Chapter 7

See illustration below for examples of how the programs and practices discussed in chapter 6 can potentially support one or more strategies comprising the process model of emotion regulation (Gross, 1998; Gross and Thompson, 2009). Programs and practices are cited for illustration purposes only, and should not be interpreted as prescriptive recommendations.

Zones of Regulation

Zones of Regulation: Leah Kuypers, M.A., an occupational therapist and social learning specialist, developed Zones of Regulation (The Zones for short) to help children with lagging self-regulation skills learn ways to effectively regulate themselves at school, at home, and in the company of their friends. The curriculum categorizes states of arousal and emotional control into four easily identified color-coded zones: the red zone, where emotions are so intense that we feel out of control; the yellow zone, where emotions are not as intense, at least not as yet, and we still have some control; the green zone, a calmer place, where we feel focused, alert, in control of our emotions, and ready to learn; and the blue zone, a low state of alertness, too low to get much work done. We know we’re in the blue zone when we’re not feeling well, when we’re tired, or when we’re too bored to focus. The zones can be explained much as we would explain traffic signs. Red means stop. Yellow is a warning to slow down and be cautious. Blue is like a rest area off the freeway, a place where we can stop, take a break, and get re-energized. Green means we’re good to go. Within the course of 18 lessons, children learn ways to identify their different states of arousal and emotional control. Children who previously struggled when asked to explain how they feel now have a vocabulary for doing so. Children also learn about different tools for moving from one zone to another, including tools for staying in the green zone, a zone we need to be in to function well in class (Katz, 2012).

The Zones curriculum also provides practice in other emotion self-regulation strategies as well, including situation modification and cognitive change. For example, lessons teach children to recognize personal triggers that typically send them into yellow and red zones. Then they practice ways of identifying and preparing for triggers beforehand. This way they can prevent themselves from losing control in situations where losing control has occurred in the past. In order to encourage children to take more ownership of their self-regulation skills, Kuypers also incorporates a number of cognitive behavioral strategies designed to increase positive self-talk, self-monitoring, and self-management.

Lessons focus particular attention on teaching the self-regulation skills necessary for making and keeping friends. Children learn how their reactions in different zones affect others, including other children at school. They also practice recognizing other people’s facial expressions and how these different facial expressions relate to different zones people are in. Children become more skilled at appreciating other people’s moods and emotions. In teaching social skills, The Zones draws upon several of Michelle Garcia Winner’s strategies for teaching Social Thinking (www.socialthinking.com).

The Zones is intended for anyone who works with students K-12 who struggle in areas associated with self-regulation. In actuality though, the curriculum has broader applications. Since most of us struggle from time to time in managing our emotions and controlling our behavior, many teachers are using The Zones for their entire class. Those interested in learning more about The Zones can do so by logging on to the website www.zonesofregulation.com. Readers are also referred to Kuypers’ book (see references), which contains a CD ROM that includes reproducible visuals and handouts related to lessons.

The Irvine Paraprofessional Program (IPP)

Students with weak attentional and executive function skills often know what to do, but may not be able to consistently do what they know (Barkley, 2010a,b; Goldstein, 2001). For many of these students, the problem is in doing – in output, or execution. With frequent reminders, prompts, and cues provided to them at the “point of performance,” or within actual situations or settings that are typically problematic, the classroom for example, these students are often much better able to focus their efforts and control their actions (Barkley, 2013). The attractiveness of the Irvine Paraprofessional Program (IPP) is that it provides a model for accomplishing this, and in a very cost effective manner (Katz, 201b; Kirk, 1992, Kotkin, 1999; Ron Kotkin, Ph.D., personal communication, December 15, 2012). A major component of the model is the use of a paraprofessional classroom aide working alongside the classroom teacher. The classroom aides are recruited from a group of undergraduate university students who completed a series of classes at the University of California, Irvine (UCI) that teach empirically validated strategies for helping school-age children with ADHD. Teachers within the local school district who find themselves struggling to manage one or more students in their regular education classrooms can call upon these trained behavioral aides to assist them. The aide will design and implement a specific 10-12 week behavioral program that addresses the needs of the struggling student. The aide also assists the teacher in providing extra help and enrichment to all of the other students in the class. The IPP is coordinated by a psychologist who serves as a liaison between UCI and the school district. The psychologist is also involved in screening the UCI students before they are assigned to a classroom. All final decisions regarding which student is to be assigned to a particular classroom rests with the classroom teacher. The Irvine Paraprofessional Program was adapted for use in over 200 schools across North America as part of the intensive psychosocial intervention of the NIMH/DOE Multimodality Treatment Study (MTA) of Children with ADHD. Three individuals, Steve Simpson, M.A., Ron Kotkin, Ph.D., and James Swanson, Ph.D., were instrumental in the original design of the program and in helping to adapt it for the multimodal treatment study. The IPP can potentially be extended well beyond 12 weeks, extending throughout the school year if necessary. The model can also be expanded beyond the classroom. Trained behavioral aides, for example, can also be placed in other settings during the day, including the playground and even at a family’s home. With these modifications, the IPP can also prevent and reduce common problems that children and youth with ADHD also experience in other life areas. And these modifications may help caregivers prevent and reduce problems associated with other conditions that impact a child’s ability to inhibit behavior and regulate emotions; conditions that can interact with one another in ways that make it difficult, if not impossible, to know where one ends and the other begins. Among candidates for residential and other out of home placements, for example, clinicians often find many different origins for a child’s hard to control behaviors and emotions - prolonged traumatic stress exposure, mood related disturbances, early attachment problems, to name a few - all potentially co-occurring with or at times even mimicking the symptoms and characteristics of ADHD. Trained behavioral aides strategically located throughout the day in situations that present the greatest risk for acting out and hard to manage behaviors can potentially prevent and reduce problems, regardless of origin. 

In an effort to replicate the IPP model for schools across the U.S., Kotkin has modified the training component for paraprofessionals. Originally, paraprofessionals were required to complete courses through UCI focusing on behavioral management strategies. The current training model now includes two full days, with ongoing coaching and collaboration (Katz, 2013).

A Modular Approach to Improving Emotional Self-Regulation and Self-Control: In recent years, mental health professionals have shown increased interest in a modular approach to treating mental health problems. A modular approach focuses on specific areas of challenge rather than on specific diagnostic classifications. A modular approach seems to be particularly suited for addressing problems associated with emotional self-regulation and self-control (Southham-Genow, 2013). One reason is that these problems can be observed in a wide range of different clinical conditions, each with different diagnostic classifications. Helping people improve emotional self-regulation and self-control skills can improve their lives, regardless of the particular condition or conditions they experience or the specific diagnoses associated with their conditions. This would be the case both for children and for adults. A modular approach also lends itself to challenges in emotional self-regulation and self-control in the absence of specific clinical conditions or diagnoses. Recall from the Dunedin Study that poor self-control skills in childhood resulted in increased risk for a range of negative life outcomes, even when weak self-control skills were not associated with specific diagnoses such as ADHD.

Skilled at Knowing Versus Skilled at Doing: Knowing these five self-regulation strategies is not the same thing as executing them. And executing them occasionally is not the same as executing them consistently and predictably. For some who struggle with problems in emotional self-regulation and self-control, they find it much easier to learn these five strategies and much more difficult to execute them consistently and predictably. Knowing this about themselves can prevent feelings of frustration, disappointment, or even demoralization that sometimes accompany problems in execution, particularly when these problems in execution are viewed as a moral failure or character flaw. Instead, they can now draw upon different tools, technologies, strategies, and resources that will help them successfully execute at the point of performance, or in the actual situation in which strategies are needed the most.

Executing at the Point of Performance: In relation to times past, today an increasing number of healthcare professionals are joining forces with families and schools to provide school-age children opportunities to practice and master emotional self-regulation and self-control skills at the point of performance. Among them are two therapists from Lafayette, Louisiana, Marcie Yeager, LCSW, and her husband Daniel Yeager, LCSW. Their treatment model incorporates a number of innovative practices. They include: 1) A dynamic assessment process that explores situations in which the child executes quite well and identifies specific supports, accommodations, or environmental influences contributing to successful execution; 2) a process for identifying persons in the child’s life who can serve as facilitators and who can help the child master executive function skills through practice; 3) engaging children in prescriptively selected games and activities that weigh heavily on executive function skills so that children can see how these functions are used when they play these or other games. Children are then shown how the same executive function skills they use to succeed at a game are the ones skills they may need to do better at school, at home, or on the playground; 4) a process for determining the amount of support and accommodations required for the child to be successful. Once this “scaffolding” is in place, therapists can focus on tools the child can use at the point of performance to succeed; 5) a process for selecting those points of performance that provide the greatest likelihood of mastery. Once success is achieved in less demanding settings, more demanding situations can be introduced; 6) introducing a long-term vision. Some children will need more scaffolding than others, and some will also need it for much longer periods of time. Still, with the right combination of self-initiated tools and strategies on the one hand, and scaffolding on the other, the quality of their lives can improve significantly (Katz, 2013). These six components seem to also provide opportunities to practice all five of Ross and Thompson’s self-regulation strategies. The Yeagers’ model is described in depth in their book, Executive Function and Child Development (see references). In the book, they also describe a number of tools and strategies designed to help children execute successfully at the point of performance.

Knowing Versus Doing, and Its Impact on the Assessment Process: According to psychologist Russell Barkley, Ph.D., individuals who struggle in areas of emotional self-regulation may often perform better on tests of emotional self-regulation than they do when performing emotional self-regulation tasks in real life (Barkley, 2010a; 2011b). To better assess emotional self-regulation and other areas of executive functioning, he developed a rating scale that assesses five major dimensions of executive functioning in daily life: self-management to time, self-organization and problem-solving, self-discipline (inhibition), self-motivation, and self-regulation of emotions. Items on the emotional self-regulation scale were drawn from Ross and Thompson’s five self-regulation strategies. Two versions of the rating scale are available. the Barkley Deficits in Executive Functioning Rating Scale (BDEFS), which is geared for those age 18 and older, and the Barkley Deficits in Executive Function Scale for Children and Adolescents (BDEF-CA), geared for children and youth 17 years of age and younger. Healthcare professionals who work in both community and school settings are using Barkley’s rating scales to show persons with emotional self-regulation problems, including parents of children with these problems, how these problems manifest themselves in daily life. According to Barkley, relying only on psychometric tests may not provide individuals with a realistic picture.