Wellbeing

Emotional regulation is the ability to manage emotions in response to the demands of ongoing experiences. Autistic children and young people with SLD can experience difficulty with emotional regulation. Autism is associated with amplified emotional responses and difficulty with expressing emotions and this can be even more challenging for children and young people with SLD.  Autistic children and young people with SLD often have differences in interoceptive awareness, meaning that they may not register body signals or link these to emotional states. Alexithymia is often associated with autism, meaning that children and young people may not be able to identify emotions and know how to respond to their emotional needs.

Strategies can be put in place to support children and young people with emotional regulation.  This includes providing opportunities for them to engage in regulating activities throughout their day, both through mutual regulation and self-regulation.

Self-regulation and Mutual Regulation

The ultimate goal in emotional regulation is that the child or young person will be able to self-regulate. Self-regulation requires the following:

  • Ability to recognise emotional states; linking feelings and physiological signs to emotions,
  • Ability to recognise dysregulation in oneself and seek supports,
  • Ability to independently access, or to request, resources and activities to support emotional regulation.

Example: One of Amy’s classmates is making loud noises. Amy senses her heart beating quickly, feels nauseous and wants to run out of the room. She recognises that she is feeling upset and anxious, so she goes to the calm area, puts on headphones and listens to calming music.

Many autistic children and young people with SLD are not yet ready to self-regulate due to differences in the interoceptive system. They may not register physiological changes in their body (such as change in breathing or feeling nauseous) and may not be able to identify different emotional states. This means they do not recognise feelings of anxiety, frustration or upset, and do not realise when they are in a dysregulated state. A child or young person who cannot yet identify and understand their emotions will not independently access regulating activities and resources.

These children and young people will be dependent on supporting adults to meet their emotional regulation needs, and this is called mutual regulation (sometimes referred to as co-regulation).

In mutual regulation, adults who work or live with the child or young person need to monitor indicators of dysregulation and respond proactively. This requires the adults to know the child or young person very well so that they can recognise the early indicators of dysregulation, and then respond before the situation escalates.

The adult may observe physiological or behavioural changes in the child or young person which indicate that he or she is becoming dysregulated. Examples may include:

  • Change in breathing e.g. fast breathing
  • Sweating
  • Change in pallor- very pale or flushed
  • Dilated pupils
  • Increase in stimming; stimming behaviours may increase in intensity and frequency
  • Echolalia
  • Shouting, swearing
  • Pulling at own hair, banging head, biting hand

When the adult observes the indicators of dysregulation, they direct the child or young person to a regulating activity or provide a calming resource. In mutual regulation therefore the onus is on supporting adults to recognise when the child or young person is in an emotionally dysregulated state and then meet their emotional needs by modifying the environment or providing supports. Self-regulation can be gradually taught through the use of visual supports and helping the child or young person to link emotions with appropriate supports e.g. ‘You are shouting so I can see you are upset. Let’s go the calm corner for a break’. Visual prompts can be used to support this. It can be a lengthy process before the child or young person starts to identify emotions and then learns how to regulate themselves, and some may always have difficulty with this complex concept. It is therefore important to continue mutual regulation and to respond in a proactive and empathetic manner.

Link to more information on anxiety indicators
Link to further information on the topic of anxiety management
Link here here to MCA podcast with Peter Vermeulen on the topic of promoting leisure, fun and happiness

Strategies for Emotional Regulation
Practical strategies to help a child/ young person to remain regulated include:

Calm/ Quiet area 
Creating an area or room where the child or young person can retreat to when feeling overwhelmed. It is important to consider sensory sensitivities e.g., noise and light. 
Personalise the area using preferences to provide an inviting, relaxing space e.g.  include a bean bag, blanket, cushion.
Link here to video on developing a calm area
Link here to view written guidance on creating a calm space
Link here to view an example of a calm space at home and in school

Calm Kit
Having access to a box/ basket of items, objects or activities which the child/ young person enjoys looking at, manipulating or engaging with. 

  • Calming scents 
  • Specific interests 
  • Fidget/ engagement toys
  • Photo album 

Link here for ideas on a calm corner
Link here to view an example of a calm down kit

Reflexology/ Massage
The child or young person may enjoy reflexology massage, hand massage or head massage. This can be done using calming aromatherapy scents and calming music (take sensory sensitivities into consideration e.g., aversion to light touch, sensitivity to smells).

Link here to view an example of mutual regulation, a massage using aromatherapy to support emotional regulation

Breathing Techniques 
Encouraging a child/young person to breath slowly and deeply will support them in remaining calm and will help them to relax. Using visual supports will provide clear structure to guide the child/young person through deep breathing exercises. 
Link here to view an example of a deep breathing visual support

Preferred Activities 
Ensuring the child/ young person has opportunities to engage in activities related to their specific interests will promote emotional wellbeing. Observation and preference/reinforcement assessment can assist in creating a list of the child/ young person’s interests.

Drawing/ colouring, 

Structured repetitive tasks e.g., jigsaws

Favourite characters 

Music 

Sensory based activities – play dough, sand, water Link here to view further information on sensory differences and regulating activities
Link here to view Autism Good Feeling Questionnaire (Peter Vermeulen)
Link here to view an example of a reinforcement inventory

Art/ Music/Drama therapy
Communicating feelings and emotions is difficult for children/young people with autism and SLD. Using art, music or drama therapy are all effective ways to help children/young people to explore and express emotion and then linking their feelings to strategies for regulation. 
Link here to view an MCA online music therapy session

Music Therapy
The British Association of Music Therapy (2020) defines Music Therapy as ‘an established psychological clinical intervention, delivered by HCPC registered music therapists to help people whose lives have been affected by injury, illness or disability through supporting their psychological, emotional, cognitive, physical, communicative and social needs’. (www.bamt.org

Music therapy allows a child or young person to engage in a musical dialogue where they can communicate and express feelings in a supportive environment regardless of their musical ability. 

Music therapy is an evidence-based profession and there is a growing body of research evidence that demonstrates the effective outcomes of music therapy and Autistic Spectrum Disorders.  ‘Music therapy has been shown to help children with autistic spectrum conditions to improve social interaction, verbal communication, initiating behaviour and social-emotional reciprocity‘ (Geretsegger et al. 2014, Gold, Wigram and Elefant 2006)

Autistic children and adults often find it difficult to express themselves and communicate with the world around them. Music therapy is non-verbal and therefore allows the individual to connect with the world by using music. Music therapy can facilitate communication skills by:

  • Exploring and imitating sounds
  • Developing listening and responding
  • Sharing and answering musical phrases therefore developing basic concepts of social conversation
  • Using song to stimulate speech

Music therapy can facilitate play and physcial development by:

  • Developing fine and gross motor skills
  • Facilitating interactive and imaginative play
  • Encouraging initiative and spontaneity
  • Using rhythm to stimulate gross movement – dancing, walking, jumping etc
  • Developing co-ordination and encouraging clients to cross the mid-line
  • Developing through play stages from solidary play to more cooperative
  • Developing decision making

Music therapy can facilitate social skills by:

  • Develop important social skills such as turn -taking, waiting, listening and joint attention
  • Promoting a sense of self in relation to others
  • Developing self-esteem and self-worth
  • Encouraging clients to explore and express their feelings
  • Promoting relaxation and helping to release feelings of frustration, anger or depression
  • Offers a safe and a creative space for outlet of difficult feelings
  • Encourages decision making and helps to empower the client

Physical Wellbeing 

Sleep
Some of the benefits of sleep include mental and physical restoration, recovery, growth, brain development and emotional wellbeing. Many children and young people with autism and SLD can struggle with achieving regular sleep patterns. link here for more information on sleep and autism.

If a child or young person has difficulties in getting to sleep and/or staying asleep, factors to consider may include:

  • An over-stimulating room – does your child get out of bed to play with their toys? 
  • Noise – are there any noises inside or outside the home that may be disturbing your child? Some children or young people with sensory issues are particularly sensitive to noise therefore what a very quiet sound may appear loud to the child/ young person and affect their ability to settle and fall asleep. Masking sounds at home, for example, with a white noise App can help. Some examples of Apps for white noise are, ‘myNoise’, ‘Hear’ and ‘White Noise Deep Sleep Sounds’
  • Light, is the room dark enough? Melatonin (our sleep hormone) is produced when it’s dark. Black-out blinds can be used to help keep the room dark at bedtime
  • Consider the temperature of the bedroom. Is it too warm? Too cold?

Strategies 

  • Sleep Diary  
    Keeping a record of sleep and waking times can be very helpful, keeping a sleep diary will help you get an accurate picture of your child or young person’s sleep patterns. This can be useful in identifying possible reasons why your child or young person is having difficulties sleeping.
  • Bedtime Routine
    Routine is very important at bedtime. Autistic children and young people with SLD respond positively to having a consistent and predictable structure at bedtime. When a routine has been established it must be kept consistent throughout the week even at weekends or if the child or young person is staying somewhere else for the night. Decide what time the child/ young person should be in bed and work back from this. A visual timetable is a way of demonstrating to a child what they can expect to happen in the lead up to bedtime using pictures and symbols. It may be useful to display the routine that you will be using at bedtime to help them to become familiar with the order of events.
    If bath-time is incorporated into this routine, it should occur at least half an hour before going to sleep so that body temperature has time to regulate. 
    The child or young person should have quiet time up to an hour before bedtime, so that the house becomes a quiet sleepy place. This time can incorporate doing a relaxing activity such as listening to calming music or having a gentle foot/hand massage. Avoid watching the TV or using tablets in this time as the light can stop the body from releasing melatonin.
    Link here to view examples of bedtime routine visual supports

How to Prepare for Going to Bed

When it is Time for Bed

  • Graduated Withdrawal
    Many children and young people with autism and SLD can struggle to settle themselves to sleep. If you stay with your child/ young person until they go to sleep, you may need to gradually distance yourself to enable them to eventually settle alone. For example, if you currently lie in bed with them until they fall asleep, try sitting next to the bed with your hand on their arm, then move to having no physical contact at all, then gradual move your chair further away each night until they no longer need you in the room. Once you have turned the lights out and said goodnight do not engage in interactions. If they do get up just return them to bed with minimal interaction. 
  • Explaining Sleep
    Some children or young people can have difficulty understanding the need for sleep. A social story could be used to explain this and help them settle.
    Rewarding your child or young person: It is important to remain positive about bedtime in order to reduce any anxiety associated with it. Give praise at bedtime for what they are doing well, use a visual reward system or chart and give consistent rewards until the behaviour is established.
    Link here to view an example of a social narrative about sleep 
    Link here to view an example of a reward chart relating to bedtime
    Link here to MCA webinar addressing sleep

Diet

Eating healthy foods and keeping hydrated is important for overall health and wellbeing. Some autistic children and young people with SLD eat a limited range of foods. 

Some of the most common issues around eating are:

  • the texture, smell or appearance of food
  • reluctance to try new food
  • the contamination response (i.e. food items touching each other)
  • not recognising when hungry or full, high anxieties around mealtimes and eating, pica, gastrointestinal issues, the rituals around the preparation and eating of food (Shea, 2017)

 It can be challenging to introduce new foods but there are a number of ways to encourage a child/ young person to eat a healthier diet. 

  • Allow the child or young person their preferred foods in order to maintain weight, health and nutrition
  • Introduce healthier foods that are similar to preferred foods to expand the range of foods, for example, introducing crackers or rice cakes if the child or young person enjoys crisps
  • Consider sensory processing differences at mealtimes e.g., reduce or eliminate noise levels or smells associated with cooking and food preparation
  • Work on a desensitisation (also known as a graded exposure) programme by familiarising the child or young person with the properties of a food by slowly introducing foods and exploring textures, smells and tastes
  • Reduce anxiety associated with food and eating. Anxiety can affect appetite. This might mean managing environmental anxieties or working on relaxation prior to mealtimes
  • Have fun with food and make it an enjoyable experience for the child or young person
  • Use a social narrative to help the child or young person to learn how food and hydration are important for our wellbeing

Click here for MCA webinar addressing food
Click here for MCA webinar addressing sleep, toileting and feeding
Click here to view top tips for restricted diets
Link here for an example of a social narrative about eating and drinking

Fun with food ideas

Link here for fun with food – Jelly
Link here for fun with food – Frozen Fruit Puree
Link here to view an example of a graded exposure to food chart

Physical Activity 

Physical health is not only positive for physical wellbeing but also for mental and emotional wellbeing as it releases endorphins which create an overall sense of wellbeing. Motivation is the key. It is important to know what the child or young person enjoys. Many children and young people may not know what they enjoy until they have experienced it. They may need to be encouraged to try a range of activities, otherwise they may never engage in any physical activities.

Activities should meet the needs of the individual, so that physical exercise is enjoyable and purposeful. For example, playing Pokémon Go, treasure hunts, helping in the garden, a structured set of physical exercises. There will need to be clear visual structure in the activity e.g., build structure into a walk by giving the child or young person a list of pictures of items to look for and tick off .  There should also be a clear end goal e.g., use a visual timer to show how long they should jump on the trampoline. 

For health benefits, physical activity should be of moderate or vigorous intensity. The main emphasis should be process based, rather than skills based, including what is described as the formal PE, Games, Sport. That is, the benefit is in the doing rather than in the acquisition of specific skills like holding a bat or passing a ball. These may be important, but perhaps not as important as improving self-confidence and self-esteem.  

The child or young person may need to be prepared for the physical changes that occur with physical activity, using visual supports to show how we feel before, during and after exercise e.g. heart rate, breathing, how hot we are and how sweaty we are. 

View Examples of Structured Physical Activities

Link here for activity cards
Link here for animal walks visuals