Chapter 2 Emotional Dysregulation. Emotion Regulation Gone Wrong. Underdeveloped Emotion Regulation

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1 Chapter 2 Emotiona Dysreguation Emotion Reguation Gone Wrong Underdeveoped Emotion Reguation Successfu accompishment of the deveopmenta tasks of chidhood and adoescence requires emotion reguation, and the abiity to reguate their emotions transates into physica and menta heath for students. Taking a ook at what can happen when age-appropriate emotion reguation has not been achieved wi carify the importance of emotion reguation in work with chidren and adoescents. The faiure to reguate emotion is caed dysreguation. When temporary, it can cause symptoms of anxiety, possiby even intense discomfort, poory controed behavior, and/or withdrawa. If poor reguation is fairy constant, it can be manifested in the disorders we observe in some chidren (Dodge and Garber 1991). Dysreguated emotion is entwined with many of the psychoogica disorders we identify in young peope; in fact, according to Gross (1998b), it is impicated in many of the disorders described in the Diagnostic and Statistica Manua of the American Psychiatric Association (DSM). It is invoved in more than haf of the DSM-IV Axis I disorders and in a of the Axis II disorders, and it has been caed a hamark of psychopathoogy (Beauchaine, Gatzke-Kopp, and Mead 2006). Patterns of emotion reguation that strongy interfere with competence can become symptoms of a disorder. They can aso pace a student at risk for deveoping a disorder or for having probematic interpersona reationships (Shipman et a. 2004). For exampe, probems reguating negative emotions are reated to internaizing disorders such as anxiety and/or depression, and difficuty with a negative emotion such as anger may be reated to externaizing disorders or acting out (Gross, 1998b). Emotion dysreguation is actuay reated to both types of probems; i.e., internaizing and externaizing behaviors. Chidren who exhibit behaviors associated with internaizing and/or externaizing disorders generay exhibit more extreme and more frequent emotions. Negative affect is more important than positive affect when considering psychopathoogy (Sim and Zeman 2006). Difficuty dissipating or decreasing negative emotions is associated with both internaizing and externaizing G. L. Mackem, Practitioner s Guide to Emotion Reguation in Schoo-Aged Chidren. Ó Springer

2 14 2 Emotiona Dysreguation difficuties. This can be thought of as a probem of caming down or simpy down reguating emotions (Sik, Shaw, Lane, Unike, and Kovacs 2005). It is important to keep in mind that the exact etioogy of sef-reguatory probems is probaby a function of many variabes acting together (Behncke 2002). Difficuty with emotion reguation is probematic but is certainy not the ony cause of identifiabe disorders of chidhood. Emotion dysreguation pays a roe in: Physioogica disorders Bioogicay based disorders Disorders caused by stress Psychoogica disorders One shoud keep in mind that many psychoogica disorders are strongy connected to bioogy. It is hepfu to expore some of the cognitive variabes such as negative emotionaity, effortfu contro, and attention that compicate a chid s abiity to deveop age-appropriate emotion reguation. Physioogica Symptoms and Disorders There are mutipe physioogica symptoms and disorders associated with emotion dysreguation. Some of these incude: (a) pain, (b) smoking, (c) cutting, (d) eating disorders, and (e) addiction. Researchers have demonstrated a connection between physioogica compaints and negative emotionaity (Hageku and Bohin 2004). Some chidren experience decreased abiity to reguate pain. Recurrent abdomina pain is a common physica compaint, experienced by 10 to 30 percent of schoo-age chidren. Chidren who have poor pain reguation focus on pain, fee it to a greater extent than their peers, and do not cope we with it (Boyer, Compas, Stanger, Coetti, Konik, Morrow, and Thomsen 2005). The roe of emotion dysreguation in the deveopment of somatoform disorders, where the primary symptom is pain that is not part of any identifiabe disorder, has been expored. Waer and Scheidt (2006) connect these disorders to a decreased abiity to experience and differentiate emotions as we as to the inabiity to express emotions in a heathy manner. Adoescents who do not cope we with anger may use cigarettes as way to manage emotion. Nicotine decreases the intensity and frequency of fet anger, and this is especiay notabe in adoescents with a high eve of hostiity (Audrain- McGovern, Rodgiguez, Tercyak, Neuner, and Moss 2006). Negative emotions cause adoescents to fai shoud they decide to try to stop smoking. Anxiety increases smoking behaviors, as smoking heps individuas who experience anxiety fee better (Tice, Bratsavsky, and Baumeister 2001). These reationships hep expain at east in part why some adoescents are more incined to start smoking and why it is difficut for others to quit. As soon as the adoescent who has given

3 Roe of Emotiona Dysreguation in Many Chidhood Disorders 15 up cigarettes is faced with a stressfu situation, the od habit of using smoking to fee better may prevai. Negative affect is tighty connected to cinica and subcinica eating disorders. Chronic negative feeings and negative mood aong with difficuty identifying and naming one s emotiona states paces young peope at risk for using eating behaviors to reguate negative emotions (Sim and Zeman 2006). Chidren and adoescents with eating disorders experience a cyce invoving emotion and food so that emotiona distress resuts in eating, which in turn, eads to increased distress, which triggers even more eating. Behaviora contro of many types breaks down when moods are negative. Negative moods resut in reguatory faiure before, during, and after treatment. For exampe, during treatment, efforts to stop drinking acoho are more successfu when negative emotions can be kept under contro. Inabiity to toerate certain emotiona states has been associated with severa other disorders and behaviors incuding cutting, binging, and excessive exercise with vomiting (Whiteside, Hunter, Dunn, Pamquist, and Naputi 2003). When associated with eating disorders, this mode ties eating disorders in particuar with difficuty in emotion reguation once an adoescent becomes upset. Fresco, Wofson, Crowther, and Docherty (2002) describe probems with eating disorders caused by worry, and indicate that binging and purging are used to reduce intense emotion. The same research group reports a connection between generaized anxiety disorders and deficits in adaptive emotion reguation. Roe of Emotiona Dysreguation in Many Chidhood Disorders Many chidhood disorders invove difficuties with emotion reguation, and a quick review of the ist wi make that cear. Emotiona dysreguation is a significant marker for both externaizing and internaizing disorders. The concept of externaizing disorders refers to conduct or disruptive disorders, whereas internaizing disorders refers to emotiona probems or any mood disorder (Gjone and Stevenson 1997; Martin 2003). Figure 2.1 ists a number of specific emotion reguation weaknesses associated with both internaizing and externaizing disorders. Of course, it is important to keep in mind that the distinction between internaizing and externaizing disorders is compicated. Severa disorders can be present at once; moreover, it has been determined that a externaizing disorders are reated to anxiety disorders (Marmorstein 2007). The association between externaizing disorders is stronger for boys than for girs and at younger ages. For exampe, according to Marmorstein (2007), there is a strong association between socia phobia and a the externaizing disorders as we as between oppositiona defiant disorder and overanxious disorder.

4 16 2 Emotiona Dysreguation Students with Internaizing Disorders Exhibit more extreme emotions, too intense for the situation. Exhibit emotion more frequenty. Have difficuty decreasing negative emotions. Have difficuty down-reguating emotion (Sik, Shaw, et a. 2005). Have difficuty inhibiting emotiona expression. Have difficuty understanding emotiona experiences. Experience more negative emotions. Are ess abe to cam themseves. Are biased toward negative or threatening cues. Choose irreevant, avoidant, or aggressive strategies to dea with negative emotions. Do not appreciate that it is possibe to change emotiona experiences. Students with Externaizing Disorders Exhibit more extreme emotions. Exhibit emotion more frequenty. Have difficuty decreasing negative emotions. Have difficuty down-reguating emotion (Sik et a. 2005). Have difficuty identifying emotiona cues. Have weak emotiona understanding and expression. Do not easiy recognize their own emotions. Tend to focus on the negative aspects of situations. Have difficuty with attentiona contro. Have difficuty inhibiting behavior. Use aggressive strategies to dea with negative emotions. (Individua students may exhibit some or many of these symptoms.) Fig. 2.1 Emotion Reguation Weaknesses Associated with Internaizing and Externaizing Disorders Borderine Personaity Disorder The most extreme exampe of emotion dysreguation may we be borderine personaity disorder; in fact, emotiona reguation disorder has been proposed as a more ceary descriptive abe (Feener 1999). Finey-Begrad and Davies (2006) note that if symptoms are observed over time and a student meets the criteria for borderine personaity disorder, it is appropriate to make the diagnosis in chidren and adoescents. Personaity disorders that begin in chidhood may be diagnosed if symptoms have been present for at east a year (Eett, n.d.). Today, borderine personaity disorder is thought to be either genetic or caused by both genes and environmenta triggers (TARA-APD 2004). The chid or adoescent with borderine personaity disorder is primariy unabe to reguate his or her emotions. Given that the centra issue is emotion dysreguation, chidren at risk for it and adoescents with the disorder react more intensey and have a particuary hard time returning to a neutra state after upset. These boys and girs are demanding, unpredictabe in reationships,

5 Roe of Emotiona Dysreguation in Many Chidhood Disorders 17 immature, and suspicious (Kernberg, Weiner, and Bardenstrein 2000, p. 139). Symptoms of borderine personaity disorder have been identified in chidren as eary as fourth to sixth grade (Crick, Murray-Cose, and Woods 2005), and such students can be expected to dispay a combination of externaizing, internaizing, and cognitive symptoms such as executive dysfunctions (Finey-Begrad and Davies 2006). Autism Spectrum Disorders Some researchers have concuded that the probems of chidren with autism spectrum disorders stem from disorganization and dysreguation, and ceary, the reguation of pay is particuary affected in this group. Chidren with autism may suddeny stop interacting and appear to ose focus. They change behaviors as the action continues, which is disconcerting for peers. They present better and are more successfu in interaction with their peers if an adut structures the pay (Banc, Adrien, Roux, and Bartheemy 2005). Bipoar Disorder Chidren with bipoar disorder appear to have poory reguated arousa systems, and they exhibit pronounced faiures of emotion reguation. The compications that may arise from a poory reguated arousa system incude: (a) difficuty managing aggressive impuses, (b) probems with seep arousa, (c) eevated anxiety and sensitivity, and (d) difficuty managing anger (Papoos and Papoos 2005). Attention-Deficit Hyperactivity Disorder From a behaviora point of view, attention-deficit hyperactivity disorder (ADHD) is primariy a disorder of sef-reguation. Certainy, chidren with the combined type of ADHD exhibit emotiona dysreguation to a pronounced degree and demonstrate intense negative and positive behaviors as we as impaired sef-contro (Casey and Durston 2006; Chen and Tayor 2005; Maedgen and Carson 2000; Voeer 2004; Wacott and Landau 2004). Young peope with ADHD are not as skied as their peers in identifying and reguating emotions and often fee frustrated. Athough they understand a good dea about emotions they are ess abe to identify how to respond to frustration and do not seem to be abe to use coping strategies whie embroied in emotiona situations. It is important to teach them behaviora skis, but they aso must earn strategies for reguating emotions (Scime and Norviitis 2006). Some

6 18 2 Emotiona Dysreguation students with ADHD aso exhibit oppositiona behaviors and are particuary reactive to the negative emotions of anger and hostiity. Aggressive Students Aggressive students have been found to have probems identifying emotiona cues in those with whom they are interacting (Bear, Manning, and Izard 2003). Conduct disordered students with poor contro or poor sef-reguation, as reported by their teachers, exhibit more behavior probems, have more angry interactions with their peers, and exhibit both anger probems and aggression (Tangney 2004). Students identified as having conduct probems have poor emotion reguation aong with weak emotiona understanding and expression. A series of studies reported by severa researchers indicates that students with conduct probems experience emotion more intensey than their peers, have more difficuty matching emotions to socia cues, are more ikey than their peers to fee angry when shown videos that might trigger anger, do not respond as we as their peers to cues used to recognize their own feeings, and tend to not ony focus on the negative aspects of situations but to vent emotionay (Fainsiber and Windecker-Neson 2004; Katz and Windecker- Neson 2004). Interestingy, girs with conduct disorders may be aware of the power that their intense behavior has over others. Many of them seem to understand that dysreguated behavior provides rewards in both attention from and power over others because their behavior is so intimidating (Kostiuk and Fouts 2002). Often girs and boys who are at risk for conduct disorders and aggression but have not yet been identified as having these disorders have difficuty with emotion reguation. Those at risk for externaizing probems exhibit more negative emotions, ess reguated emotions, and ess reguated behaviors than chidren at ow risk (Cakins and Dedmon, 2000). Dennis and Brotman (2003b) indicate that attention and inhibition make independent contributions to whether or not a chid wi respond with aggression. It is important to identify individua differences in abiity to reguate emotion in order to understand a chid s risk for psychopathoogy (Smith 2002). Internaizing Disorders Chidren with externaizing disorders, incuding ADHD, substance abuse, oppositiona disorders, conduct probems, aggression, and even Tourette syndrome evidence probems with emotion reguation and sef-contro in genera (Chen and Tayor 2005). But, it is not ony chidren with externaizing disorders who have difficuty with emotion reguation; those with internaizing disorders

7 Internaizing Disorders 19 aso have difficuty managing their emotions. Young peope with anxiety disorders have itte understanding that it is possibe to change their emotiona experience and very itte idea of how to inhibit emotiona expression (Shipman et a. 2004). Young peope with depressive disorders have difficuty reguating negative emotions. Anxiety and depression appear to be reated: in chidren, anxiety precedes depression. Chidren and adoescents with internaizing disorders seem to process emotiona information differenty than their peers, focusing attention on negative or threatening information. Youngsters who deveop anxiety disorders focus on threatening cues in their environment, whereas chidren who become depressed are biased toward negative emotiona information and cannot seem to suppress negative emotion (Beauregard et a. 2004: Ladouceur, Dah, Wiiamson, Birmaher, Ryan, and Casey 2005). Generaized Anxiety Disorder Emotion dysreguation has been proposed as a centra feature in generaized anxiety disorder (GAD). Youngsters with generaized anxiety have difficuty understanding emotiona experiences and have itte ski or abiity to moduate their intense emotions (Mennin, 2006). Not ony do they experience more intense emotions than their peers, they are more negative, are ess abe to cam themseves, and have more physioogica symptoms after an anxietyproducing experience (Mennin, Heimberg, Turk, and Fresco 2005). Anxious ambivaent chidren have difficuty reguating emotions so that their arousa is too intense for the situation, and they both misidentify and misdirect their emotions (Kostiuk and Fouts 2002). Chidren and adoescents with anxiety disorders have difficuty handing worries, sadness, and anger. This may be due to the intense degree to which they experience negative emotions. They generay have itte confidence in their abiity to dea with intensey aroused negative emotions (Suveg and Zeman 2004). Depressive Disorders Depressive disorders are very common, with one in five adoescents showing symptoms of unipoar depression before they compete secondary schoo and one in eeven evidencing depression by the end of midde schoo. Depressive symptoms are even more common, with percent of adoescents reporting symptoms at moderate to high eves. It is important to note that young peope with significant symptoms of depression appear very much as cinicay depressed individuas in regard to socia interactions (Giham, Reivich, Freres, Lascher, Litzinger, Shatte, et a. 2006). Low sef-esteem appears to be a cear

8 20 2 Emotiona Dysreguation risk factor for depression in eary adoescence, with girs who act out and girs brought up in famiies who ive in ower socioeconomic areas being particuary vunerabe (MacPhee and Andrews 2006). As difficut as negative emotions may be for chidren with internaizing disorders, depressed juvenies do not process positive emotiona information in the same way as their peers. Moreover, they avoid approach-reated behavior (Ladouceur et a. 2005). Rottenberg and Gross (2003) remind us that emotiona numbing occurs in individuas who are depressed. A study of depressed adoescents (Sik, Steinberg, and Morris 2003) showed that these young peope experienced more intense and variabe emotions than their typicay deveoping peers. They were not as competent in reguating their emotions, sef-reported more depressive symptoms, and exhibited difficut behaviors. There appear to be differences in girs who are depressed as compared to boys. It is we known that adoescent femaes report more depressive symptoms and have more difficuty controing ruminating behaviors than boys. When ruminating, girs think negative thoughts over and over and have significant difficuty thinking in heathier ways (Thayer, Rossy, Ruiz-Padia, and Johnsen 2003). In genera, depressed young peope use different and ess effective methods for deaing with negative emotions. The strategies they choose to dea with issues and feeings are usuay irreevant or more physicay aggressive. They tend to prefer avoidance strategies, such as seeping or doing nothing, when they do not choose aggressive ones. These chidren do not beieve that what they might think of to do to hep themseves wi work, nor do they think that the strategies that aduts might suggest wi work for them. This negative sefefficacy beief, combined with a ack of strategic knowedge, makes it very difficut for depressed juvenies to reduce negative emotions. A key chaenge for these young peope is recovering from negative moods. Athough they do experience some positive moods, the negative moods cause extensive probems (Garber, Braafadt, and Zeman 1991). Pessimism is associated with efforts to reduce unpeasant feeings when a chid is stressed rather than probem soving. In fact, pessimistic students disengage from their goas when they are stressed. Optimism, on the other hand, appears to be a buffer for schoo stress. Students with optimistic mindsets cope better and report ess academic stress (Huan, Yeo, Ang, and Chong 2006). Negative Emotionaity, Effortfu Contro, and Attention Negative emotions can be a primary cause of pain and dysfunction among chidren and adoescents (Beauregard 2004). Negative affect is a mix of moods and emotions such as anger, distress, and agitation, and is prevaent in both externaizing and internaizing disorders. In fact, negative emotionaity is a key component of both types of disorders. Students with either type of disorder, or

9 Negative Emotionaity, Effortfu Contro, and Attention 21 both, experience consideraby more anger than their peers, and their negative emotionaity is extreme. Externaizing chidren have difficuty expressing emotion in appropriate ways, particuary negative emotion, which they in turn manage poory. They experience intense anger and irritabiity. Students who internaize tend to experience more intense sadness, depression, anxiety, and fear. They act out when they cannot meet their needs in any other way. They are angrier, sadder, and more fearfu than their typica cassmates. They dea with even more negative emotion as they get oder and become even ess we adjusted over time. Their difficuties with negative emotionaity as they grow oder has been (at east in part) inked to experiences in which they have not been successfu in reguating emotions (Eisenberg, Sadovsky, et a. 2005). Abiity to suppress negative emotion determines a student s tendency toward aggression (Davidson, Putnam, and Larson 2000). Fox and Cakins (2003) suggest that three variabes are reated to emotion reguation: Executive functions Effortfu contro Attention These three genera cognitive processes affect an individua s abiity to contro emotion. First, two types of executive functioning are particuary important: sefdirectedness or drive and performance contro. The atter must be brought to bear before initiating behavior; it must be utiized whie the behavior is being carried out and then brought to bear ater, after the behavior or task has been terminated. Fox (1998) indicates that other executive functions, incuding switching set (changing behavior or thinking midstream), panning, generating aternative responses, or strategies to reach goas, may be invoved as we. Second, effortfu contro is invoved as the chid s abiity to inhibit responding or not to respond to environmenta triggers comes into pay. It is aso reated to the abiity to remain vigiant. These contro processes reguate behaviora tendencies to approach or avoid situations. They aso reate to whether or not a chid wi react to positive or negative emotions. Effortfu contro is required so that the chid can act against a tendency to react in a particuar manner, so that his or her behavior in a given context is appropriate. Reguating an emotiona response requires effort, just as controing impuses requires it (Fox and Cakins 2003). Conduct probems in students are associated with poor skis in effortfu contro, weak inhibition, and difficuties sustaining attention (Dennis and Brotman 2003b). Students with externaizing disorders are ow in a kinds of effortfu contro (Eisenberg, Sadovsky, et a. 2005). Studies indicate that effortfu contro in typicay deveoping chidren rises sharpy at around four years of age. This rise is reated to a deveoping abiity to moduate impusivity, in which the chid is becoming more competent through the use of strategies taught by

10 22 2 Emotiona Dysreguation the parents. At this age chidren work to contro a behavior, but as they get oder they tend to exert effortfu contro when anxious. There are cear age and individua differences in sef-reguation. Young peope who internaize exert efforts in anticipation, ahead of encountering a stressor (Lewis and Stieben 2004). Those who externaize act first and think afterward. Third, studies show that attentiona processes are invoved when emotiona information is processed. The abiity to focus attention is reated to emotiona sef-contro. Attention used in this context refers to executive attention contro. Chidren with stronger abiity to focus attention and thus have ower distractibiity are more ikey to experience positive rather than negative emotions. They are aso more ikey to approach their peers in a positive way and remain engaged once they are interacting with others. They are comfortabe asking others to pay and can foow the action of the game. Young peope with better abiity to contro their attention are aso better at controing their emotions. They remain in contro when the pay action does not go their way. In order to shift attention away from stressfu negative triggers toward something positive, executive attention must be under conscious contro (Fox and Cakins 2003; Ladouceur et a. 2005). Externaizing juvenies have difficuties with attentiona processes that reate to deaing with negative emotions. Chidren who internaize have difficuty shifting their attention away from cues or triggers in the environment that cause them distress. The abiity to shift attention is invoved not ony in socia interactions but in academic contexts as we (Eisenberg et a. 2005). A weak abiity to contro attention by shifting it or refocusing predicts behaviora difficuties in both eary and midde chidhood. When a chid can focus on something positive and can draw his or her attention away from negative stimui or away from something threatening, he or she wi function better. Young peope who have stronger tendencies to be drawn to negative emotions are most in need of attention contro in order to dea with feeings of anger and tendencies to act out (Shipman et a. 2004). The abiity to shift attention from negative toward neutra or positive stimui appears to be especiay important in shutting down negative emotion (Eisenberg, Sadovsky, Spinrad, Fabes, et a. 2005). Attention may be the key connection between emotion reguation and processing socia situations. Attention is required in order to organize thoughts and feeings to fit a given context. Students with poor attention reguation are at a disadvantage in socia situations and demonstrate probems in socia competence. They are ess we iked by their peers and ess we accepted (Gross, 1998b; Parke, Simpkins, McDowe, Kim, Kiian, Dennis, Fyr, Wid, and Rah 2002). It has been demonstrated at severa different ages that chidren who ack socia competence and chidren who experience high negative emotionaity have ow attentiona persistence in common (Huizinga, Doan, and van der Moen 2006). Behaviora inhibition is aso inked to executive functions (Davis, A. 2006).

11 Impications for Heping Students in Schoos 23 Impications for Heping Students in Schoos Understanding the pervasiveness of difficuties in emotion reguation among students with socia and emotiona probems and disorders, as we as among chidren at risk, eads to an awareness of the need to deveop interventions to ameiorate some of the stresses that these vunerabe young peope have to dea with. Before taking an in-depth ook at specific strategies and approaches, it may be hepfu to review suggestions made by researchers studying the roe that emotiona reguation pays in the various disorders described here. Researchers suggest that students of eementary and midde schoo age have to be exposed to one of the severa evidence-based curricua that directy teach socia and emotiona competence (Bair 2002). Successfu preschoo programs have been deveoped that increase chidren s knowedge about emotions and hep them become more aware of their own and others emotions (Smith 2002), and there are many socia-emotiona earning curricua from which to choose. It is important to research the effectiveness of a program and to match the curricuum to oca needs. For eementary schoo-aged students, specific skis such as how to distract and soothe or cam onesef are important. Listing the positives and negatives of stressfu or potentiay stressfu events and situations, earning to act differenty from the way one has acted in the past, and negotiating are skis that have to be taught (Mier 2002). Since anger is often the resut of bocked goas, it is important to teach chidren to think of more appropriate ways to get what they want or need (Fox 1998). It is vitay important for aggressive chidren to master the abiity to inhibit behavior, as chidren with externaizing disorders have specific deficits in this area and their anger wi fuctuate more when they cannot inhibit behavior (Dennis and Brotman 2003a; Hoeksma, Oosteraan, and Shipper 2004). A program that improves parents awareness of emotion may be particuary important for famiies that incude younger chidren with behavior probems (Fainsiber and Windecker-Neson 2004). Cognitive-behaviora interventions and cognitive restructuring (thinking about stressors in a different, more positive way) are frequenty recommended for decreasing negative affect for ate-eementary, midde schoo, and high schoo students (Chen and Tayor 2005; Dodge and Garber 1991; Mier, Wiiams, and McCoy 2004). More specific skis such as shifting attention toward positive moods, activities, and events are important, as are engaging in peasant activities, probem soving, utiizing avaiabe resources, and techniques for questioning one s negative thinking (Garber et a. 1991; Ladouceur et a. 2005; Woer 2006). Group interventions that teach stress toerance, improve interpersona skis, and hep students become more aware have been recommended, aong with improving emotion perception and interpretation, goa setting, generating aternative responses, and evauating behaviora responses (Garber et a. 1991; TARA-APD 2004). Prevention programs deveoped for adoescents

12 24 2 Emotiona Dysreguation that may be hepfu incude probem soving, coping with anger, examining the consequences of behavior before acting upon emotions, and refusa skis training (Audrain-McGovern et a. 2006). More specific interventions may be needed for the most invoved students and those identified with disorders. For exampe, teaching aduts to mode facia expressions when interacting with chidren who have autistic spectrum disorders is important because these students do not spontaneousy dispay the emotions they are experiencing. They do not aways understand tone of voice or read body anguage we. Teaching chidren with autism to distract themseves by engaging in motoricay active behaviors is ikey to be an effective strategy and can sometimes be taught easiy (Bryson, Landry, Czapinski, McConne, Rombough, and Wainwright 2004). Specific strategies wi be needed to hep a chidren cope with stress and negative emotions. Research with individuas who have serious inesses provides some information about the strategies that may be hepfu. The iterature on coping with cancer in chidhood, for instance, has identified some specific strategies that are important: An optimistic outook A minimizing perspective Probem soving Positivey reinterpreting situations Sef-restraint Finding socia support These have been demonstrated to be hepfu, aong with a beief that one is capabe of coping successfuy (Livneh 2000). There are severa considerations in regard to interventions and teaching approaches. First, a universa intervention designed for a students with the goa of teaching them about emotions and their reguation coud not ony serve as a prevention too for typicay deveoping chidren, but woud aso be hepfu for students who are aready exhibiting difficuties with emotion reguation. Second, more focused and targeted interventions may be needed for students with identified difficuties. Third, the intervention must be matched with specific needs. For some chidren, contro of behavior or training inhibition must be added to emotion reguation strategies. For others, the appropriate ways to express emotion must be taught. For sti others, enisting a parent wi greaty enhance the power of the intervention.

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