Presence and Perspective


Presence and Perspective By Murielle DiBiase, M.D.

In the chaos of the world we are living in today I find the challenge that rises to the top of my heap across settings and interactions with others of all ages is to be present and consider the perspectives of others. We are so inundated with the stressors of everyday living complicated with all of the Covid chaos that it’s a true challenge to stay in the moment and even consider the perspectives of others.

In my work in the field of Early Care and Education, I have many opportunities to engage with families, children, professional colleagues, teachers, and a wide variety of support staff involved as educators in this phenomenal field. We know that parents/family are children’s first “teachers”. Everyone involved in the classroom dynamics has an impact on the foundation of learning for each child in their care. We are all “cognitive coaches”, incidentally as well as intentionally, for every child we connect with, even for those we come to know in utero. It’s simply amazing to consider that the first 3 years of our lives are known to be the time in our lives that we will learn at an extraordinary pace like no other time in our entire lives. This, to me, magnifies the importance of intentionally being present as much as we possibly can across settings and ages for all to truly benefit from the interaction.

As I engage in the work of coaching educators to elevate the quality of their engagement with children, there are frequent conversations about taking a child’s perspective in the moment given any number of daily situations we encounter. As adults, we often make unintentional assumptions about children’s perspectives… “When you push your chair away from the table, you’re telling me you’re all done with snack.” (said to an 18 month old) I had to wonder if that was so or was this child merely experimenting with cause and effect given the moment… Just as unintentionally, we often forget that young children are just beginning to understand their world and are learning things like self-regulation. They are truly novices at social engagement and are new to the concept of emotions. They learn what they are living with no regard to “right or wrong” ideations at such a young age. Understanding a young child’s perspective is key to quality engagement. The more we learn, the more we are able to support learning for our youngest human beings.

This is all food for thought, which might shift our perspectives a bit. We don’t know what we don’t know and we do the best we can with what we do know at any given time in our lives. Thank goodness we have a lifetime to learn and grow and there are so many opportunities for us to do so! Learning is a work in progress, not an aim for perfection…

Favorite Resources:

Ted Talks : Jun Li, Fred Rogers (Google these individuals for more resources)

Brazelton Touchpoints Center
Connection Parenting, Pam Leo (Google her for more resources to her credit)

Creative Connections LLC
Murielle S. DiBiase, M.Ed.
PO Box 15
Palermo, Maine 04354


By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Small children engage in stealing for at least two reasons. First, everything “belongs” to a 2- or 3-year-old until someone tells him differently.

If he sees a toy in a toy store or a bag of cookies in a grocery, he thinks they’re his – until he learns that such things belong to others. This lesson takes time.

Punishment will drive the behavior underground, only to come out later in less acceptable ways. Gentle explanations of how to respect possessions, coupled with firm limits, are much more effective.

A more subtle reason for stealing is the desire to identify with others. As a preschool child increasingly identifies with his parents, his siblings or his schoolmates, he may take things from them. Thus, in his concrete way of thinking, he becomes like them.

When stealing first appears, it’s exploratory and acquisitive rather than a sign of being “bad.” If you explode with anger, you’re likely to engender fear and repeated acts of stealing.

Of course it frightens a parent when a small child steals, particularly if he seems to realize what he’s done by lying about it. But if you can understand that stealing is universal among children, you can avoid overreacting – and turning such behavior into a pattern.

Your goal is to use each episode as an opportunity to teach. But a child will only be ready to learn if he isn’t overwhelmed by guilt.

Helping a child understand his reasons for taking others’ possessions enables him to hear you when you discuss others’ rights. Learning to respect others’ possessions and territory is a long-term goal. Handled with sensitivity, each stealing episode can lead in that direction.

Try not to label the child as a thief as you talk to him, and don’t harp on the incident afterward. It’s wise not to confront the child by asking him whether he stole; this may just force him to lie.

Simply make clear that you know where the object came from. Ask your child to produce it if necessary, and say, “You know you can’t take something that isn’t yours.”

Help the child return the object to its owner and apologize, even if it means going back to the store and suffering the embarrassment of returning the object or paying for it. Let the child work off the cost by doing chores.

Preventing stealing involves patient teaching – over and over. Be consistent in your reactions each time.

  1. Show the child how to ask for what he wants.
  2. Make simple rules about sharing with others, such as “You don’t take another child’s toy without asking her and offering her one of yours.”
  3. Explain the concept of borrowing and returning a toy: “You may ask whether you can play with it. If they say no, that’s it. If they say yes, you must offer to return it.”

“If we’re in a store and you want some cookies, ask me whether you can have them. If I say yes, wait until I’ve paid for them before you take them.”

In this way, you’re teaching the child respect for others’ things, demonstrating the manners he needs when he asks for something and helping him learn to delay gratification.

It’s also important to explain why such rules are necessary – “to protect others’ toys the way you want to protect yours.” Help him see your point of view: You can’t allow him to take others’ possessions.

Then ask him how he plans to handle the situation, to give part of the responsibility of limits to him. If he can come up with a satisfactory solution, you can give him credit. Finally, and most important, when he succeeds, be sure to let him know you’re proud of him.

If stealing continues, look for possible underlying reasons. Is the child guilty and frightened and reacting by a sort of repetition-compulsion? Is he so insecure that he needs others’ possessions to make him feel like a whole person? Do others already disapprove of him and label him?

If he repeats his acts of stealing, he may be asking you for therapy. Don’t wait until he feels like a failure and the labels stick. Seek outside help. Your child’s doctor or the child psychiatry department at a teaching hospital can make a referral.

(This article is adapted from “Touchpoints: Birth to Three,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at

Reprinted with permission from the authors.


By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Routine visits are opportunities for me to develop a relationship with the child and the parents right from the start.

I never expect a baby between the ages of 9 months and 3 years to leave her mother’s lap for an examination. When I recognize the child’s need to be close to a parent, the child knows I respect her.

I never look the child directly in the face or ask for her to accept me. In this period, I gradually approach her, using a doll or teddy and her parent to show what I am about to do – like using the stethoscope.

I make a big effort to get a slightly older child to want to come to my office – loading it with toys, a fish tank, a climbing gym, a flexible cloth tunnel to crawl through, and a rock collection, and I offer stickers and plastic rings (for children old enough not to swallow them) that they can show off as tokens of their bravery.

As the child comes into my office, I watch to see how comfortable she is. If she’s frightened about me, I know that. Giving her time to get used to me is respectful. The time is well worth it. She’ll be far easier to examine. Her parents will be less hesitant to warn me of potentially serious problems – early – once they’ve seen this demonstration of my concern for their child’s comfort.

As I examine the child in her parent’s lap, I urge her to listen to my chest. We’re sharing the experience and she knows it. She also knows that I respect her privacy and her natural anxiety about being examined. We’re setting the stage now for a long future relationship.

I comment on the child’s temperament and mode of play. She knows I understand her. She listens. Anything her parents and I need to discuss is talked about in front of her, and I try to put it in her terms. I want her to understand what we are talking about. No secrets! I prepare her for a shot, honestly, and urge her to cry and to protect herself. After it’s over, I congratulate her on her success.

As a child gets older, at 4 or 5, I may even urge her to ask her own questions and to call me on the phone. She won’t yet. But by 6 or 7, she will.

We can discuss her illness between us, though of course I won’t leave the parents out. In later years, when she’ll let me see her alone, we can share confidences without its being a triangle – though she, her parents and I all know that I will help her to tell them what she needs to.

I believe in sharing all I know about each illness with the children themselves. My goal is to help them take an active role in conquering their own diseases. If they can call or talk with me, and carry out my advice, this lesson will stay with them. When they recover, I can congratulate them: “Look how you knew what to do – and it worked!”

When children must go to the hospital, it becomes even more critical that a physician explain the reasons and the procedures in front of the child. We have found that preparation for acute or chronic hospitalization cuts down on the child’s anxiety in the hospital, shortens the child’s recovery time and reduces the symptoms of anxiety afterward.

In my office practice, the best reward for me at the end of a busy day always came when I heard a child’s chortle of delight as she rushed in to see me and my familiar toys. Then I knew we were off to a good start.

Sharing Responsibilities

  1. Seek to establish a trusting, respectful relationship between your child and her doctor. You must do your part as well. It’s is no help to enter the office saying, “He’s going to cry” or “She hates coming to see the doctor.”
  2. Prepare the child ahead of time, truthfully, and with reassurance about what is likely to happen.
  3. Remind her that you’ll be there, and that it’s her own doctor who wants to be her friend. The doctor knows how to help her when she’s well and when she’s not. It’s surprising to me how much it helps a child’s self-esteem to learn to trust her physician. Working with a pediatrician is a mutual job of learning what you can – and can’t – get from each other. You must demonstrate respect, and you deserve respect in return. Both of you have the same goal – a healthy, competent, confident child!

(This article is adapted from “Touchpoints: Birth to Three,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at

Reprinted with permission from the authors.


By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

In our culture, toys play a major role in many children’s lives. In the first few months, a child is given a “lovey” to hold and to use for transitions such as when she’s going to sleep or feeling hurt or lonely.

The lovey – often a blanket, a piece of soft material or a beloved teddy bear – becomes an extension of herself and her caregiver.

With the lovey, she feels secure and ready to face transitions. Without it, she must rely on adults who can’t always be there, no matter how reliable they are.

From the time a child looks at or reaches for objects, some parents equip the crib with the latest toys for infants. “Learning” toys soon supplement cuddly ones.

Musical, speaking and reading toys reflect parents’ concerns about providing enough “brain stimulation” to enable toddlers to excel in competitive preschools.

Computer games have become part of many 3- and 4-year-olds’ lives. Children imitate their parents, manipulating handheld electronics, just like them. But watch a child’s face when a parent looks away to a smartphone at each intruding text message.

Such sophisticated toys can cause pressure rather than stimulate exploration and play. Parents who are away all day or are leading very busy lives may feel they need to satisfy a preschooler by offering constructive, educational replacements of themselves. Toys can become surrogates by filling the isolation in which many of us live. But toys don’t have to be used this way.

When a child chooses an object as a toy, it becomes part of her world. Toys extend a child’s dreams. A parent can attend seriously to a child’s choice of toys and observe how she plays with them.

If a parent can help choose a toy as a way to learn about the child and who she’s becoming, the process can become a form of communication. (Toy stores, too stimulating for most children at this age, are rarely set up to encourage such communication.)

For a toddler, pots and pans give her an opportunity to mimic kitchen chores. At 3, 4 and 5, simple dolls and toy soldiers help children live out fantasies.

The distorted anatomies of Barbie dolls and pumped-up action figures are intriguing to some children, as is the mysterious adult sexuality they evoke. But toys like these impose adult preoccupations on child’s play and don’t encourage a child’s self-discovery and self-expression.

Many children turn to safer toys, such as toy animals and puppets, when they play out the aggressive feelings that they need to test. Simpler toys leave room for a child to try out her own dreams and wishes, her own aggressive or sexual fantasies. Toys offer the child a link for play with a peer as well as an opportunity to learn about others.

A parent must ask: Does the toy elicit her own fantasies and imagination and allow her to spin them into dreams that sustain the play? Does it challenge her, while leading her to find her own solutions? How much room does the toy leave for her – or does it take over and make her give in to it?

Other considerations include:

  • Safety. Inspect toys for parts small enough to be inhaled or swallowed. A toy shouldn’t be breakable or easily taken apart. Toy safety is regulated, but not always enforced, so parents need to be careful.
  • Durability. Will the toys withstand the experimentation that is a necessary part of their future?
  • Noise. Can you stand the repetitious music or crooning speech that accompanies some toys?
  • Interest. Can the toy hold the child’s long-term attention, or will it be forgotten?
  • Appropriateness. One child may need a quiet, solitary toy that challenges her intellectually; another might prefer an activity-based toy.

(This article is adapted from “Touchpoints: Three to Six,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at

Reprinted with permission from the authors.


By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Awareness of her own power brings new fears to a 4-year-old. She becomes more aware that she’s a small child, a part of a larger world, dependent on her parents or others at critical times. Her new understanding makes her conscious of her limitations. She feels pulled between this sense of dependence and a desire to master her world that propels her onward.

Play and fantasy are powerful ways to work this out. The child’s ability to verbalize and reason makes her fantasies more elaborate.

But these vivid fantasies lead to fears and bad dreams. “I dreamt of a witch in my closet.” “I know there’s no monster in my room, but I feel it.”

The monsters and witches may also represent the strain of facing “new” feelings. Becoming aware of powerful negative and aggressive impulses can be frightening. A parent can help her accept them. But to master them, the child needs to learn, gradually, the difference between having a feeling and acting on it.

Fears and nightmares are common in 4-, 5- and 6-year-olds. Children worry about “bad guys,” witches, lions, tigers and monsters.

These night problems occur at the same time as a fear of dogs, loud noises, sirens and ambulances. Such problems herald the child’s more openly aggressive feelings, which frighten her when they seem echoed by forces beyond her control.

At this stage, children want to test their own limits more openly. They want to act out aggressive and rebellious play. Such feelings are important to a child’s personality and sense of security. They need to know they can feel angry and not lose control.

Firm discipline and consistent limits are reassuring to a child at this time: “You may not wander around the house at night. I may well have to fix your door. I can come to you, but you can’t come out alone.”

What helps a child learn to cope with fears and nightmares?

  1. Comfort the child and take the fears seriously, but don’t add your own anxiety to hers.
  2. Look under the bed and in the closet. Let her understand that this is for her comfort, not because you really think there is any danger.
  3. Set firm limits on bedtime. They’re reassuring.
  4. Don’t forget the power of a comforting lovey.
  5. Help a child learn how to soothe herself when she wakes in fear. She can distract herself by singing songs, making up stories or thinking pleasant thoughts. In modified form, adapted to other situations, she will use these skills for the rest of her life.
  6. Help the child learn “safe” aggression during the day. Modeling your own ways of handling your aggression becomes even more important. Talk about them with the child when they occur.
  7. Read fairy tales together. They encourage young children to face their own fears and angry feelings. Or read, among many others, “There’s a Nightmare in My Closet,” by Mercer Mayer; “Where the Wild Things Are,” by Maurice Sendak; and “Much Bigger Than Martin,” by Steven Kellogg.

Books allow a child to face and eventually master such feelings: She can turn the pages at her own pace, study a picture as long as she likes, go backward or close the book tight. Television and movies have a pace of their own – they present scary situations too vividly and fail to respect the child’s need to control how much she is able to confront.

(This article is adapted from “Touchpoints: Three to Six,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at

Reprinted with permission from the authors.


By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. What does a parent do if a child won’t stay in timeout?

A. Timeouts are widely used, and almost as widely questioned.

Timeouts don’t work when they are misunderstood or misapplied. They are just one step in the process of helping a child learn not only to control herself but also to know and care about the difference between right and wrong.

The term “timeout” was borrowed from sports in which a team may officially call for a brief interval – to regroup, to rethink or to slow the pace.

Timeouts were never meant to be used as a punishment or consequence or boundary-marker. They should be used to stop the action when things are getting out of hand and to help children settle themselves down and think things through.

Yet when a child is told to go on “timeout,” she must be ready to listen and self-possessed enough to pull herself together to comply. When she’s too upset, you may need to scoop her up and hold her until she’s calm enough to handle a timeout. If she’s too big for this approach, but she’s in a safe place, just backing off is often enough.

Children are far likelier to follow through with a timeout when they are calmly and firmly instructed to do so. Tone of voice is important. If a timeout is assigned angrily, or as a punishment, any but the most docile child is likely to respond with a struggle.

A child is all the more reluctant to accept a timeout if it is imposed by an adult who needs a timeout too. The same child may be happy to comply if, instead, the adult proposes, “Let’s both take a timeout.”

A child will also calm down faster if stimulation can be reduced during a timeout, with no more back-and-forth.

But the child needn’t be isolated. We know one child care center that doesn’t use timeouts. Instead there’s a “cozy couch” on one wall where children can go, or are told to go, when they need to calm down. But they can see all the action and can settle themselves down without feeling embarrassed or cut off from everyone else. The message is that learning self-control is necessary and completely respectable. These are timeouts without stigma.

Limit-setting and consequences come next. There is no point in reasoning with a child who is behaving wildly. As soon as she’s calm and able to listen, let her know that her behavior was unacceptable, and that she will be forgiven, but that she will need to make reparations.

The consequences should be as closely tied to the transgression as possible – if she hit someone, she’ll need to apologize; if she took something that wasn’t hers, she’ll need to return it.

But the rough-and-tumble challenge of mastering self-control often starts with a quiet timeout.

(This article is adapted from “Touchpoints: Three to Six,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at

Reprinted with permission from the authors.

Polyvagel Theory

Eye Contact with baby

Polyvagel Theory By Mark Rains, Ph.D.

How can parents help soothe stress in infants and build their capacity for attachment, self-regulation, social engagement, and resilience? Of all the many ways to understand this, one article that transforms how we look at relationships and stress response systems is “Neuroception” by Stephen Porges1. Published in Zero to Three in 2004, it remains timely; applicable to current problems with traumatic or “toxic” stress, childhood protective factors, and prenatal substance exposure, as well as classic infant mental health challenges with temperament, attachment, parenting, etc. It also introduces concepts of personal and social stress management that support coping with the psychosocial and professional challenges of COVID care.

Neuroception involves how the brain senses safety or threat through (primarily) visual, auditory, and tactile cues in the social environment and organizes responding. A complementary article by Porges, also in Zero to Three [1993], focuses on Interoception2, a “sixth sense” response to internal physiological cues. Both social and internal inputs are linked via the vagus nerve to multiple response systems. The multiple roles of this nerve and its contribution to Social Engagement Systems of parents and infants are elaborated within a Polyvagal Theory of stress response3.

Basically, polyvagal theory refers to (1-6):

  1. the general variety of inputs and outputs of the ventral (front) and dorsal (back) branches of the vagus nerve in the parasympathetic Autonomic Nervous System (ANS),
  2. the involvement of the ventral branch of the vagus in communicating (receiving and expressing) cues of safety and threat within interactions in the Social Engagement (i.e. Safe to Friend 4) System.
    In conditions of safety, the ventral vagus regulates the ups and downs of:
  3. mobilization without fear for action (waking, food gathering, defense, etc) by inhibiting and disinhibiting the sympathetic arousal branch of the ANS, especially heart function, and
  4. immobilization without fear for physical maintenance (sleeping, digesting, lactation, intimacy, illness recovery, etc.) by dorsal branch of the vagus and release of oxytocin.
    In conditions of significant or life-threatening stress:
  5. mobilization with anger/fear leading to dominance of ventral vagus by sympathetic arousal and limbic system overriding cortex (“losing your head”), i.e. Fight/Flight systems OR
  6. immobilization with fear involving physical shutdown by dorsal branch of vagus nerve, i.e. Freeze/Faint systems, going into shock, loss of blood pressure, etc.

In other words, with safety the parasympathetic ventral vagus nerve regulates both the sympathetic ANS and the parasympathetic dorsal vagus, as it balances waking and sleeping, gathering food and digesting it, engaging socially and withdrawing for reflection, energetic sexual activity and safe intimacy, child protection and lactation, etc. When this homeostatic balance is overwhelmed and sympathetic ANS or dorsal vagus is unregulated, an individual is vulnerable to physical and/or mental health problems.

Health and resilience involve accurate sensitivity to threat cues and flexibility in response. Problems result when persons see threat in safe situations and miss threat in stressful situations and/or when their mobilization or immobilization with anger or fear is chronic and less flexible. Polyvagal theory adds another lens to viewing current problems in self- and social-regulation: the importance of safety, the role of social engagement system in communicating and managing safety, and dysregulation that follows lack of safety.

The Social Engagement System develops within the attachment relationship between infant and parent and continues through adult interactions. Social engagement involves muscles of face and head, available in infancy, before development of extremities.

Following are some of the highlights:

Social Engagement

with Safety

(higher vagal tone, more flexibility)
• Make eye contact
• Display contingent facial expressions
• Vocalize with appealing inflection and rhythm
• Modulate middle-ear muscles to distinguish human voice more efficiently
• Problem solve
• Safe Touch, Massage
• All the above contribute to Attachment and to Soothing stress before it becomes toxic


with Danger

(lower vagal tone, less variability)
• Eyelids droop
• Positive facial expressions dwindle
• Voice loses inflection
• Awareness of human voice is less acute
• Sensitivity to others’ social engagement behaviors decreases
• Chest (crisis) breathing

Porges (2004)

There is a YouTube video that depicts the role of social engagement system in soothing stress and relationship development v=zcz2Towvf8A. Spoiler alert: It portrays a father attempting to comfort the cries of his infant daughter. Their facial expressions mirror as he becomes stressed and she continues to fuss. He contacts her mother by cellphone where she is shopping in a grocery store and mother tries a variety of attempts to connect with and entertain her daughter via the cellphone screen, unsuccessfully. A grandmotherly figure in the grocery store appears to wonder, “What is going on here? How ridiculous to think technology could replace human interaction.” Nothing works.

The father then picks up his daughter with safe touch, brings her up to make eye contact with his safe face; all of which soothes her upset and catches her interest, and they eventually calm and connect. Its poignancy brings tears to mother’s eyes, perhaps gratified to see father and daughter’s capacity to join her in parenting. Both father and daughter were able to utilize their social engagement systems. Although it’s not clear that the producers of the video clip were thinking beyond “Technology will never replace love”, it seemed to me to illustrate social engagement well.

Polyvagal theory adds another lens to viewing current problems in self- and social-regulation. Heart Rate Variability (HRV) is a measurable biomarker of flexibility in ventral vagal regulation of heart function. Heart rate rises and falls with respiration. I won’t attempt to go into detail about this, beyond noting that it is one of the ways of studying the tone (high or low flexibility) of the ventral vagus in a variety of physical and mental health problems. Porges (2004) proposes that faulty neuroception (ability to switch effectively from defensive to social engagement strategies) may contribute to autism, schizophrenia, anxiety disorders, depression, and Reactive Attachment Disorder. Infants may learn defensive behaviors with frightened or frightening caregivers, which may then be ineffective or costly within safe environments.

For example, in infants exposed prenatally to substances and experiencing withdrawal symptoms as neonates, sympathetic arousal may be dominant, resulting in difficulty with parasympathetic functions of eating and sleeping and being comforted.5 Caregiving within the Eat, Sleep, Console program6assists in regaining sympathetic/parasympathetic balance, supported by medication to manage sympathetic arousal. Massage has been helpful in vagal tone of premature infants, enabling better weight gain. 7

The social interaction and communication challenges associated with autism spectrum difficulties8 are another area of research on polyvagal theory where intervention increases eye contact, vocalization, and anxiety; sensitivity to stimulation, etc. It doesn’t cure autism, but addresses some of the challenges, which might lead to a vicious cycle of withdrawal, behavioral difficulties, etc.

Turning to the parental role in the social engagement system involves parents being able to regulate their own emotional state and sense of safety, in order to be a safe partner interacting with their child. After ensuring that the child’s “alert system” is not hyper- (“wired”) or hypo- (“tired”) aroused and that the child’s “alarm system” is not activated by internal (interoception) or psychosocial (neuroception) threats, a parent can communicate safety within the parent-child social engagement relationship by providing nonverbal (right brain) relationship cues and utilizing developmentally appropriate language (left brain).9 Synchrony in the parent and child social engagement systems supports resilience. As the child develops beyond infancy, neuroception of safety is needed for verbal communication or executive functioning to be successful. Infant mental health interventions can model and provide safe social engagement by therapists to support safe parent and child interaction.

Parallel to the experience of parents, providers of healthcare and social services experience both vulnerability and opportunities for resilience, managing exposure to stress, utilizing professional coping strategies, practicing personal self-care, and experiencing organizational support. In particular, social engagement through teamwork and mutual support can help maintain resilience and reduce feelings of unmanageable threat. Unfortunately, this has been limited during COVID, in which distancing and masking undermine social engagement opportunities. When such social connection is not available, individual practices can help ‘jump start’ vagal tone through a variety of portals to the ventral vagus nerve. These include:

  1. Confident (diaphragmatic) “belly-button-breathing” (e.g. four count inhalation and six count exhalation), which is an alternative to crisis (chest, up-and-down) breathing.
  2. Massage, safe touch, which renews vagal tone.
  3. Vocalization (e.g. singing, chanting), which can engage the cranial nerve regulating the trachea and, together with diaphragmatic breathing, stimulate the ventral vagus nerve.
  4. Auditory stimulation which renews the balance in sensitivity to voice frequencies that can be dysregulated after exposure to danger frequencies, e.g. with soothing music in the range of voice frequencies (e.g. classical stringed instruments) or specially programmed music (Safe and Sound Protocol10) to stimulate middle ear functioning and flexibility.

Using such vagal stimulation strategies to achieve or renew a parasympathetic state of Safe to Friend provides a foundation for confidence and other cognitive coping strategies. This is built into a series of “Resilience Stretches”, which help recover from, manage, and prepare for psychosocial stress; like physical stretches prepare for physical activity.11

Research into these areas is still at early stages in many respects, at promising to evidence-based levels. As polyvagal theory has gained popularity12 , interpreters (myself included) may stray from science or evidence base, promoting short cuts to social engagement with oxytocin, vagus nerve stimulation, quick fixes, etc. I recommend sticking close to the source and staying up to date with the evidence base.

Take Home / Take to Work points:

  • In addition to Fight/Flight and Freeze/Faint responses to
  • Adverse Experiences, there is a Safe To Friend system of social engagement to manage stress with resilience.
  • This system is ready to begin from birth and is developed within safe, stable, supportive attachment interactions and relationships.
  • Vulnerabilities in the Social Engagement System may contribute to a variety of physical and psychosocial health problems.
  • There are multiple portals to renew safety at a personal level of neuroception and interoception and at a social level of protective factors for parents and professionals
  • With professional/personal/organizational resources, Infant mental health specialists can bring their own social engagement systems to safe, healing, growthful, interactions with parents and children.
  • Ongoing research will contribute to better understanding of the potential and limits of the preceding points

  1.  Porges, SW. (2004) Neuroception: A Subconscious System for Detecting Threats and Safety.  Zero to Three, 24:5,19-24.  (Downloadable from )
  2.  Porges, SW. (1993) The Infant’s Sixth Sense: Consciousness and Regulation of Bodily Processes. Zero to Three 14(2), 12-16. (Downloadable from )
  3.  Porges SW (2017). The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. New York: WW Norton.
  4.  There are a variety of abbreviations for describing the Social Engagement System in contrast to “Fight/Flight, Freeze/Faint” systems, e.g. Tend and Befriend, Rest and Refresh, Friend, etc.  I am proposing “Safe to Friend” as a psychophysiological state, which an individual may reach through social interaction or personal activities.
  5.  Jansson, LM, DiPiero, JA, Elko, A and Velez, M. (2010) Infant Autonomic Functioning and Neonatal Abstinence Syndrome. Drug Alcohol Depend. 109(1-3): 198-204.
  6.  Grisham, L. et al. Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome. Adv Neonatal Care. 19(2):138-144.
  7.  Field, T. (2019). Pediatric Massage Therapy Research: A Narrative Review. Children (Basel), 6(6): 78.
  8.  Porges SW, Bazhenova OV, Bal E, Carlson N, Sorokin Y, Heilman KJ, Cook KH, Lewis GF. (2014). Reducing Auditory Hypersensitivities in Autistic Spectrum Disorder: Preliminary Findings Evaluating the Listening Project Protocol. Frontiers in Pediatrics. Doi:10.3389/fped.2014.00080
  9.  Rains, M. Contact for handout. Brief video illustrating Brain in Palm of Hand
  11.  Rains, M. 2022. “Resilience Stretches” Contact for copy.
  12.  Porges SW & Dana D (2018).  Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies. New York: WW Norton.
  13.  See also a wide variety of YouTube videos featuring Stephen Porges.


By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

When you arrive home with the new baby in your family, I’d suggest that you have a new and special toy ready to give your older child – preferably a baby of his own that he can feed and diaper while you care for your baby. If he’s more interested in trucks, give him one that he can hold, fuel and wash. This is a chance for him to model on your nurturing.

Don’t be afraid to set limits on how much he can handle the new baby. Limits will be reassuring for him as his feelings about her come to the surface.

If he wants to hold her “like you do,” ask him to sit in a chair. You will need to stay right by his side. You can show him how to put one hand under her neck and head to protect her. He will be learning how to “be a big brother.”

If the older child soon loses interest in being a big brother, don’t be surprised, and don’t make too much of it. Though he may at times be proud of his new role, it’ll be a burden for him, too. Instead, expect him to want to be your baby again. Let him.

Many children who are just discovering what it means to be an older sibling begin to be cruel to the dog or cat. Stop your child firmly but gently, and let him know that you can’t allow this. Help him with his feelings by letting him know that his anger is understandable even though he can’t take it out on the pet.

It won’t help if these feelings are allowed to go underground. An older child is likely to feel that the new baby has displaced him because he was not “good enough.”

A 3- or 4-year-old can often recall mischief that made you angry and led you, in his mind, to want to replace him.

A child of 6 or 7 or older may just ignore the baby – and you. He may even seem to disappear because he’s spending more time with his friends, or dawdling on his way home from school.

Instead of being your companion as you get to know the baby, he seems to want to avoid you to punish you. Time alone with you and your willingness to listen and answer questions will be all the more important.

How to Help an Older Child Adjust to the New Baby

  • Let the older child know how much you’ve missed him.
  • Let him know that the baby has been added to the family and is not a replacement: “Now you have a brand new baby sister. But nobody could ever be just like you!”
  • Hold him close, and remind him of experiences you’ve shared and will share again.
  • Be ready for his need to fall back on old behavior you’d thought he’d outgrown. Don’t expect too much of him right now.
  • If he pushes you to discipline him, remember that limits can be especially reassuring to him with the new baby around. Limits mean to him that his parents “haven’t changed, still love me and will stop me when I need it.”
  • Don’t urge him to be “such a good big brother.” This job won’t always seem so appealing. It will mean more when he finds his own motivation to fill the role.
  • Guard against wanting him to grow up too fast. He will grow up when he’s ready. And his younger sibling is already pushing him enough.

(This article is adapted from “Understanding Sibling Rivalry” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at

Reprinted with permission from the authors.

Social Emotional Learning

Maine Association for Infant Mental Health

Social Emotional Learning

Social Emotional Learning (SEL), what is it? Why is this so important for growth and development within a child’s life, and why are schools, communities embracing this now as our world continues to go through changes. Some changes are known, and some are unknown as COVID continues to be present. I wanted to start off my writing with this poem that I feel captures SEL very well.

I am going to address the definition of SEL, the importance of SEL, myths of SEL, along with the impact of SEL for children and long-term effects of SEL and social development. Then I will finish with providing tools that can be useful in cross over into the classroom.

Social Emotional Learning (SEL): The set of skills, knowledge, and behaviors involved in understanding and managing emotions, setting positive goals, feeling empathy for others, engaging in relationships, and solving problems. Through SEL both students and adults acquire and apply the knowledge, skills and attitudes to manage their emotions, achieve personal and collective goals, reciprocate empathy for others, and make thoughtful decisions. These are crucial life skills.

There are 5 components of SEL which are, social- awareness, self-awareness, emotional management, responsible decision making and relationship skills that students need to succeed in every area and stage of their lives.

This is a collaborative relationship between students and adults as they acquire and apply the knowledge, skills and attitudes to manage their emotions, achieve personal and collective goals, reciprocate empathy for others, and make thoughtful decisions which are the core concepts of CASEL, (Collaborative for Academic, Social and Emotional Learning). This requires teaching, and providing supports that can be utilized by educators, administrators, social workers, or anyone who is a part of a student’s life.

SEL focuses on the interconnectedness of school, family, and community to create environments that emphasize safe, trusting relationships and intentional curricula and instruction. SEL can build on issues around inequality and inspire young people and adults to have a voice and share their thoughts and feelings in continuing to foster healthy, thriving and equitable communities.

We all need authentic relationships that are trust worthy and build confidence in students to try new things, encourage open sharing of ideas, and to be themselves with their peers. This gives them permission to be who they are and feel that they matter.

Solid relationships are important for learning, as well as to provide healthy outlets for students to express negative emotions and feelings. The past 20 months living with COVID-19, we have all had feelings of depression, anxiety and restlessness triggered by COVID-19.

An understanding of SEL will help with building external relationships, though the most important relationship any student will develop at any point in their lives is the one they have with themselves.

SEL builds relationships using five interrelated sets of cognitive, affective and behavioral competencies, defined by CASEL.

These competencies are as follows: Self-awareness, social-awareness, relationship skills, self-management, and responsible decision-making. These can be used for any situations a school or community may be going through.

Self-Awareness: The ability to understand one’s own emotions, thoughts, and values and how they influence behavior across contexts. This includes capacities to recognize one’s strengths and limitations with a well-grounded sense of confidence and purpose. Such as: • Integrating personal and social identities • Identifying personal, cultural, and linguistic assets • Identifying one’s emotions • Demonstrating honesty and integrity • Linking feelings, values, and thoughts • Examining prejudices and biases • Experiencing self-efficacy • Having a growth mindset • Developing interests and a sense of purpose.

Social-Awareness: The ability to understand the perspectives of and empathize with others, including those from diverse backgrounds, cultures, & contexts. This includes the capacities to feel compassion for others, understand broader historical and social norms for behavior in different settings, and recognize family, school, and community resources and supports. Such as: • Taking others’ perspectives • Recognizing strengths in others • Demonstrating empathy and compassion • Showing concern for the feelings of others • Understanding and expressing gratitude • Identifying diverse social norms, including unjust ones • Recognizing situational demands and opportunities • Understanding the influences of organizations/systems on behavior

Relationship-skills: The ability to establish and maintain healthy and supportive relationships and to effectively navigate settings with diverse individuals and groups. This includes the capacities to communicate clearly, listen actively, cooperate, work collaboratively to problem solve and negotiate conflict constructively, navigate settings with differing social and cultural demands and opportunities, provide leadership, and seek or offer help when needed. Such as: • Communicating effectively • Developing positive relationships • Demonstrating cultural competency • Practicing teamwork and collaborative problem-solving • Resolving conflicts constructively • Resisting negative social pressure • Showing leadership in groups • Seeking or offering support and help when needed • Standing up for the rights of other.

Self-Management: The ability to manage one’s emotions, thoughts, and behaviors effectively in different situations and to achieve goals and aspirations. This includes the capacities to delay gratification, manage stress, and feel motivation & agency to accomplish personal/collective goals. Such as: • Managing one’s emotions • Identifying and using stress-management strategies • Exhibiting self-discipline and self-motivation • Setting personal and collective goals • Using planning and organizational skills • Showing the courage to take initiative • Demonstrating personal and collective agency.

Responsible-Decision Making: The ability to make caring and constructive choices about personal behavior and social interactions across diverse situations. This includes the capacities to consider ethical standards and safety concerns, and to evaluate the benefits and consequences of various actions for personal, social, and collective well-being. Such as: • Demonstrating curiosity and open-mindedness • Identifying solutions for personal and social problems • Learning to make a reasoned judgment after analyzing information, data, facts • Anticipating and evaluating the consequences of one’s actions • Recognizing how critical thinking skills are useful both inside & outside of school • Reflecting on one’s role to promote personal, family, and community well-being • Evaluating personal, interpersonal, community, and institutional impact. www.casel.or/what-is-SEL

There are also benefits to social emotional learning in the classroom which includes improvement in school and classroom climate, increases student motivation for learning, teaches problem-solving skills, helps student set and meet goals, and reduces behavioral issues in the classroom. These skills teach study skills and habits, along with opening the door to discuss more about mental health needs, and moving past thinking, “what is wrong with you”, to “what happened to you”. There are many more benefits to SEL and classroom climate.

An important skill that SEL teaches and encourages is empathy, (understanding what another person is feeling), as this builds on conscious decision making and if students can have a sense and understanding of other’s feelings and emotions, then negative responses can decrease, and positive response increase. This builds in having more of a compassionate, kind, school environment. The more that empathy can be present and modeled, the more children will see and begin to also choose these approaches. Being able to understand and show empathy, can help in decreasing acting out behaviors, and build on developing and growing a conscience for all children. There is research noted that the impact of social-emotional learning runs deep. SEL is shown to increase academic achievement and positive social interactions, and decrease negative outcomes later in life. These competencies help individuals throughout their lives. This study found that teaching social emotional learning to kindergarteners leads to students being less likely to live in public housing, receive public assistance, or to be involved in criminal justice system according to Child Trends.

SEL teaches young students how to cope with everyday disappointments as well as deep cuts of trauma. “Students can better respond to the effects of trauma by developing social-emotional competencies. The brain’s neuroplasticity makes it possible for repeated experiences to shape the brain and even reverse the effects of chronic stress,” says Susan Ward-Roncalli, a Social-Emotional Learning Facilitator for the Division of Instruction with the Los Angeles Unified School District. For our most at-risk students, who live in poverty and/or who may witness or experience traumatic experiences, SEL is an extraordinary tool for repairing the damage and for building lifetime coping skills.

There are many tools available for all grades to address social emotional learning and here are some websites that maybe helpful in building your library of social emotional learning tools.

Sel4Me | Registration & Login This is a great resource if you are teaching SEL in the class as there are options for every grade and videos to accompany the lesson.

What is nice about social emotional learning is that you can design a curriculum based on the needs of the classroom culture and build on each learning point. Taking each core competency and developing activities for each one will help children develop those skills and continue reinforcing from each grade to the next. It is encouraged to assess the culture of the classroom and structure your activities to address this culture and focus on building from these skills in developing new ones for your students.

Social Emotional Learning can be fun and rewarding as students are embracing their strengths, similarities and differences in building the best version of themselves, and we are all a part of this and can continue to be for a very long time.

Julia Macek, LCSW
Behavioral Health Specialist
Aroostook County Action Program

Supporting the Development of Self-Regulation in Children

Maine Association for Infant Mental Health

Supporting the Development of Self-Regulation in Children
By C. Michael Sandberg, MA

Recently the world of early childhood education has once again been echoing with terms like self-regulation, executive functioning, and social skills. This is a welcome moment! Not that STEM (Science, Technology, Engineering, and Mathematics) and literacy are not important, but, rather, that it is once again being realized that success academically, socially, and personally is more dependent on these “soft skills” than it is on the content of the knowledge being taught and learned!

Flavell in 1977 called these skills “one of the really central and significant cognitive-developmental hallmarks of the early childhood period.” Their importance has been well demonstrated by several recent studies that followed children over time. In one, done in New Zealand, 1037 kids were followed birth to 32 years. They were looking specifically at what they call self control, certainly one of what might today be called the executive functions. They defined self control as being willing to delay gratification, able to control your impulses, and able to modulate your emotional expression. Even though some of the study’s participants improved their ability to control themselves over the period of the study, they did find that self control at older ages could be largely predicted by self control at 5. Children were first measured at 3-5 with a 90-minute scored observation. They were scored again in their preteen years. In adulthood they were evaluated for several social, health, and financial outcomes. Their heath score was a composite of their cardiovascular health, respiratory system health, dental health, sexual health, and their inflammation status. They found that self control at 5 was highly predictive of improved finances, better physical health, lessened levels of substance dependency and fewer interactions with the justice system. They also found it to be predictive of better decision making in the teen years. Higher self control children were less likely to become pregnant as teenagers or to leave school early. They also had significantly fewer interactions with the authorities. They were also able to do an analysis comparing the differences using social situation as a child and IQ with those found using self control and they found that self control was a much better predictor.1

These kinds of results have been found by several other long-term studies.2 Interestingly these findings echo the findings of studies of the impact of quality early childhood programming such as that done of the High Scope programming evaluated by the Perry Preschool Project. There, even though the initial finding of improved IQ washed out over time, the children still had improved outcomes in terms of social, academic, and financial success. It could easily be argued that what they had gained was improved executive function. 3 For me, these are important findings because the children failing and being expelled by our schools and preschools are mostly being excluded because of poor self-regulation skills. 4 At the same time most researchers and educators agree that most executive function skills can be taught.

While most evaluators use teacher reporting to assess self-regulation skills, (the most responsible researchers recognize that there may be bias included in these ratings and evaluate the ratings across different ethnicities and SES (Socioeconomic Status) to guard against as much as they can), there is interestingly one evaluation method in relatively common use. It evaluates cognitive flexibility in 3-5 year olds by using cards featuring different attributes. There are different shapes, such as bunnies and turtles, and among each shape there are also two different colors. Children are asked to sort the cards by shape and then to switch and redo the sort by color. What is being evaluated is their ability to let go of the old references and switch to the new one. Most 3 year olds struggle with this change, while most 5-6 year olds can easily shift. This method, known as the dimensional change card sort, can separate the age at which children are able to succeed and show that cognitive flexibility is used as an indicator of emerging self-regulatory skills. 5 For me, this is reminiscent of Piaget’s work with classification and it may demonstrate a link between cognitive and social skills!

For a while, people also thought the marshmallow experiment conducted at Stanford could become an assessment tool. The method tried to evaluate the ability to delay gratification by tempting children with a marshmallow, while promising them a second one if they could wait about 15 minutes before eating it. While the researchers reported good predictive power of later success, when people tried to replicate the experiment controlling for SES, they found SES had a higher impact than any maturity measure. The kids, who could wait, were those who had not experienced scarcity!

In order to decide what we need to be teaching and come up with teaching methods, we need a more specific definition of these executive or self-regulation skills. They include the ability to monitor and manage emotions, thoughts and behavior via impulse control, maintaining attention and focus, filtering distractions, emotional regulation, problem solving, and prosocial behavior. When we know what we are trying to promote we can both appreciate and protect it when it is happening and know more about how to create situations that will enhance the learning of those skills.

Interestingly, even fetuses have some self regulation skills. We know that because their activity level often varies dependent on the mother’s activity and mood. After birth, many newborns also illustrate their ability by turning away to take a break after an intense social interaction. They know how to shut down in the face of too much stimulation! So we are not starting with a blank slate. Reading last month’s piece on perinatal psychology might give you some ideas on how to support higher skill levels even before a baby is born!

Once they are born, what can we be doing! We can help children learn that their emotions can be regulated. We do that by allowing them to become upset, and then intervening when they are no longer able to regulate and coregulating them through our calmness and nurturance. We do it by honoring when a child needs a break and waiting for them to come back online before proceeding. We do it by recognizing when they are losing focus or becoming too frustrated to continue and then supporting their efforts and directing their attention back to what they were working with. We do it by scaffolding their explorations (Tools of the Mind, a Vygotsky based curriculum has been shown to be very effective at building self-regulation skills for those children who are starting further behind. It was less effective for those who already had higher skill levels6).

The first key to all of this is that if we expect children to learn self regulation skills, we as the adults must model those skills and remain centered and calm. It is only when we are calm that we can use our support to calm children. How can we give teachers and caregivers the supports that allow them to be present and listening most of the time? When teachers become stressed by their jobs, they may react with frustration and anger to misbehavior in the room, leaving the children who are acting out feeling alone, without an ally. As allies we are engaged in trying to assist children in meeting their goals for themselves, while doing so in socially acceptable ways. When you see yourself getting that kind of support it is easier to let go of the emotionality of the moment and to begin to use and improve the functioning of your thinking brain. Mark Rains, a board member of the Maine Association for Infant Mental Health and a psychologist, suggests that when children lose it (Flip their lids to use Dan Siegel’s expression), they need us to help them feel safe, connected to others, help them learn language to talk about feelings, gradually support their ability to see the patterns in behavior, before we can expect them to be ready to plan better actions.7

In general, we have to ask, how can I support the child’s autonomy and self-regulation rather than working to control them. As one example, if we have a child who is struggling with entering groups and tends to charge in and destroy things, what method can we come up with that might help them learn the skills needed. Could we ask them to try something new and then sit down with them to play alongside the group they want to join, without ever asking to join (the child who has poor executive functioning will often be told no if she or he asks to join a group)? Soon the child will be playing with the other children, and depending on their play skills you may have to remain and continue to support their involvement, or you may be able to leave. Later we could talk about what had worked and give them another tool (By the way, this may have to be repeated multiple times before it begins to take).

How can I help them learn to evaluate risk and make decisions? Instead of saying, “No that isn’t safe!” could we ask about where they would be landing the jump and do they want to land on that? That can be followed with, “well how could we make it safer.”

Executive functioning can be built better, and if it is, children are likely to be better citizens and parents when their time comes. Join me in trying to learn more about how to do this every day.


  1. Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., Houts, R., Poulton, R., Roberts, B. W., Ross, S., Sears, M. R., Thomson, W. M., & Caspi, A. (2011). A gradient of childhood self-control predicts health, wealth, and public safety. Proceedings of the National Academy of Sciences of the United States of America, 108(7), 2693–2698.
  2. Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early Social-Emotional Functioning and Public Health: The Relationship Between Kindergarten Social Competence and Future Wellness. American journal of public health, 105(11), 2283–2290.
  3. Heckman, J., Pinto, R., & Savelyev, P. (2013). Understanding the Mechanisms Through Which an Influential Early Childhood Program Boosted Adult Outcomes. The American economic review, 103(6), 2052–2086.
  4. Gilliam, W. S. & Shahar, G. (2006). Preschool and child care expulsion and suspension; Rates and predictors in one state. Infants and Young Children, vol. 19, No. 3 p. 228.
  5. Zelazo P. D. (2006). The Dimensional Change Card Sort (DCCS): a method of assessing executive function in children. Nature protocols, 1(1), 297–301.
  6. Blair C. (2016). Executive function and early childhood education. Current opinion in behavioral sciences, 10, 102–107.
  7. Rains, Mark. “‘Getting It Together’ Healthy Start Community Forum.” YouTube, YouTube, 21 Oct. 2009,