The "Zones of Regulation" as a remedial program for internationally adopted children with complex childhood trauma
For internationally adopted children, development has been mediated by complex childhood trauma. Many, if not all of them, demonstrate, in different degrees, the signs of what was defined as Developmental Trauma Disorder (Van der Kolk, B.A. 2005. "Developmental Trauma Disorder," Psychiatric Annals, 401-408): emotional reactivity, inability to temper emotional responses, behavior impulsivity and the like. Children with difficulties interpreting emotions, paired with impulsivity, may be at risk for aggressive behavior (W. D'Andrea, J. Ford, J. Spinazzola and B. van der Kolk, 2012, "Understanding Interpersonal Trauma in Children: Why We Need a Developmentally Appropriate Trauma Diagnosis," American Journal of Orthopsychiatry, Vol. 82, No. 2, 187-200). Mixed maturity is at the base of many internationally adopted children's psychological profiles, together with sensory integration issues, underdeveloped language as a regulatory mechanism, delayed social cognition, limitation in executive functions (B. Gindis, 2005, "Cognitive, Language, and Educational Issues of Children Adopted from Overseas Orphanages," Journal of Cognitive Education and Psychology, Vol.4, No 3, 291-315). All these attributes require direct therapeutic interventions with appropriate methodology.
Within the last 10-12 years, a number of training programs aiming to remediate children with difficulties with self-regulation were created. These programs, being basically cognitive/behavioral techniques, are designed for children of different ages and different medical conditions. To the best of my knowledge, none of these programs address the trauma issues. Among those programs, the well known are the Alert Program (www.alertprogram.com/), which focuses on sensory integration as a major means of regulating alertness; the Incredible 5-Point Scale program (www.5pointscale.com/5-point_scale_paper.pdf), created initially for autistic children, but now widely used for children with ADHD and behavior and emotional issues; and the multitude of the Behavior Management Programs (www.sagepub.com/sites/default/files/upm-binaries/40497_1.pdf).
The most recent addition to this host of existing programs for developing self-regulation in children is The Zones of Regulation. As of now, it exists in a book format called "The Zones of Regulation: A Curriculum Designed to Foster Self-Regulation and Emotional Control." The author is Leah Kuypers, an occupational therapist by training, who is a specialist in the autism spectrum disorder (ASD) field. The program, released in 2011, became rather popular among school personnel and private therapists and counselors. There is a good reason for this: The Zones of Regulation methodology is sequentially organized, logically structured, multisensory in nature, and very practical. The multisensory approach is at the base of the curriculum (visual, auditory, tactile, kinesthetic, role-play and imagery) and is used to develop emotional control, sensory regulation, and executive functions in preschoolers through middle-school students with social and behavioral difficulties. The program is clearly school-oriented: the author prefers to call her program a "curriculum" and her therapy/instructional sessions are named "lessons."
The theoretical foundation is rather diverse, rooted in the fields of psychology, education, occupational therapy and speech pathology with a particular focus on Theory of Mind (understanding other people's beliefs, desires, intentions, and perspectives, see: https://en.wikipedia.org/wiki/Theory_of_mind) and Social Thinking concepts: perspective-taking and understanding how behavior impacts other people, (see http://www.socialthinking.com). However, basically, The Zones of Regulation is a practice, based on evidence obtained during hands-on work in the fields of autism spectrum disorders, attention deficit disorders (ADD/HD), and with children having social-emotional management problems. By all means, The Zones of Regulation system belongs to the category of "best practices"; that attracts the attention of clinicians, educators and parents.
My encounter with The Zones of Regulation happened about three years ago during the search for methods to facilitate self-regulation in traumatized children - the majority of internationally adopted, post-institutionalized kids. I was particularly attracted to The Zones of Regulation because students would gain an increased vocabulary in the understanding and communication of emotional states; skills in "reading" facial expressions; perspective on how others see and react to their behavior; insight on what triggers their maladaptive behavior; calming and alerting strategies; problem-solving skills and much more. I also was attracted by its multisensory methods of presentation and the interactive nature of many activities. The obvious advantage was in the incorporation of Social Thinking concepts in teaching students to identify their feelings, understand how their behavior impacts those around them, and learn what methods they can use to manage their feelings and behavior. By addressing underlying deficits in emotional and sensory regulation, executive functions, and social cognition, the curriculum is helpful with advancing students towards independent regulation. In short, The Zones of Regulation appeared to me as a sensible, hands-on, well-structured and detailed approach that deserved trying its application with a particular group of traumatized children: international adoptees.
The Zones of Regulation curriculum classifies feelings and states of arousal into four easily identifiable distinct color-coded Zones. As presented in the book, the Red Zone is used to describe extremely heightened states of alertness and intense emotions. A person may be elated or experience anger, rage, explosive behavior, devastation, or terror when in the Red Zone. The Yellow Zone is used to describe a heightened state of alertness and elevated emotions while control is still possible: when a person experiences stress, frustration, anxiety, excitement, silliness, or nervousness but is still able, to some degree, to self-regulate his or her behavior. The Green Zone is used to describe a calm state of alertness: a person may be described as happy, focused, content, or ready to learn: actually, this is the zone where optimal learning occurs. The Blue Zone is used to describe low states of alertness and down feelings, such as when one feels sad, tired, sick, or bored.
The Zones can be compared to traffic signs. When given a green light, one is "good to go." A yellow sign means be aware or take caution. A red light or stop sign means stop. The blue zone can be compared to the rest area signs where one goes to rest or reenergize. All of the zones are expected at one time or another and the curriculum focuses on teaching students how to manage their zone of emotional state. As explained in the book (page 9), the Zones of Regulation method is intended to be neutral, without projecting judgment when helping students recognize their feelings and levels of alertness.
The program consists of 18 sessions (lessons) and, even if the therapists "cut and paste" some sessions, it still may take from two to five months to graduate from it. Each lesson consists of:
Overview - a concise description of the lesson.
Goals for the activities.
Preparation of materials needed for the session. As I mentioned above, this is a multisensory curriculum, and this includes many visual colored posters, drawing, tracking drawings with fingers, using some OT tools, such as "fidget ball," etc. A significant number of colored and black-and-white reproducible posters are ready to be printed out using an external USB drive, which is located inside of the book cover.
Note to teacher/therapist - further detailed explanation on material preparation or some procedural specifics.
Lead-in for all ages - how to start the session, how to introduce the major concepts and/or activities, often with a detailed script of what to say and how to run the activity.
Activities for the different age groups.
Wrap-up for all ages - how to conclude the session.
Ways to generalize learning - a discussion of what to do to further enhance the learned skills and knowledge in school, home and community.
Ways to adapt the lesson to different individual and developmental differences.
Additional learning activities.
In lesson 1 the concepts of Zones are introduced via different colored posters and explanations geared to the child's age and intellectual level. In lesson 2 the students work on their "emotional vocabulary" and learn how to recognize different emotions through facial expression and body language. In lesson 3 the students work with videos trying to identify emotion and place these emotions into Zones. In lesson 4 the students are taught to recognize when they are entering into any zone themselves. It is learned through role-playing according to different scenarios presented in the book.
In lesson 5 the students learn how others may view their behavior. Normally, we as social beings are motivated to behave according to what we think will keep other people thinking positively about us. Those with impaired self-regulation are often unable to consider others' perspectives and subsequently are not motivated by social expectations to self-regulate. This lesson directly uses the concepts of "Theory of Mind" and "Social Behavior Mappings." In lesson 6 the students are taught to "read" physiological signs of being in different zones of self-regulation - the most sophisticated part of the whole program. In lesson 7 the students learn to do matching of certain emotions to hypothetical scenarios that are read from interactive books; they continue expanding the vocabulary to explain emotional states (e.g., using idioms and vernacular describing emotions: "cool as a cucumber," "lost my cool," etc.
In lesson 8 the students have to chart zones in relation to different events during the day. It is a rather sophisticated activity, requiring a certain degree of reflection and analysis. In lesson 9 the students examine external "triggers" that may move a child to a yellow or red zone. The students are expected to participate in a discussion of some hypothetical situations. Again, a rather high level of cognitive ability is needed for this activity. The author of the program believes in the existence of an external cause for losing control. However, a child with complex trauma may at times experience deep-rooted tension and frustration that have internal neurological roots. It should be understood, that for some children the external triggers do exist, but for some it is a trauma-produced inner tension that leads to losing control. In conclusion to this part of the program the author added a section called: "Ways to Check for Learning," a smart didactical way to include behavior observations, visual-based assignments (like preparing wall posters) and independent work.
The next section of the program is devoted to teaching regulating techniques, mostly, of course, the ways to calm down. There are three types of psychological "tools" offered by the program: sensory support, calming techniques, and thinking strategies. The key point is to teach a child certain techniques when he or she is calm and open to learning states of mind and emotions (in other words, in the Green Zone). Practicing the new skills should be consistent and repeated in different settings until these skills are fully internalized by the child and will be automatically applied when the child is in the Yellow Zone.
In lesson 10 the author puts on her OT hat and discusses moving the students between "stations," where they are trying different "sensory tools" (used mostly by occupational therapists) to experience sensory support intended to heighten their alertness or calm them down. The tools include such well-known things as a fidget ball, weighted west or blanket, wall push-ups, deep pressure squishes (e.g., a bean bag), etc. During these activities, the students will try to determine which tools work better for them; the result is presented in a Zones Tool Worksheet.
In lesson 11 the students explore and practice such calming techniques as taking deep breaths (six sides of breathing, "Lazy 8 Breathing," belly breathing), counting to ten, and calming sequences. In lesson 12 exploration moves to different thinking strategies that may affect advancement from Yellow Zone to Green Zone. The concepts of "Size of the Problem," Inner Coach vs. Inner Critic, and Flexible vs. Rigid thinking are introduced. In lesson 13 the students work to assemble their own (individual for each student) Toolbox. The lesson contains Zones Tool Menu that includes 24 different tools to choose from, and a student is to decide what tool is to be used in which zone. In lesson 14 role-playing activities aimed at understanding which tool is to be used in a number of hypothetical situations are described. These are rather interesting, engaging and funny activities, but the issue of proper understanding of these situations by the students may arise.
In lesson 15 the students continue working on the goals set forth in the previous lesson and concentrate on problems with impulsivity: when to stop and think before acting. In lesson 16, which is called "Tracking my Tools" and is one of the most demanding in the whole program, the students need to select a proper tool to help themselves to self-regulate, but also chart the frequency of use of this tool and the usefulness of its application. In lesson 17 the final concept of the program, called "STOP, OPT and GO," is introduced through group games. It provides the students with an easy-to-remember phrase and visual clue to slow down and think before acting on impulse. In lesson 18 there is a celebration of the achievement: the final sequence of informal tests takes place to see how well the skills have been mastered and a Zones License is awarded.
In conclusion, The Zones of Regulation program provides students with psychological "tools" (sensory supports, calming techniques, and thinking strategies) to regulate their behavior. However, let us be realistic: neither a teacher nor a parent would be the right person to deliver this program. It must be a professional: a school psychologist, occupational therapist, speech/language therapist, school counselor, or private psychotherapist or counselor. The service provider must invest time and energy to learn and practice the program. For a private therapist, particularly one practicing cognitive/behavioral therapy, this is the ideal program for developing self-regulation in children suffering from the consequences of trauma, highly functional autism, or severe ADHD. There is always the danger that some students would be bored and irritated by worksheets and stories and it is up to the skillful therapist or counselor to make the curriculum playful and engaging.
Furthermore, the program is designed for use in a group format. The author claims that the program could be adapted for individual sessions as well, but it will require substantial modification.
The author of the program stated that The Zones of Regulation methodology is suitable (with some age-related adaptations) to a rather wide range of students: from the preschool population to middle school and even high school students. In my view, the targeted population should be limited to elementary school population: ages 6 to 12. Exceptions are possible, of course: advanced preschoolers (ages 5 to 6) and children with cognitive limitations beyond age 12 could be included in this group. I think this is a very good program for children with high-functioning autism and ADHD (as a therapeutic supplement to medical treatment). I believe that children with complex childhood trauma, ages 6 to 12, will benefit from this program as well.
I started looking at this methodology with the goal of adapting it for the parents of internationally adopted children at home. Knowing my clients as mostly hardworking parents living in a survival mode with difficult children to bring up, I believe that a serious adaptation and simplification of the program is needed to make it useful for the home environment. But I see another option: the adoptive parents may request their counselor or therapist (either private or school-based) to implement the program with their child with the parents being in charge of "follow-up" (or "generalization") at home. This "follow-up" may have crucial significance in the generalization of students' learned skills outside of a therapy office and their conversion into the use of automated responses to external challenges.
The creation of "Parental Follow-Up to Zones of Regulation" is a challenge that is worth taking on. The whole concept of "zones of self-regulation," many ideas and activities could be taken from the original program fully "intact," some activities are to be modified (from mild to significant degrees), and some activities are to be omitted as not applicable in the home environment. Home-based "follow-up" would strongly, if not a decisively, support a therapist's or school counselor's efforts to instill the basis of self-regulation in internationally adopted, post-institutionalized children.