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,


Prenatal and Perinatal Psychology: Why it Matters

Maine Association for Infant Mental Health

Prenatal and Perinatal Psychology: Why it Matters

I have spent most of my life speaking for little ones. Putting words to their actions, behaviors, and feelings is simply what I love to do and what I help others do. When my granddaughter comes home from a long day at school and falls apart, I know she’s worked hard to hold it together for 7 hours, and now she’s made it to her safe place. I use my words to articulate her feelings and to help her and her parents understand her behavior. I do the same for the preschool students in my classroom and the babies in our parent/infant program. Watching their actions, making sense of their behaviors, and empathizing with their feelings, is second nature. Is it any wonder that I would do the same for prenates? These little ones also communicate through their actions, behaviors, and feelings. They too have a lot to share, what are they telling us?

This is what the field of prenatal and perinatal psychology has been exploring for decades. Dr. Thomas Verney wrote The Secret Life of the Unborn Child in 1981 telling us that “the unborn child is a feeling, remembering, aware being and because he is, what happens to him – what happens to all of us – in the months between conception and birth molds and shapes our personality, drives, and ambitions, in very important ways (p. 15). Dr. Verney founded what is now known as the Association for Prenatal and Perinatal Psychology and Health in 1983. It has been described by Dr. David Chamberlain as “the mother that nourishes us all”. Certainly, the association has gestated theories, given birth to new ideas, and provided a nurturing environment for the “language” of prenates to be heard and understood. This matters to me… it’s my why, why I do what I do and how I do it.

I am a mom, and it matters: My daughter is pregnant, and I take pride in the way she and her spouse connect with their baby girl. They know she hears and feels them, and I am blessed to witness these exchanges. I am a mom, and it matters: My granddaughter speaks of her time in the womb, and I believe her recollections. I am a woman, and it matters: I see birth as a beautiful and natural process that both mom and baby were created to participate in, and I strive to minimize the medicalization surrounding this journey. I am a maternal child nurse, and it matters: I want families to be empowered in the birthing process and I encourage writing birth plans that focus on intentions and feelings and creating pictures of ideal birth scenarios as a perfect place to start. I am a teacher of early child development, and it matters: When I consider development, “zero” begins at conception, not birth. Growth happens from the very beginning and so does our exploration. We marvel at the wonders in the womb and the incredible talents of the developing baby. I am a prenatal yoga instructor, and it matters: When a mom is happy and at peace, so too is her baby. As we practice grounding and balancing physical postures, we also bring forth an emotional grounding and balancing as well. I am a lactation consultant, and it matters: Promoting undisturbed birth and honoring the sacred hour after birth is vital. The newborn is capable of crawling to mama’s breast and initiating a pattern of connection that has lifelong implications. I cherish making this happen. I am a therapist, and it matters: Research tells me the physical, emotional, cognitive, and spiritual destiny of babies relies significantly on the quality of the interactions with their mothers from the beginning of life. Attachment is essential and I have an incredible responsibility and honor to educate, nurture, and support this newly formed dyad from conception, through birth, and beyond. Perhaps you do too.

Ultimately if you are someone who recognizes that what happens to us when we are small impacts who we become when we are big, then this may matter to you as well. The goal then becomes for the mother and those around her to create an environment that allows for the blossoming of this little bud of humanity. We become the dedicated nurturers of this period before birth and immediately after birth. This, I believe, is what prenatal and perinatal psychology is about and why it matters.

Additional Resources for Prenatal and Perinatal Psychology

Book Review: Parenting for Peace: Raising the Next Generation of Peacemeakers

Parenting for PeaceI am a fan of acrostic poems. Over two decades ago I wrote such a poem regarding attachment. This poem became the back of a bookmark that was shared with the Maine Association of Infant Mental Health and is still used today. Though time has passed, the words, that were put to paper then, still hold true.

I began a special journey a decade ago, one that I continue to cherish. Exploring the field of prenatal and perinatal psychology spoke to my heart as did infant mental health. Honoring the relationship between parent and baby from the very beginning, from conception, has always made such perfect sense to me and this field had allowed me to do just that. Seeing prenates as sentient beings with incredible capabilities gives opportunity for parents to connect with their little ones, truly before they even conceive. Viewing the role of parenting in this light prompts me to see it as a blessing.

Marcey Axeness, author of Parenting for Peace, chooses to discuss principles of parenting using pneumonic assistance (as she describes it). I loved this book, not only because I love acrostic poems but because it is beautifully written. I appreciate her rationale for using principles “unlike rigid rules, principles encompass individual differences, where rules are static, principles give room to breathe, to discover, to inhabit, where rules constrain principles offer an endless palette of application” (p. 3).

I also love that this author considers the parenting journey from preconception and takes the reader through pregnancy, birth, the first seven years, and the next seven years. Her principles spell the word PARENTS; Presence, Awareness, Rhythm, Example, Nurturance, Trust, and Simplicity (p. 4). They are taken from a parent’s perspective and visited in each chapter. Axeness applies these principles and gives parents tools to practice along the way. The notion of visiting the same principles throughout her book with different age groups, is brilliant. Nuggets of information and things to do are threaded beautifully from one age to the next. This predictability is reassuring to the reader/parent as I’m sure it is reassuring to the child. In doing with us (cultivating peace) as she would have parents do with children is a beautiful way of paralleling the process. For instance, she explains,

Our children’s healthy development calls us to pursue our own development and presence practice is a rich way to do so. We can attune ourselves more deeply to what we are engaged in: gestures can become prayers, thoughts can become meditations, comments can become blessings” (p. 287).

I have read this book twice now and I keep revisiting different pieces. It truly is a work meant to be savored, I wish I was embarking on my parenting journey now and had this remarkable guide by my side.




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

In a recent column a grandmother recommended her solution to the problem of children biting: Bite back. We demurred. Now another mother lobbies for the fight-fire-with-fire approach.

Q. This is in support of the politically incorrect biting mother and grandmother. There is nothing like experience to teach us, and I’m talking about biting toddlers. We can talk a blue streak, and it’s all abstract to a toddler; they need to learn that if they cause pain, it comes back at them.

These are my biting stories from the trenches. I was nursing my baby and his teeth were starting to come in. After having toyed with the idea for some time, he finally bit me while nursing. I let out a very loud bellow out of proportion to the pain, because I was not going to have that happen again. The poor baby got quite traumatized by my loud scream, but he never bit me again.

When he was a toddler, I took him to a day care where there was a hyperactive boy who was a frequent biter. Nothing the parents or day-care provider tried changed anything. Finally the day-care provider’s toddler took matters into his own hands and bit him back. End of biting.

When my boy was a toddler, he kicked my leg. Like the politically incorrect grandma, I very carefully placed a kick on his leg (I was so scared of hurting him that the first attempts were air kicks). He never kicked anybody again. I must add that this boy is now 14 and a joy (besides the fact that, being a teenager, he counters everything his parents say).

A. Small children’s biting certainly creates a red flag for everyone. Yet it is such a universal response in late infancy and toddlerhood that it deserves all its eminence.

Starting out as an exploratory and often loving response when a nursing baby bites the breast of his mother, it gathers drama from the surprised, angry and even frightened response, “Have I lost my baby? Do I deserve this negative hurtful response when I’m giving him everything I can? Will he turn out to be a monster?”

For him, it is likely to mean that when he suddenly raised such a dramatic response, “Should I try it again when I need to get her attention?” Then, he may begin to fall back on it when he is tired or overwhelmed or doesn’t know any other way to get the attention of someone he craves. He tries it out on a peer toddler. The world blows up. Everyone overreacts. “Wow! This is more important than I thought. I’d better shove this behavior way down underneath. I’ve learned there are certain behaviors that I don’t dare to express. They mean something terrible to other people, even though that’s not what I meant when I tried them. I’d better be more inhibited than I was.”

Inhibitions can be expensive in the long run. Your method of retaliation has surely worked. But what has it meant to the baby or toddler? “I’m bad, or she wouldn’t have hurt me, and I’m not sure why. But I guess I’m just a bad kid.” Is that what you meant to teach him by your response?

Meanwhile, seeing it from the standpoint of the baby’s development, it has been a missed opportunity. Each behavior which becomes an intrusive or painful one presents the child the chance for him to learn about how to control himself.

A child who learns self-control is already way ahead of a child who must rely on an adult’s presence to be controlled by force or by retaliation. Learning self-control is a major goal for childhood in our present out-of-control society. Discipline (teaching) is the second most important gift we as parents can give a child. Love first, but discipline that says, “I shall have to stop you until you can stop yourself.” That’s a much longer goal in time than just teaching him to suppress his responses and his feelings.

Everything we know from research in child development demonstrates that suppressing angry, hurt feelings just postpones them. For a parent or a teacher or any caring adult, each episode needs to be understood from the child’s standpoint. We can use his hurtful behavior, share the idea of self-control rather than just shutting it off. “I can’t let you bite. It hurts and no one likes to be hurt. Let’s find another way for you to say what you’re trying to say.”

The story you tell of the child’s learning from another child how biting hurts and how necessary it was to control himself was on a different level. Children learn so much more from each other than they do from an adult. It’s fascinating to watch two toddlers as they reproduce by imitation hunks of behavior from each other.

I have recommended putting two 2-year-old biters together. One would bite the other. They’d look at each other with a startled look. “That hurt.” And they wouldn’t bite again. This is an almost sure cure, but maybe one to be used sparingly, in case it could get out of hand. When it works, one can see on the biter’s face that he recognizes the fact that he’d hurt him. “I never knew what I was doing could hurt someone. I can’t do that again.” He will have learned (at 2) how to experience what another is feeling – a major step toward empathy for others.

When an adult bites him back, his reactions are hurt and anger. He may not have meant to be aggressive in the first place. Now, biting could become loaded with angry feelings. Certainly, it has not been a learning experience except to stop the biting – but not the anger that being bitten has generated.

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.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, 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 currently 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.

Problems in toilet training nearly always arise because of an imbalance in the parent-child relationship. Children usually show signs of readiness between age 2 and 3. When parents can’t wait until then, and impose toilet training as their idea, the child will feel the pressure as an invasion.

All parents, of course, want their child to grow up and cross this threshold. Preschools often insist that a child be “trained” before he comes to school.

Other parents may offer advice and condescending comfort when their children are already trained. Grandparents may imply that toilet training is a measure of effective parenting and of a child’s overall competence. Some families may see the child’s entire second year as preparation for success in this area.

A toddler for whom independence is a passionate issue anyway will have his own struggles. He may stand in front of a potty, screaming with indecision. Or, he may crawl into a corner to hide as he performs a bowel movement, watching his parents out of the corner of his eye.

It’s a rare parent who won’t feel that such a child needs help to get his priorities straight.

When a parent steps in to sort out the guilt and confusion, the child’s yearning for autonomy becomes a power struggle between them. Then the scene is set for failure.

In bedwetting, as in many of the problems encountered with toilet training, a child’s need to become independent at his own speed is at stake. When a child’s need for control is neglected, he may see himself as a failure: immature, guilty and hopeless. The effect of this damaged self-image on his future will be greater than the symptoms themselves.

Given that toilet training is a developmental process that the child will ultimately master at his own speed, why do parents feel they must control it? My experience has led me to the conclusion that it’s very hard for parents to be objective about toilet training.

The child becomes a pawn – to be “trained.” It may take us another generation before we can see toilet training as the child’s own learning process – to be achieved by him in accord with the maturation of his own bladder and central nervous system.

When Problems Exist:

A.) Discuss the problem openly with your child. Apologize and admit you’ve been too involved.

B.) Remember your own struggles, and your eventual successes, so that you can let the child see that there is hope ahead.

C.) State clearly that toilet training is up to the child. “We’ll stay out of it. You’re just great, and you’ll do it when you’re ready.”

D.) Let the child know that many children are late in gaining control, for good reasons. Then, let him alone. Don’t mention it again.

E.) Keep the child in diapers or protective clothing, not as a punishment, but to take away the fuss and anxiety.

F.) Don’t have a child under age 5 tested unless the pediatrician sees signs of a physical problem. A urinalysis can be done harmlessly, but invasive tests and procedures – enemas, catheters, X-rays and so on – should be reserved for children who clearly need them.

G.) Make clear to the child that when he achieves control, it will be his own success and not yours.

(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.

Q. My almost 4-year-old refuses to give up her pacifier and I am concerned about her teeth. Since her sister was born 10 months ago, she seems to be using it much more. Do you recommend we get rid of it cold-turkey as some pediatricians have recommended? Will the pacifier cause long-term damage to her palate and/or teeth?

A. Some studies associate pacifier use with orthodontic problems, especially as children get older. Such findings don’t mean that any child who uses a pacifier will need orthodontic treatment, but treatment appears to be necessary more often with pacifier use.

We know of no studies that link cold-turkey termination of the pacifier with significant psychological problems later. Concerns arise from the notion that interfering with a young child’s need for oral soothing may lead to overeating and other problems.

The practical challenge in stopping pacifier use is that there’s no sure way to do it. Often, when a parent tries, the child just clings harder to the pacifier.

You mention that a baby sister came along 10 months ago.

Children often suck their thumbs, fingers or pacifiers to reduce stress. They’re bound to feel more anxious when the whole family is.

When a new baby is brought home, parents are understandably preoccupied, worn out and less available to the older child. She may wonder why her parents had to go to all that trouble for this crying, demanding, inert little creature who won’t be much fun for a long time. The question may vaguely cross her mind, “Is the new baby here because I wasn’t enough to satisfy them?”

As she tries to adapt to her new role of older sister, and learns to wait until her parents have time for her, she’s likely to feel upset. As the baby grows, there will be new challenges for the older child – when the baby says her first words, or begins to crawl or walk and get into all of the older child’s toys. A thumb, finger or pacifier can be a welcome refuge.

It may help to offer this child other strategies for soothing herself – a “lovey” such as a soft blanket to stroke and cuddle, or a stuffed animal to squeeze tight. There’s no need for lots of dolls and animals – too many will just distract her. Instead, she’ll need to become attached to a single special one. Hand it to her when she’s distressed, tired or has scraped an elbow or knee, and tell her to hug it hard to help her feel better.

After a new baby is born, the older child feels the need to be a baby, too. The baby just seems to suck up all the time and get all the parents’ attention – so why wouldn’t an older child try the same thing?

Parents often think they can help the older child adjust by praising her for being such a “good big sister.” But the older child also needs reassurance that she can be a baby again when she needs to. The more her need to regress is openly expressed and accepted, the less she’s likely to do so.

Family life is especially busy with a 10-month-old, but the older child might need some extra time to cuddle with you. Don’t say a word about it, and don’t make it an issue, but try to give her some gentle one-on-one time when she doesn’t have her pacifier. Thus she’ll learn – through actions rather than words – that there are even more rewarding places for her to find the comfort she seeks.

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.