Raising an emotionally intense child
One of the biggest parts of my practice is working with emotionally intense kids who are super sensitive, highly reactive, and seem to melt down at everything.
These kids come to the practice with a variety of diagnoses (Attention Deficit Disorder, Sensory Processing or Sensory Integration Disorder, Auditory Processing Disorder, Autism, Social Anxiety, Anxiety NOS, histories of attachment disruption, or even some of the newer diagnoses like Disruptive Mood Dysregulation Disorder or Social Pragmatic Communication Disorder) or sometimes no diagnosis at all. They are often highly intelligent, and may even be doing very well and showing very few difficulties in school (teachers are often surprised to hear that families are concerned at all), but these kids are frequently very frustrated with all sorts of small events in daily life. Everything seems to be a struggle (especially at home where it is safe to melt down). They and their families just know that the world seems to be much harder for them to navigate than for other kids and young people their age.
Families who come seeking help for kids with these challenges have usually tried all sorts of standard parenting approaches and have gotten all kinds of well-meaning advice, and they have found that the usual approaches not only don’t work, but seem to backfire and make things worse. Escalation can come out of nowhere, calm reasoning never seems to stick, and firm consequences just seem to make your kid go even more ballistic (and then you are stuck with trying to enforce high levels of consequences if you have really upped the ante in a power struggle). It can even seem like your kid is being mean or manipulative on purpose to get their way…and that it is working. Which can lead to highly frustrated responses on the parental side and even more explosive meltdowns all around.
My work with families in this kind of stalemate centers on helping parents understand the mechanisms that underlie emotionally intense behaviors, and on helping kids develop better self-acceptance, self-advocacy, and coping. Some really helpful reading that will enrich our work can be found on my resources page. The first is a practical book about changing the agenda when you talk to your kid called The Explosive Child (although it may be helpful to think of some children who “shut down” as implosive). The second book is a much more thorough book of strategies that will provide back-up explanations and review for most of the techniques we will be covering. The version for younger kids is Parenting a Child Who Has Intense Emotions and the version for teens is Parenting a Teen Who Has Intense Emotions. If you have a child who fits the above description, and if you decide I am a good fit for you as a therapist and that we will be working together, I recommend you buy these two books.
It has become apparent to me over my years of work with these types of children that a lot of emotionally intense kids have differences in their sensory processing systems that mean they can emerge from perfectly normal and even enriched attachment backgrounds without having registered the wealth of normal attachment information available to them. What this means is that kids from loving, effectively parented families, often having typically developing siblings, can end up looking and functioning a lot like attachment disrupted kids because of their sensory registration differences.
Another category of kids who struggle a lot in their attachment are adopted kids. Even kids who are adopted soon after birth, if they have highly reactive nervous systems and difficulties with sensory processing, will show higher levels of symptoms of attachment disruption than might be expected.
A complicating factor in an anxiously attached relationship (whether it is a biological or an adoptive relationship) is that anxious attachment responses on the child’s part pull for more anxious responses on the parental side than these same parents might be giving their other kids, creating a cascade effect of interactive anxiety responses, and continuing the anxious attachment pattern across the developmental stages for the emotionally intense child. For this reason, I frequently bring a lens of attachment theory to the work I do in helping parents understand their children’s dysregulated behavior.
The most important thing to understand about emotionally intense behavior is that it is driven by anxiety and fed by an overactive nervous system. Some families find the label “highly sensitive” to be useful (there are a whole series of books and websites about “highly sensitive” people, for example). While I am not familiar firsthand with the “HSP” resources, you will learn from working with me that I am a big fan of labels (not of the stigma that goes with them but of the labels themselves).
The reason I like labels is this: people who are struggling already know they are somehow different. A label, when presented in a positive self-advocating light, almost always gives a sense of relief, a thrill of self-recognition—“Ah! that’s the name of my challenge! I’m not the only weird one! There’s a name for it and there are other people like me!” Just like having a sense of cultural or racial identity is important, having a label for your neurotype means having an identity and a tribe, a sense that you belong to a group of people with similar struggles and a sense of solidarity with folks with similar struggles. (A great book that talks about all the flavors of neurotypes is Neruotribes by Steve Silberman—see resources page for the full reference.)
So, my first step in working with young people is often to find some comfortable way to refer to their experiences either as “emotionally intense” or “highly sensitive” or, if they already have a diagnosis with which they are familiar, by the name of their diagnosis. I am a big proponent of direct psychoeducation and giving kids a sense of power and control through knowledge. I have a poster of the brain in my therapy room so that I can teach kids about the amygdala and the function of the limbic system in alerting us to danger. Then we can talk about the difficulty of an overactive amygdala and how to bring the “pilot brain” (or prefrontal cortex) back on line to calm the amygdala down and reassert rational control.
The thing about anxiety is that no one except the person inside that brain can tame it, but kids need a lot of help getting there. Telling a person to “calm down and take some deep breaths” is probably one of the worst things you can do for an agitated person. Have you ever had someone do that to you when you are really angry or anxious? It feels condescending and controlling and it makes most people flare up. Kids feel that way too when their parents or teachers do it. The thing is, they already want to calm down—telling them to do so is beside the point!
They ways I will help you work with your anxious child will be different than asking your child to calm down or “use their skills,” and may feel counterintuitive or even a little scary. For example, instead of soothing or calming their anxiety, I will ask you to “go towards” the anxiety and validate or even amplify it. (I can explain more about specifically what to do and why it works when we meet). If these approaches feel strange or uncomfortable, I hope that means they will feel worth trying, because they will feel pretty different from what you have tried before.
Your job one, however, will be to be scrupulous about regulating your own anxiety (the “put your own oxygen mask on first” approach). You cannot provide a calmly mirroring response and a loving “holding container” for your child’s emotions unless you are fully calm and regulated first—and I mean truly calm, not just pretending to be! Your kid’s nervous system can tell the difference. (So, parents, you get to work on your skills, too!)
They ways I will be asking your child to work come from a combination of therapeutic approaches. For kids who thrive on a more programmatic approach, I use material from workbooks in a sequential way to support our therapeutic work. For kids who need a more flexible, responsive approach, it makes more sense to use the same techniques but in a less structured way, using the material that comes up each week in family life as the basis for our work together.
These are the therapeutic modalities from which I draw (I will make any copies you need, however, all of the workbooks can be purchased for relatively low prices on Amazon, if you’d like your own copy at home for review later—see resources page for link):
- Cognitive Behavioral Therapy: We can’t just change our emotions—wouldn’t that be great! But we can’t…However, we can notice our thoughts and then notice the emotions that flow from them. Some thoughts are not so useful, and some are more useful, and we have a choice about which thoughts we choose to turn our attention to. I often use an adapted version of the Coping Cat curriculum, which is an approach designed for anxiety, adapted for “activation,” to talk about this theme.
- Dialectical Behavioral Therapy: Sometimes our brain is working really hard to protect us from scary things that our predecessors might have encountered on the savannah, like a predator or some other threat—thanks brain! But now our pilot brain has the job of figuring out when “there’s no tiger.” I use the Don’t Let Your Emotions Run Your Life DBT skills workbook series to support these skills.
- Mindfulness: We have greater capacity to tolerate activated states when we can notice that what is in our mind is a thought or a feeling and not a fact. Mindfulness is about noticing where we are and what is happening in the moment, and then non-judgmentally accepting ourselves in that moment—easier said than done, so we use workbooks and exercises to practice in session. I use Don’t Let Your Emotions Run Your Life, Superhero Therapy, and mindfulness apps.
- Self-Advocacy and Interpersonal Effectiveness: It’s great knowing that we have needs that are different from other people’s, but unless we can speak up effectively for our needs and create safe and effective boundaries, we won’t feel safe, empowered, and heard. I use the Kidpower work book series to support these skills. This series also has great material on bullying, safety from sexual abuse, bodily boundaries, respecting others’ boundaries, levels of trust for strangers and acquaintances, and other really important safety information for kids.
- Expressive therapy and play therapy: I use Sandplay, artistic expression, games, and outdoor therapy to foster self-exploration and awareness. I also use these modalities to get a glimpse into how kids think, reflect, and regulate their anxieties when given a lot of freedom to express themselves. I use games to see how kids handle competition, the stress of losing, and if they are black and white thinkers when it comes to rules, or if they want to change the situation by making their own rules—I often empower kids to completely be in charge by taking a “rules vacation” (letting them make very unfair rules and making me lose).
Theories of Mind 