We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. Hello, everyone. Thank you very much for tuning in. This is a session titled Emotion Regulation in Children and Young People, Early Childhood, 0 to 6 years. My name is Alessio Bellato. And I am a Lecturer in Child and Adolescent Mental Health at the University of Southampton. As part of my work, I'm also an honorary assistant professor of psychology at the University of Nottingham Malaysia. And I collaborate with different colleagues worldwide as part of the Centre for Innovation in Mental Health at the University of Southampton and a newly established Southeast Asian Mental Health Consortium at the University of Nottingham Malaysia. So today, we have an interesting session. I say interesting because it is my topic. It is my topic of interest, my research area. But I want to share my expertise and the knowledge that I have acquired over the last few years with you all to really understand, first of all, what is emotion regulation and how emotional regulation skills develop in children from birth to six years of age. I will help you to somehow recognise and acknowledge the role of caregivers and early environments in supporting healthy emotional development, again, in children from 0 to approximately 6 years of age. And I think it's also important to conclude this session by looking at early signs of emotional regulation difficulties, what we call emotional dysregulation, to really understand what we can do and when we should provide additional support. As a reminder, we also have recorded another session on children and adolescents between 6 and 12 years of age. So I really, really encourage you to take a look at that session that is really complementary to this on 0 to 6 years. So whenever I talk about emotional regulation, I start with this very important question that a lot of people ask. Even if you are an adult, maybe you ask sometimes yourself, how can I regulate my emotion? Or if you have a child and this child is struggling, maybe you will ask yourself, how can my child regulate my emotions? So to fully understand this question, which is really the topic of today's session, we really and I think I really believe that we need to somehow turn these questions around, actually, in this way. We should start by looking at emotions. What are emotions? And how are emotions experienced at a certain period of life? And then what does regulation mean? How can children, in this case, very, very young infants, babies, or young children, how can they regulate? And also, the last one, which I think is the most crucial one is, can all children regulate their emotions? And if they cannot, if they experience challenges, what can we do to support them? So that's actually the structure of today's session that we will follow. And we will really start with emotions, first of all. What are emotions? And how are they perceived, experienced, and expressed in very, very young children? This is a classic definition of what we mean when we talk about emotions. Emotions are physical and mental states caused by events, caused by stimuli or specific situations. And the first important thing to consider that I would like you to bring home today is that we experience, as humans, a lot of emotion. And very young children experience as well a lot of emotions. However, it is true that all the emotions that we experience are also expressed. Maybe you can think a bit about your life and then compare that to a very young child. And I will tell you a bit more about this link between what we experience and how much we express in relation to emotion. We also need to acknowledge that there are what we consider positive and negative emotions. So some emotions are positively balanced, for example, happiness, excitement. And others are negatively balanced. In some cases, for example, anger or even sadness are considered negative emotions. However, it's important to understand that this is a connotation that sometimes we could try to avoid because it's important to not give too much meaning, especially negative meaning, to an experience which sometimes could be normal. For example, sadness could be a really normal experience that each of us actually feel and see and perceive almost on an everyday basis, actually. And lastly, what I would like you to bring home today about emotions is that really, emotions are experienced both in the body and in the mind. So we really need to consider our whole body, our whole organism as something that experience but also express emotion. So let's try to start with the earliest stages of life, the first two years of life. How are emotions perceived, experienced, and also expressed in 0 to 2 years old? After birth, we know that babies, infants are already trying to express, to communicate something. Some babies, some infants cry a lot. Some infants move a lot. And this is usually to communicate, primarily, distress. So immediately after birth, what we can interpret as adults as emotions are usually signs of distress. So the babies basically cry. They move their body. They show frustration to really communicate that they are not feeling very well. So they need us as adults, as caregivers to help them to relieve from that distress. Later on, very, very early, still early in life-- you're talking about two months of age-- we see the first signs of what, as adults, we consider emotion. So there are, for example, the first social smiles, the babies smiling or sustaining sometimes eye contact to something they really, really like. But all these expressions are actually always in response to something else, so for example, the baby really responding to what's happening around them. It's only a bit later, around six months or even later sometimes, in the second half of the first year that children and, in this case, infants start laughing, start smiling to really express that they are in a good mood, in a good situation. Maybe they express pleasure because they are playing, or they are engaged into a social interconnection with their caregivers, or they are really liking what they see, for example. It's not consistent. It's not that infants and babies laugh and smile all the time. But it's around six months that we see these first signs of emotional engagement. On the other side, if we think about a negative expression of emotions the last six months, babies and infants cry a lot, especially when they are separated from their caregivers. This is what we call separation anxiety. Or also, when they are in presence of people who are not really familiar, and this is what we call stranger anxiety. So we start seeing both positive and negative expressions of emotions in the second half of the first year of life. And then gradually, while infants and babies grow up, we start also seeing a gradual differentiation of different emotional expressions. For example, the baby will become more and more able to communicate when they are happy compared to when they are excited. And we will see it in how they express this kind of emotion with their bodies, but also with their faces. And similarly, for fear versus sadness or frustration versus anger, so there is this gradual differentiation. So the emotional expressions become more complex, more refined so that adults and other children can really understand what the baby wants to communicate. In the second part of early childhood, which is between usually 2 and 6 years of age, you see something that is really, really fascinating and interesting, which is an explosion in brain development. So we have this sudden and gradual development of brain structures or brain connections that is really underlying what we see then from a behavioural standpoint. Babies and infants and toddlers, they change in how they speak. They start learning the language. They understand more and more. We have what we see and what we interpret as the vocabulary explosion. So as soon as a child starts talking, they really, really start using a lot of new words. And this is really an explosion in vocabulary. And we also have a lot of improvements in relation to cognition. So for example, all those skills that allow us to make sense of our environment, to plan things in advance, both from the motor standpoint, you can really see that the toddler is growing up. However, our nervous system, although there are all these improvements in brain functioning, the nervous system is still sensitive. So we react a lot to what happens around us. So especially when something happens, let's say, at preschool or at primary school, when we are very young, we tend to react very, very frequently to what happens around them. And this is why you see, for example, as in this picture, a lot of children sometimes crying because, I don't know, they were playing with their siblings or with their peers. And then at some point, something went wrong. And they start fighting. And it is really, really something that every caregiver and every parent will tell you about. Our nervous system is really sensitive. It's really reactive. And we see this reactivity also from an emotional standpoint. Other skills we develop are really around empathy and theory of mind. So in this age range between 3 and 4 years of age, children start to really understand, at the beginning, basically, but they really start understanding what other people think why, for example, they behave in a certain way. And they start making sense of anybody else's behaviour, because then that's actually a sign of maturity to be able to adapt our own behaviour to what we see and what we see other people are actually doing. And the fact that we have this sensitive nervous system and these initial experiences of understanding, of making sense of the surrounding world is actually what causes a lot of fluctuations in emotional experiences and expressions in toddlers and young children. Rapid shifts in emotionality-- for example, as I said before, maybe you have siblings that are happy. They are playing around, very happy, very engaged. And then at some point, the situation rapidly shifts. They got angry. They start fighting. And when one cry and the other laughs, it becomes really, really difficult to cope with those kind of situations. Other changes we see in relation to emotion, experience, and expression, obviously, with the development of speech and language, we go from what we call emotional labelling to what we call emotional interpretation. So very young children might be able to tell, for example, I am mad. I am angry. Or maybe if they see their caregiver, their parent a bit sad, maybe they ask them, are you sad? Because they see a certain emotional expressive pattern. But later on, especially at the end of this period, around five or six years of age, children start making sense, really assigning a meaning and interpret what happened and the kind of emotion that was the consequence of that situation, of that event. For example, they could say, oh, this happened. So I am sad. I am happy. I am angry. So they start making a connection between events, something that they see or they experience, and their emotional state. And this is really, really important from an emotional regulation standpoint. It's actually via this interpretation, starting interpreting, making sense of our surrounding world that we start experiencing our complex emotions, for example, guilt, shame, jealousy. These are really, really complex emotions that we start experiencing around six or even seven years of age, depending on each individual trajectory. But they are really complex because they do not rely only on, OK, I just look at your face to understand what you are experiencing, what you are expressing. Guilt and shame and jealousy, they really require an understanding of what we call social settings. We need to understand social interactions and relationships. For example, if we do something and we become guilty when we know that, actually, we did something that we were not supposed to do, for example, so this is a very complex high level of interpretation. This is a [INAUDIBLE]. Even in this age range, the link between experience, what we experience and what we express is still strong. Basically, children up to six years of age, whatever they experience in relation to their emotions, they also express. That's why we see also this very rapid shifts. So does that mean that if everything we experience, we also express, we cannot really regulate when we are very young very early in life? That's not really true. And that's actually what I'm going to talk about in the second part of this session. So before we really talk about emotional regulation and how children regulate their emotions during their everyday life, it's important that I provide you with a really, really in-depth definition of emotional regulation, because emotional regulation is not an easy concept. It's not an easy definition. And there are different people that provide a different definition of this concept. But this is the best definition that I can share with you so far, the one that I think is the clearest, the most clear ever. So emotional regulation actually can be conceptualised as our ability as humans to monitor, to evaluate, but also to modulate our emotional reactions and experiences, but also our ability to suppress, to control any behaviour that could be considered socially inappropriate or dysfunctional, so behaviours that, for example, can be harmful for either ourselves or other people. So you can see that even from this very long definition, there are a lot of skills involved in emotional regulation. So I wanted to briefly talk to you about what we use. How can we become really mature in our emotional regulation skills? What do we need to regulate our emotions as humans? First of all, we need our brain. We need the neural structures within our brain, especially the prefrontal systems, so the higher-level cognitive systems. But also, our emotional brain, for example, the amygdala, are fully matured, fully developed both structurally but also functionally. So we need really that our brain and the brain together with the whole body develops properly. And we know that there are different things that can go wrong with this, because there are diseases that affect brain development, infections. But we also know, for example, that chronic stress affects brain development. Early adverse childhood experiences or even malnutrition could affect brain development. This is why it's really important to continue understanding how can we make our brain the healthiest as possible, because all these systems and having a fully functioning brain is really what helps us to control, to evaluate, to really make sense of our emotional experiences, but also to stop when we need to stop. For example, if you think about when you are at work, maybe you have some colleagues who can be sometimes mean. Or maybe they ask you to do something, and you really don't want to do it. You have to really stop for a moment, breathe, and then respond appropriately because you are in a social environment. This is actually what is reflected in the involvement of the prefrontal cortex, like our higher-level frontal areas of the brain. We don't need only the brain, though. We also need the autonomic nervous system. So the autonomic nervous system is part of our neural system. And it really helps us to balance physiological arousal, to balance the physiological activations of our body. For example, it controls heart rate. It controls our level of sweating. And all these mechanisms are involved in how we express and we experience emotion. So if we become super angry, usually, our heart rate goes up, really, really up, and we start sweating when we are anxious. So we really need to balance those states of distress so that we can function and we can perform properly. But we also need our mind. We also need to know how to make sense of our emotional experiences. We need to make sure that we are aware, for example, when our attention is not focused on the present moment, when we are, for example, ruminating, thinking too much about negative events, negative emotions. And we need to really train our mind to somehow rethink about what happens to us. That's what we call reappraisal. It's a very good emotional regulation strategy, because this is really what helps us also to control our impulses. Again, the example that I made earlier. If a colleague comes to your office and say, oh, you have to do this, I cannot do it, please do it now, and then you become angry because let's say you have all the days scheduled, you can't really react by throwing books or throwing your laptop out of the window. You really need to control your behaviour, even if, for example, inside, you could be really, really angry. And that's really an exercise that we engage with every day, to be honest, in any aspect, any situation of our life. And then we need to learn something that it is very important and will be very important when we talk about young children. We need to learn about behavioural strategies. So we need to know what to do in certain situations. For example, when we become too stressed, too dysregulated, basic actions like walking away, disengaging from the situation, distracting ourselves are usually really, really helpful. Some of us like, for example, to breathe, to modulate our breath and our breathing pattern because we know that for some of us, for example, this really, really works to, again, balance the autonomic nervous system and to feel really, really calm. And we need social support. We need our peers. We need our families. We need our parents when we are young children because without them, we cannot really learn to coregulate. And to regulate together with someone else is really, really core of our emotional regulation skills as adults. In early years, it is really associated with the quality of the caregiving and the quality of the attachment with important figures, like your parents, your caregivers. So how do we do that? How do we do that when we are very young, when our brain is not really that developed, when we are not fully in control, for example, of our body? When we are very, very young, in the first year of age, we really rely on external strategies. We cry because we want to attract caregiver attention and care. And we understand that. Even if you can say that infants are not really that developed in relation to, let's say, their cognitive skill, they can understand this very basic association. If I cry, I attract my caregiver, my parents' attention so that I can receive care. Another strategy that we use when we are very young is shifting away attention from whatever is distressing for us. And this is why, for example, whenever you see an infant or a baby becoming distressed, sometimes they turn their head away, or they close their eyes because they want to stop becoming overwhelmed by whatever they are experiencing. And in relation to self-soothing behaviours, we see a lot of thumb-to-mouth actions, because we know that thumb-to-mouth actions is, really, a really, really important mechanism that stimulate the activation of one particular branch of the autonomic nervous system that really helps to self-soothe, to bring arousal down and feel calm and relaxed. It's only later on, between the end of the first and the second year of life, that we start and we engage in this process, which is called coregulation. So to self-regulate, a young child or an infant really need to self-regulate together with an adult, together with a caregiver. And that's why, within this age range, we see a lot of infants seeking proximity with caregivers. And they seek being hugged. They seek being together in the same space very close to their caregiver, because they know when they feel that in order to self-regulate, they need to learn from the adults how to do it. And to learn from the adult, they need to be really, really close. And this is also why, for example, touch and social touch is really, really important at this age to provide care, to provide comfort and it's really, really important to consider when thinking about emotion regulation, because what happens really is when the child is close to the adult, they can see, they can observe how the adults actually self-regulate. How do they become calmer when they are stressed? How do they make sense of their emotional experience? And how do they calm down? So the adults actually become a model. So whatever they show, actually, the infants, the child observe, and they will learn from that. So it's really, really important to think about also the kind of behaviour that we show and that we engage with whenever we are in proximity of very young children because they are looking at us and they are learning a lot by observing. And this is actually what happened. So if we show, let's say, 10 times the same kind of strategy when we are stressed, we engage in this, at some point, the child starts to learn that this is a good association. So whenever something happens, I can behave like that. I can learn to cope with this stress. Or whenever I am distressed, I know what I have to do. And I learn, once again, by looking, observing at someone else's behaviour. Like in this picture, you can see you have an adult talking to the child. And they can see, OK, when I am distressed, when I am crying, what do I have to do to calm down? And by learning, actually, they will establish some patterns that I will continue using even later in life. It's only later around, again, two or three years of age that the child starts to go a bit far away from the caregiver. They will still need a caregiver there to show how to regulate emotions. But they will probably need a bit less proximity, especially in times of distress. So what we see at this particular stage, we see a lot of self-regulatory and self-soothing strategies that are implemented autonomously, independently now. For example, you might have a child that becomes angry or sad, and they independently decide to, let's say, bring a toy and then hug them. So hug the toy, not the caregiver anymore to calm down, to self-regulate. But even self-talk, for example, is something that we see a lot in young children, which is really, again, an attempt to make sense of the experience, but also to, let's say, tell ourselves, OK, there is something that happened. Don't be sad. It's fine. It will pass. Tomorrow is another day. These are all examples of self-talk, which we sometimes see in young children. The limitation is really there. So this stage, besides observing adult models, children start to imitate specific behaviours and strategies. And this is why, for example, maybe there are some funny videos sometimes appearing online where you see some young children, like 3, 4 years old, that seem to behave like adults. They seem to engage in some strategies. For example, they say, oh, I really need a break, or I really need a holiday. It's not that they really need a holiday, or they need a break to self-regulate. But obviously, they have seen, they have observed the behaviour from their caregivers. And now whenever they are in distress or tired or bored, they actually implement the same strategy. So they imitate basically whatever they saw their caregivers and parents doing. And lastly, again, is this repetition of observation, imitation, observation, imitation that actually allow children up to six years of age really become more independent in emotional regulation and in the establishment of routine. Basically, whenever I know that I am a school, if I get upset, I know what I have to do. Whenever I am at home, maybe I get into a fight with my sibling, I know what I have to do. However, in unfamiliar situations, it's really, really difficult still for a six-year-old to understand what they have to do. And this is why it is important that the caregiver, the parent is still there, or even other kind of role model within a child's life are there to really show, to really think about what's happening and understanding what to do. So now that we have really understood what's happening, how young children, babies, infants, and young children up to six years of age experience and express emotions and what they can do, how do they learn to regulate emotions, it's important to focus on the last section of our initial question. Can all children at different ages actually regulate emotions? And what can we do as adults, as caregivers to support them? So here, I know this is a lot of text, but I'm not going to focus on all of this. This is really for you to take a look and try to read as well, even by looking at the PDF of the slides that I will publish together with this video. What I would like you to focus on here, if you really want to understand how to support, how to promote, how to nurture the development of emotional regulation skills in 0 to 6 years old, I feel that we need to act at three different levels. We need to think about the environment that the child really lives in. We need to think about the activities that they are involved in on a day-to-day kind of basis. And we need to think about the specific support that us as parents and caregivers need to give as soon as we see that, and that an infant or a child is experiencing some distress. So if you take a look at what happens and what I have added in this first column, you will see that really, the kind of environment that promotes emotional regulation is a calm, not really that stimulating environment, especially early in life, a space that it is really safe and cosy for the developing child. They really need to understand the different spaces in the house, but even at school or whenever actually they leave and they spend most of their time. They really need to have the opportunity as well within the environment to have a space where they can calm down. For example, especially with toddlers, but also young children, it's really, really good to show them that they can have an independent space where they can go, for example, when they are angry or when they are sad, whenever they want to stay alone, basically. And we need to keep this space within. I know that houses can be very busy. But it's really important to think about the environment because, again, as I said before, even babies, even infants, they absorb a lot of information from what they see around them. And having a safe, a cosy space, a cosy environment where they can really feel free to experience and express their emotions is really, really important. In relation to the activities, obviously, whenever you have a baby or an infant actually expressing negative emotions or expressing emotion dysregulation, the strategies actually that we implement to feel them better are based on our sensory environment. So there is a lot of holding, a lot of skin to skin. As I said, social touch is really, really important, especially early in life, because these produce what we call calming reflexes. By a soft touch and social touch, especially when babies are very, very young, babies can feel a sense of calmness and quietness. And this is really, really helpful to, again, protect their over reactive nervous system and sensory system. [INAUDIBLE] your sensory play later in life are really, really important, again, for the infant, first, but also for babies and toddlers to really understand what the surrounding environment look like, because for them, environment is really, really unfamiliar. They really need to discover and have time, a safe space to discover and understand what to do, because, for example, water and the use of objects with different textures is really, really important for children than to calm down and to regulate emotions. So each individual child will probably have and develop their own strategies, their own routines. And some of these routines initially will be based on materials, textures, as I said before, for example, hugging a toy or having a favourite blanket. And really, the sensory component of that experience is crucial here. It's only later when they obviously comprehend more about language, about stories, that we can involve young children in stories, for example, about feelings, about motion. This is actually the space where a child can develop their emotional literacy, basically understanding what emotions are, where do we feel them in the body, what labels we can put on them, and both basic and complex emotions and so on and so on. It's only later when you have these six or seven years old that you really want to engage children in activities that help them to train their emotional regulation skills. A lot of sports actually are for that. And you have a lot of interactions in sports or in other activities and a lot of problematic interactions as well, so a lot of fights, getting angry, getting sad, getting happy. And this is a safe space, once again, for the child to experience, first of all, those emotions, to make sense of those emotions and then to regulate them. So these are really, really important activities that I encourage to think about. In relation to support, once again, there is a gradual switch from more sensory touch-based support strategies, like staying close, talking to the baby with a gentle tone, using simple, calm words that are really, really important for the child to see that you are there, that you are calm, and that they can get calm as well together with you. Whenever you have a child or a toddler, even, bringing words about emotions into the plate, whenever they start expressing emotions, not only behaviorally, but also via their speech is really, really important to allow them to express. Even if they do not have a big vocabulary, maybe they cannot find the right words, allow them to express what they are experiencing and validate that experience, whatever it is. Even if it is a positive or a negative emotion, it's important to validate, to basically acknowledge to the child that what they are experiencing makes sense is something that a lot of people are experiencing. There's nothing wrong with that. There's nothing wrong, for example, with experiencing anger or sadness. What is important is that we understand it together and we find a good way so that the child can feel safe, can feel comforted, and can feel really well. And it's only later on that you can really be what I call a gentle coach. So you are there. You are present even with your six-year-old. You acknowledge emotions, once again. So you really tell the child, it's OK to feel like that. Positive or negative, it's fine. And then you can really model more complex strategies. For example, OK, whenever you feel overwhelmed, you can take a break. You can go to your cosy space, your safe space. Or maybe you can also model together with the toddler, with the child. You teach them specific breathing strategies and patterns that help to bring down arousal and stress. These are some examples that I'm going to put here because I would like you to take a look. I'm not going to talk about all of these right now. But it's important to show you that emotion dysregulation and difficulties in emotion regulation could present very, very differently across different children. So there is not only one way through which we can understand and identify, really, a child that is experiencing emotional dysregulation. Some children, for example, are born like that. There is a genetic component of surrounding emotional dysregulation. So there are some children, for example, really, some babies that really, really struggle to calm down. They sleep really, really not that much. They are highly reactive. For example, they are chronically stressed out. And it's important to be aware of that, that each child, each baby is different on that. Others on the other side could show and express just a limited range of expressions and emotions. This is what, for example, we label as limited responsiveness, like flat affect or little eye contact. And it's important, again, to understand if, for example, there are developmental delays, or there have been really, really adverse experiences that have somehow affected that specific behaviour. You have toddlers who can become aggressive, who can withdraw. And some of these behaviours are really responsive, to basically a lack of understanding of the situation. You have some children that basically fight or really become dysregulated because they cannot express what they are feeling. If for example, this is the issue and you are working, for example, with the practitioner or you try to understand a bit more yourself, about this child, try to understand, what is the level of emotional literacy of the child? Do they know about the different emotions? Do they know what an emotion looks like when they are experiencing it in the body? Do they know what to do when they experience a certain emotion and so on and so on? And if they don't, there are many books that you can use, videos, cartoons, and movies where, really, the child can see and try to understand a bit more about their emotional experiences In relation to the 3, 6-years-old range is still some children who are more active, more dynamic, or can really, really struggle. Maybe they really, really struggle to calm down even when they are helped by an adult. In this case, it's really, really important to sometimes reflect with them and try to understand the level of anxiety and physiological autonomic stress that they are experiencing because it could be that, for them, really, if they are really experiencing a very high level of stress constantly, they might find it really, really difficult to calm down, even when they are helped by an adult. Another thing to really take a look around five, six years age is really how children react to specifically minor events, because it is there at this stage that you can see early signs, for example, of worrying or rumination. And you can somehow target these. You can somehow think with the child about this and try to offer them different alternatives, different strategies that you could implement whenever they find experience in the future. Last but not least, and I want to conclude this session by thinking about you, the adult, the parent, the caregiver, because a lot of parents that I work with, they ask this question, can my child do it? Why cannot my child do that? Why isn't my child bonding with me? What is wrong with me? Nothing works. They are always angry. They are always sad. What will other parents think about me and my child? So the message that I would like to share with you here is that you are not alone. There are many children, even young age children, who struggle to regulate their emotions. And sometimes even their parents, they struggle because their child is struggling. You are not alone in this. It's really, really important to remember that yes, the quality of the early relational context, the family, the home environment is fundamental, is crucial. But especially negative affect, negative emotionality has a strong genetic component. So as I said before, there are a lot of infants that are like that. So we need to accept it. So we can do whatever we want. We can be super cosy, super welcoming, super caring. But there are some infants that really, really struggle for some genetic susceptibility to negative effects and emotionality. Developmental trajectories play an important role. So there are many factors that unfortunately can affect development of children, including, as I said before, infections, nutrition, early childhood experiences, and so on and so on. And it's important to consider these when we talk about emotional regulation. Equally important is to think and be aware that some children can only engage with basic sensory-based emotional regulation strategies. So for some children, even if they are six or seven or eight years old, maybe they will just need the adults, the caregiver, the parent hugging them to coregulate. Maybe they are not there to think abstractly, to be independent in self-regulating. And as caregivers, we really need to be aware of that. So it doesn't really matter the age of the child as long as we offer support, which is in line with what the child can understand and can do. So thanks very much for listening to this session. If you want to keep in touch, feel free to watch all the other videos on ACAMH Learn or be in touch with me. And the QR code is linked to my website if you want to know more about the projects. Thank you. [MUSIC PLAYING]