By Leah Kuypers, Think Social Publishing, 2011, ISBN: 978-0982523165, $47.99 For many adopted children, development has been mediated by complex childhood trauma. The major symptoms of developmental trauma are “mixed maturity:” difficulties with self-regulation of behavior and emotions, inability to temper emotional responses and behavior impulsivity, underdeveloped language as a regulatory mechanism, delayed social cognition, limitation in executive functions. Children with difficulties interpreting emotions, paired with impulsivity, may be at risk for aggressive behavior. All these attributes require direct therapeutic interventions with appropriate methodology. Within the last 10-12 years a number of training programs aiming to remediate children with difficulties with self-regulation were created. These programs, being basically cognitive/behavioral techniques, are designed for children of different ages and different medical conditions. To the best of my knowledge, none of these programs address the trauma issues. Finally, we have one that can be the most helpful to children suffering from developmental trauma disorder. This therapy methodology exists in a book format called “The Zones of Regulation: A Curriculum Designed to Foster Self-Regulation and Emotional Control.” The author is Leah Kuypers, an occupational therapist by training, who is a specialist in the autism spectrum disorder (ASD) field. The program, released in 2011, became rather popular among school personnel, private therapists and counselors. There is a good reason for this: “The Zones of Regulation” methodology is sequentially organized, logically structured, multisensory in nature and practical. The multisensory approach is at the base of the curriculum (visual, auditory, tactile, kinesthetic, role-play and imagery) and is used to develop emotional control, sensory regulation and executive functions in preschoolers through middle school students with social and behavioral difficulties. The program is clearly school-oriented: the author prefers to call her program a “curriculum” and her therapy/instructional sessions are named “lessons.” “The Zones of Regulation” is a practice, based on evidence obtained during hands-on work in the fields of autism spectrum disorders, attention deficit disorders (ADD/HD), and with children having social-emotional management problems. My encounter with “The Zones of Regulation” happened about three years ago during the search for methods to facilitate self-regulation in traumatized children — the majority of internationally adopted, post-institutionalized kids. I was particularly attracted to the Zones of Regulation because students would gain an increased vocabulary in the understanding and communication of emotional states; skills in “reading” facial expressions; perspective on how others see and react to their behavior; insight on what triggers their maladaptive behavior; calming and alerting strategies; problem-solving skills and much more. I also was attracted by its multisensory methods of presentation and the interactive nature of many activities. The obvious advantage was in the incorporation of social thinking concepts in teaching students to identify their feelings, understand how their behavior impacts those around them, and learn what methods they can use to manage their feelings and behavior. By addressing underlying deficits in emotional and sensory regulation, executive functions, and social cognition, the curriculum is helpful with advancing students toward independent regulation. In short, “The Zones of Regulation” appeared to me as a sensible, hands-on, well-structured and detailed approach that deserved trying its application with a particular group of traumatized children: international adoptees. “The Zones of Regulation” curriculum classifies feelings and states of arousal into four easily identifiable distinct color-coded zones. The Red Zone is used to describe extremely heightened states of alertness and intense emotions. A person may be elated or experience anger, rage, explosive behavior, devastation or terror when in the Red Zone. The Yellow Zone is used to describe a heightened state of alertness and elevated emotions while control is still possible: when a person experiences stress, frustration, anxiety, excitement, silliness or nervousness but is still able, to some degree, to self-regulate his or her behavior. The Green Zone is used to describe a calm state of alertness: a person may be described as happy, focused, content or ready to learn. This is the zone where optimal learning occurs. The Blue Zone is used to describe low states of alertness and down feelings, such as when one feels sad, tired, sick or bored. The zones can be compared to traffic signs. When given a green light, one is “good to go.” A yellow sign means be aware or take caution. A red light or stop sign means stop. The blue zone can be compared to the rest area signs where one goes to rest or re-energize. All of the zones are expected at one time or another and the curriculum focuses on teaching students how to manage their zone of emotional state. As explained in the book (page 9), “The Zones of Regulation” method is intended to be neutral, without projecting judgment when helping students recognize their feelings and levels of alertness. The program consists of 18 sessions and, even if the therapists “cut and paste” some sessions, it still may take from two to five months to graduate. Each lesson consists of:
- Overview — a concise description of the lesson.
- Goals for the activities.
- Preparation of materials needed for the session. As I mentioned above, this is a multisensory curriculum, and includes many visual colored posters, drawing, tracking drawings with fingers, using some occupational therapy tools, such as “fidget ball.” A significant number of colored and black-and-white reproducible posters are ready to be printed out.
- Note to teacher/therapist — further detailed explanation on material preparation or some procedural specifics.
- Lead-in for all ages — how to start the session, how to introduce the major concepts and/or activities, often with a detailed script.
- Activities for the different age groups.
- Wrap-up for all ages — how to conclude the session.
- Ways to generalize learning — a discussion of what to do to further enhance the learned skills and knowledge in school, home and community.
- Ways to adapt the lesson to different individual and developmental differences.
- Additional learning activities.
Furthermore, the program is designed for use in a group format. The author claims that the program could be adapted for individual sessions as well, but it will require substantial modification. The author of the program stated that “The Zones of Regulation” methodology is suitable (with some age-related adaptations) to a rather wide range of students: from the preschool populations to middle school and even high school students. In my view, the targeted population should be limited to elementary school population: ages 6 to 12. Exceptions are possible, of course: advanced preschoolers (ages 5 to 6) and children with cognitive limitations beyond age 12 could be included in this group. I think this is a good program for children with high-functioning autism and ADHD (as a therapeutic supplement to medical treatment). I believe that children with complex childhood trauma, ages 6 to 12, will benefit from this program as well. I started looking at this methodology with the goal of adapting it for the parents of internationally adopted children. Knowing my clients as mostly hardworking parents living in a survival mode with difficult children to bring up, I believe that a serious adaptation and simplification of the program is needed to make it useful for the home environment. But I see another option: The adoptive parents may request their counselor or therapist (either private or school-based) to implement the program with their child with the parents being in charge of “follow-up” (or “generalization”) at home. This “follow-up” may have crucial significance in the generalization of students’ learned skills outside of a therapy office and their conversion into the use of automated responses to external challenges. The creation of “Parental Follow-Up to Zones of Regulation” is a challenge that is worth taking on. The whole concept of “zones of self-regulation,” many ideas and activities could be taken from the original program fully “intact,” some activities are to be modified (from mild to significant degrees), and some activities are to be omitted as not applicable in the home environment. Home-based “follow-up” would strongly, if not a decisively, support a therapist’s or school counselor’s efforts to instill the basis of self-regulation in internationally adopted, post-institutionalized children. — Reviewed by Dr. Boris Gindis, a child psychologist specializing in psycho-educational issues of older internationally adopted children. He is the chief psychologist at the Center for Cognitive-Developmental Assessment and Remediation, the author of many publications on international adoption issues and frequent presenter at conferences and workshops. See more at www.bgcenter.com.