing speech language pathologist, and I have been for the last almost 30 years, but I’ve learned that emotional regulation is actually the foundation of everything, and without the emotional regulation, people really struggle.
HR:
Let’s start with the basics. You say, emotional regulation. And before I ask you for some examples, tell us what that means to you.
TD:
So emotional regulation, as far as I have defined it, is that ability to manage our emotional and physiological state so that we can including our subsequent reactions, so that we can fit our emotional regulation to the context. So it’s not just about emotions, it’s also that physiological state. Some people separate that out and talk about our emotions and our physiology and our physiological state as separate things, but I see them as so intertwined that they’re too difficult. It’s too difficult to separate those out. So I talk about emotional regulation to include our entire emotions, our physiological state and our subsequent reactions. And the real trick about managing emotional regulation is fitting it to the context. It’s about having the right level of emotional regulation that fits the right context and to be able to manage so for example, in a classroom, the emotional regulation state you want to be in is calm, focused, ready to learn. But if you’re at a hockey game, you want to be in a really high level of emotional state, and that emotional regulation is going to be very different.
HR:
So what are some common example of challenges to this regulation?
TD:
So a lot of us have challenges in our ability to regulate our emotional state and our and our physiological state, and in fact, it is something that develops over a lifetime, and we never stop learning emotional regulation and how to have better tools for managing our regulation and our emotional states in in different contexts. But a lot of our kids and our neuro divergent kids and adults really have a lot of challenges in this area. And you know, having that different wiring leads to a lot of challenges with emotional regulation, and a lot of our kids and adults spend a lot of time dysregulated, and there’s lots of reasons for that. Part of it is that they may have limited tools to manage their emotional regulation, but also there’s a lot more factors impacting their emotional regulation, and those are the factors that I go through in the book, and those factors really put our neurodiverse kids in a state of dysregulation a lot.
HR:
So in relating this to neurodiversity, it must be very specific for the different neurodiversity, although there’s lots and lots of overlap. So if I have issues with emotional regulation, what can help me?
TD:
So really, it’s knowing both things, knowing the factors that are impacting your emotional regulation. So what is making it hard for you to stay emotionally regulated? And then what are some of the tools that you can do? And then, really, what are some of the proactive things that you can do to stay regulated as much as possible? So when we talk about the factors that are impacting your emotional regulation there, I’ve divided it into sort of four categories, just because it makes it easier for for me to understand, and I’m hoping others, the four categories that we talk that I talk about are sensory factors, physiological factors, mental health and trauma factors and cognitive factors. So in each of those there, there are separate sort of areas that we look at. And. And in our neurodiverse populations we have they may be more impacted in one and less than another, or it could be all four areas that are impacted in some individuals. And when you start to sort of stack them, one on top of another, it becomes even more difficult to stay regulated.
HR:
And as I think, in my mind, about the different types of neuro diversities, you really, really have to tailor it, I imagine, your approach.
TD:
Yes, and individualizing is part of is one of the things that’s difficult. It is easy to get a sort of cookbook that tells you what exactly what to do. And you know, here is autism, here is ADHD, do this thing for this neurodiversity. But that’s not real life. It doesn’t really work that way. Every individual is so different. So we all need to first of all, the very first step is to get to know what are, what are the factors? So what I go through in the book are all of the different possible factors that could be impacting emotional regulation. So for example, in the in the physiological section, what are the possible things that are impacting our physiological or our physical sort of factors. So sleep is one. If there are sleep challenges, that’s one. And in our neurodiverse population, sleep challenges are common, and food and what they’re eating, physical activity, things like pain, either gastrointestinal pain or, you know, I remember one of our little gals, she was so dysregulated all the time, and we were looking at all of the different factors, and she was had self injurious behavior. She was hitting her head, and she was dysregulated almost all the time, and we were trying to figure what was going on. She was non speaking, and she was highly dysregulated. And over a period of time, we realized that she had tooth problems, she had an abscess, and she was in pain, and it was, in fact, that pain that was causing her to be dysregulated all of the time. So there’s physiological factors in our body that can cause us to be dysregulated. So that may be one of the factors that that’s influencing our emotional regulation. And then when we when we look at all of the different factors, sometimes they stack one on top of another. So knowing the individual, knowing the different things that are affecting them, and then knowing the strategies to help.
HR:
“Know the individual” – boy that carries through to a lot of different specialties and walks of life, doesn’t it? You’re the founder and executive director of the children’s autism services of Edmonton. Tell us how that came to be and the work that you all are doing.
TD:
Yeah, it’s interesting. I actually started off when I was a student, my first encounter with any child on the spectrum or any neurodiverse individual, I actually started working in the early 90s with a four year old, young autistic boy, and I fell in love with the field. I just I found it so interesting, and he was so interesting, and the family was such an incredible advocate. And that’s where I learned a lot about family centered practice and and about working, and about how little we knew about autism at the time. In the early 90s, I used to tell people I worked with a child with autism, and they’d say, what is that? And they really, literally had never heard of it. And now you couldn’t even imagine that, but back then, I was working and building a program with this mom, her and I kind of built it together in the family home, because there weren’t programs. And that’s where I sort of where it planted the seed of this idea of we need to build programs. So I went on to get my speech language pathology degree, my master’s here in Alberta, and from there, I worked in the field for a while, and then in 2004 I was working with a number of autistic children and families, and they really wanted the type of approach that I was using at the time. ABA or behavioral approaches were pretty ubiquitous. They were everywhere, and that was what almost everybody was using. And it was this drill based training, and I was using something quite different. I was using an emotional regulation approach. I was following Barry presence search model, and he was one of my mentors. And really. Really shaped my career. So because I was using that kind of model, I had a group of families that came to me and said, We want this model, and we want a whole program around it, not just just the speech pathology part. We want this whole program. And so it was really co created with families, and we built the program in 2004 so this is our 20 year anniversary, but I started this program to be able to offer this approach to families as an alternative to a behavioral approach and as a kind of a wraparound service. So now we serve probably between five and 600 families a year. We have over 250 staff. We have all kinds of programs. So we do intensive home programming, we do preschool programming, both in the community and in sites. We have respite programs. We run a conference every year that draws you know, hundreds of five, 600 attendees. We do consulting. And then this year, for the first time, we actually opened a school, a private school that is specialized, that is using an emotional regulation approach, that is also a teaching school that allows with observation rooms, that allows community schools to come in and see how does this approach actually look in a classroom, and what do you actually do in an emotional regulation approach? So it’s been quite a journey over the last 20 years with our organization…
HR:
And you’re pioneer.
TD:
Well, I stand on the shoulders of pioneers like Barry prezant, but and Michael John Carly has been a huge influence on my career as well. But all of those folks and all of us that that are moving forward with this type of of service and this, this type of approach, really, it’s about acknowledging neurodiversity before it was even called that.
HR:
Yeah, you know, it’s amazing that it is such a relatively new thing. I remember when I, when I wrote the book on Aspergers and autism Practical Guide, it was because I, I’m an MD, and I had no exposure to it. I knew nothing about it, and then when it affected my family, then all of a sudden, I said, as you did, you know, everybody should know about this stuff, you know. And in the years since the pioneers like yourself, who are doing so much, have really put things on the table, along the lines of a Temple Grandin and such. What is the biggest challenge to a family that is experiencing problems with emotional regulation, where the the child, who’s might be an adult now is experiencing emotional regulation issues?
TD:
When children and adults are dysregulated. Often it’s misunderstood. And so I believe that the biggest challenge that families and individuals face is that misunderstanding that they are being, I hear the term aggressive or violent, or they’re being, they’re being non compliant, or they’re misbehaving, or, you know, hear all those terms, and I believe that one of the biggest challenges that families face and that individuals face is being misunderstood. They’re they’re seen as as bad kids, and they’re seen as non compliant. And I just wish we would stop referring to these kids as as non compliant or as being bad, or as being in some way, purposefully targeting. You know, individuals don’t wake up in the morning trying to make everybody else’s life difficult. That’s not what they’re trying to do. So I think they’re just misunderstood a lot.
HR:
Well, if our viewers in our audience pick up your book “Why Emotional Regulation Might Mean Everything”. Do you have the remedies for these situations in there is it? Can I buy them and say I’m going to turn to page 34 and see what I should do in this situation?
TD:
Yeah, yeah, I wanted to include as many strategies as I possibly could. So it might be a little bit of overload of strategies, but after every sort of section, I’ve got a section that I say, you know, how do we help? What can we do? And I put both phrases, how do we help? As. As in, how do we support those neurodiverse individuals in our lives? So you know, as teachers, as parents, as therapists, as clinicians, how how do we help? Because we all want to help. But then also, what can we do in that, if you are an autistic adult or neurodivergent adult reading this book, then what can you do in your own life to manage your own emotional regulation? So there I put all kinds of different strategies. So there’s lists of what you know. How do we help? What can we do at the end of every section, how do we help with sleep? What can we do? How do we help with cognitive factors like executive functioning? There’s all kinds of strategies in there. How do we help with focus and attention? How do we help with all of those things? So each of the factors, the four factors, has all kinds of strategies about, how do we help and what can we do? And then the final part of the book actually is about proactive ways to maintain our own regulation. One of the things I acknowledge in the book and really emphasize is that it’s not just about the neurodiverse individual. A dysregulated adult cannot regulate a dysregulated child, so you as the caregiver, also have to manage your own regulation. I remember a situation where I was watching a parent interacting with a child and and the parent was getting more dysregulated, and the child was getting more dysregulated, and they were dysregulating each other, because we influence each other. Fortunately, in this circumstance, the the happened to be the father in this moment, came over and with a very calm, very regulating, very predictable sort of presence, was able to bring all of that over, aroused or dysregulation down. So as the as the adults and the caregivers, we have to have our own strategies for staying regulated, and I’ll just run through a few of the proactive ones that I have in the book. They’re chapters. So I have a chapter on music and regulation, and how music helps art and regulation, how religion can actually help with regulation, meditation and mindfulness, using being in nature and the effects of nature on regulation and animals and the effect of animals on regulation. So all of those I see as proactive ways, using all of those strategies, proactive ways to stay regulated and to stay in that sort of just right space where we’re able to manage day to day challenges.
HR:
Well, that’s very good. That’s very good. How can people learn more about you?
TD:
I have our website is childrenautism.ca. So “childrens” with an S autism.ca, and the book is available as well.
HR:
What is one thing that you wish everyone understood about emotional regulation?
TD:
I really wish that people understood that these individuals don’t want to be dysregulated. They’re not doing it intentionally. This isn’t an intentional thing. This is a state, an emotional regulation state, where they’re struggling. And if someone is struggling with emotional dysregulation, if they are dysregulated, what we need to do is help them, not punish them or judge them, or, you know, in any way, look at them as doing it purposefully. We need to help them. We need to step in with strategies. We need to support them, and if we could just support those dysregulated people in our lives, instead of trying to control them or more, get them to comply, or, you know, judging them. If we could just support these dysregulated folks in our lives, it would make everything so much easier.
HR:
Very well said, Has there, have there been any neuro anatomical pathways and physiology demarcated for this?
TD:
It is the system that we’re talking about is actually, I go into this a little bit in the book. I’m not an expert in that area, but I did include some of that the research that’s been done, and it’s about the the cortisol system and the it’s about the the impact of the cortisol and the the hormones and and that fight or flight, type of fight or flight, or freezer fawn, all of those that that response system in our body. Body, that’s what emotional regulation is, and and our our mind and body are so connected that when we are dysregulated, it actually impacts our our hormones and our adrenaline and our cortisol and all of those things that happen in our bodies, and that influences our behavior, and it influences all of the things that we do. So yes, there is a physiological component, and it’s about those that hormonal component, and that piece where our mind influences our body, and our body influences our mind, we’re connected, and that’s where it really is about our state. So our physiological state is influenced by all of those things.
HR:
Now is it also as a corollary to that been explored as to the parts of the brain that do the interpretation of what’s happening that may then put you in that state, like somebody comes up to give me a hug, and I they want to be affectionate, and I think they’re coming to attack me. I’m going to react differently.
TD:
It is a lot about our interpretations and how we are reading the situation, and how we are how we are reacting to everything around us. We we all interact so regularly and with others, and everyone is a little different. So it is about our reactions to that. There’s some really interesting research being done about how neurodiverse and autistic adults in particular do react quite a bit differently, and the emotions that you see, the signs or signals of regular emotions, are not the same. And so there’s some some work being done where they’re actually taking heart rate measures and cortisol measures. And so on the surface, the emotions and the regulation may look a certain way, but physiologically inside, something different is happening. So it is about interpreting things around us, and the different wiring causes us to react in different ways. So part of it’s the interpretation of that emotion and of that experience, and then part of it is this, this internal reaction that’s different and sometimes not visible. So even so much as facial expressions, facial expressions for emotions in autistic adults have been shown to be quite different. So those facial expressions when we look at someone, when a neurotypical individual looks at someone and interprets something in a certain way that might not be correct. And you know, our lives are full of those kinds of misunderstandings and tripping over communication and misconstruing intentions. And it’s it’s a common thing. We’re human, and you know that that happens all the time, and with emotional regulation, it does influence us, and it does impact us. So it’s a challenge that we have as humans and as humans who interact.
HR:
And I would probably assume that fear plays a role.
TD:
Yeah, interestingly, there’s, there’s some research that’s showing that the fear response, that that adrenaline, cortisol response, is more intense in young autistic children than it is in in neurotypical children. There’s some inter really interesting research going on around that. And the other problem is, is that not only is there a fear response, there’s a really strong emotional memory. So some of our kids have such strong, negative emotional memories that it really impacts them. So I had a situation with a little guy. He walked into our office, and it was a barbecue. So it was a welcome back barbecue. So it was a kind of a fun activity. And he walked into our office and just melted down all of a sudden, on the floor, crying, so dysregulated, so upset, we couldn’t figure out what had happened. And we said, wow, nothing triggered him. There’s no reason for this. What’s going on. So we got him regulated. We took him out of the building. We mom used music as a calming strategy. They were rocking, and he was calm. He came into the building again. Exact same thing happened, and we couldn’t figure out what was going on, what was the cause. So eventually we realized that the mom realized that the front desk has that our front desk has a curve around it and two levels. It’s one of those sort of front desks that you see that has a curve that goes around and the two levels, it is the exact same design as that child had at his dentist. And he had had a traumatic, painful experience at the dentist. He thought he was at the dentist. Yeah, and his emotional memory was so strong that he had that fear response, and it was this sort of immediate, triggered fear response. And once we figured it out, we actually took him around the back for a little while so he could realize that this isn’t the dentist. This is different. But really, I encourage people to realize and to understand that there’s always a reason. We say to these kids, oh, he out of the blue. He was so upset. It came out of nowhere. Every time I hear that, I think it didn’t come out of nowhere, we just missed the signs. We just don’t know, and we need to dig a little deeper and figure out it didn’t come out of nowhere. There is always a reason. Dysregulation always has a reason, and finding out the reason is sometimes tricky, but spend some time figuring out the reasons, because then you can get at the core of it.
HR:
That is absolutely brilliant and important, absolutely and that was a great example. Great example. Terri, is there anything we have not covered that you’d like to cover?
TD:
Oh, there’s a lot of content. So I you never have time to cover everything. One story that I often tell is actually about the cover. Do we have time to get into that? A little bit Sure? Okay, the cover of the book actually was drawn by one of my staff and a parent of an autistic child, newly diagnosed autistic child, and what I said to him was, first of all, I want a picture or a window frame, because it’s about reframing behavior. So I wanted to reframe it and have the the window frame of of a child looking out, but so that was the sort of the original design is just to have the child looking out the window with a window frame, because it’s about framing behavior. Then as I went through the book, I wanted to try and depict, and he’d actually did a really nice job of it, the light coming through the window and the the light coming in to the to the child. And the reason I wanted to depict that is there’s a story in the book about a time I was consulting in a classroom, and I was watching a child flicking his fingers, and he was flicking his fingers through the air. And he did it regularly. And I was there consulting with this, with this school, and they said, Yeah, he stems like that all the time. I said, you know, when does he do it, and why? And and they were trying to get rid of it. They wanted him to stop stimming. And so I was doing the the observation. And what was so interesting is that at one point, I was sitting there watching him, and he was sitting in a shaft of light, and as a neurotypical individual myself, I can’t see the dust that’s all around us. There’s dust around us all the time. Everywhere it’s it exists. There are particles in the air. We can’t see them, but we can see them when the light hits them, just right in a beam of light. You can see those dust particles. And I happened to be at the right angle to see him sitting in this beam of light, and he was swirling the dust particles, and I could see them swirl, and they were creating these little eddies. It was, it was beautiful. He was, he was swirling those dust particles in the air. And I found that just so fascinating, because I wondered, can he see those all the time? Can he see does he not maybe he doesn’t need as much of a light differential. Maybe he can see them more often than I can, but he was playing with them, and that’s what he was doing, was was swirling those dust particles. So I talked to them about not getting rid of that behavior. It is calming for him. It is regulating. If you try and dis extinguish that behavior, you’re getting rid of one is one of his calming tools for him, sitting and and regulating by swirling those dust particles was calming and so really encouraging them to support him in that. And I tried to capture that. We tried to sort of capture that on the cover of the book, with the with the light beam coming down and some of the particles there, to sort of link it to that story in the book, where it talks about the boy who sat in the light, in the beam of light, playing with those dust particles. So it just goes to show us that sometimes kids will come up with their own regulation strategies, and sometimes those regulation strategies are very effective.
HR:
Great example, great story. Well, Terri Duncan it has been a pleasure to speak with you.
TD:
Thank you so much.
HR:
Your book, “Why Emotional Regulation Might Mean Everything”, is going to be very, very successful. Thank you so much. I’ve learned so much from this interview, and we hope you’ll stay in touch with those of us at Different Brains, and hope to have you back here again sometime.
TD:
Absolutely thank you for the opportunity. I. Enjoyed our conversation.
