Climbing Out of Limbic When anxiety takes hold, children default to their brain’s fear-focused limbic system. And learning stops short. Features
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Features  |   September 01, 2017
Climbing Out of Limbic
Author Notes
  • Nicole Archambault Besson, EdS, MS, CCC-SLP, is founder and executive director of Minds in Motion, a speech-language pathology, orofacial myofunctional therapy and sleep literacy clinic in Santa Monica, California. She is the myofunctional therapy section leader of the American Academy of Physiological Medicine and Dentistry. nicole@mindsinmotiontherapy.com
    Nicole Archambault Besson, EdS, MS, CCC-SLP, is founder and executive director of Minds in Motion, a speech-language pathology, orofacial myofunctional therapy and sleep literacy clinic in Santa Monica, California. She is the myofunctional therapy section leader of the American Academy of Physiological Medicine and Dentistry. nicole@mindsinmotiontherapy.com×
Article Information
Development / Attention, Memory & Executive Functions / Features
Features   |   September 01, 2017
Climbing Out of Limbic
The ASHA Leader, September 2017, Vol. 22, 54-59. doi:10.1044/leader.FTR2.22092017.54
The ASHA Leader, September 2017, Vol. 22, 54-59. doi:10.1044/leader.FTR2.22092017.54
A man ahead of his time, Plato declared more than 2,000 years ago that emotions underpin all learning. But it wasn’t until the 1980s that neuroscientists began exploring emotions in earnest. Since then, researchers have discovered that learning and emotions are intricately intertwined, bi-directionally connected in higher and lower cortical brain areas.
Researchers are finding that emotions drive transfer of skills from school to the real world, guide judgement and action, focus attention and help us form meaning and memories from our experiences (see sources). In short, emotions are key to effective learning—and when emotions are negative, learning takes a hit.
Stressors from home, like poverty, divorce, relocation and loss of a family member, can interfere. So can burnout from overscheduling: A barrage of homework, playdates, extracurricular activities, enrichment classes and therapies can leave little time to decompress.
These factors can send children into a “fight or flight” mode that’s heightened for those with special needs diagnoses—the 15 percent of 3- to 17-year-olds with one or more developmental disabilities (per the Centers for Disease Control and Prevention), many of whom we see on our school caseloads. And there’s a compounding problem: Our educational system is so geared toward performance on high-stakes testing that the emotional component essential to all learning is often left at the classroom door.
Although there are no easy fixes for this conundrum, one approach that can help ease stress and boost learning is brain-targeted intervention. Drawing on neurocognitive research, the approach develops children’s creative thinking and problem-solving skills to help them defuse their anxiety—and boost their learning.
Providing a physically and emotionally supportive learning environment is the foundation of the approach. As the new school year kicks off with its added unfamiliarity stressors, there’s no better time to consider integrating brain-based intervention into treatment.

Ground zero for the toll of stress on learning is the limbic system: interconnecting brain regions where we process emotions, learn and remember.

From limbic to learning
Ground zero for the toll of stress on learning is the limbic system: interconnecting brain regions where we process emotions, learn and remember. The limbic system is home to such structures as the amygdala, hippocampus, thalamus and hypothalamus, and regulates the autonomic nervous system, in particular its reaction to emotional input.
Now consider the physical, cognitive and emotional obstacles that children with special needs encounter on their path to learning. Such obstacles can put them “in their limbic systems” (that is, fight or flight mode) and result in autonomic dysregulation—airway function disorders, for example, or sensory processing problems.
When children get stuck in their limbic systems, they struggle to access the prefrontal cortex. This foremost portion of the frontal lobes governs emotional regulation and executive function (EF) skills—cognitive processes essential for goal-directed cognition and behavior. And when it comes to speech-language treatment, EFs are critical to children’s ability to perform tasks, demonstrate mental flexibility, self-monitor their behaviors, organize thinking or physical selves, and hold new information in working memory.
Given the interplay of stress, emotions, EFs and speech-language performance, it’s critical that we support children’s emotional needs. And one means of doing this is the Brain Targeted Teaching (BTT) model developed by Mariale Hardiman, interim dean of academic affairs in the School of Education at Johns Hopkins University. (I recently spent a year in the Johns Hopkins graduate certificate program in Mind, Brain and Teaching, learning how to implement BTT with my clients).
Using Hardiman’s framework—described in her book “The Brain-Targeted Teaching Model for 21st-Century Schools”—we can set the foundation for optimal learning through 1) a physical environment that promotes attention and engagement and 2) an emotional climate that nurtures positive feelings and quells the negative. As a speech-language pathologist, I find that incorporating these two brain targets into my treatment is essential to moving children out of their limbic systems into higher cortical areas.

Obstacles encountered by children with special needs can put them “in their limbic systems” (that is, fight or flight mode) and result in autonomic dysregulation.

The physical environment
How do we design our treatment rooms to boost clients’ engagement in treatment? I like to think of my treatment room as a neurosensitive environment individualized to each child’s needs. But all children need an environment that isn’t too hot, cold or noisy. And we can also optimize other universally important physical elements: novelty, sensory inputs, lighting, scent and seating.
Novelty. Environmental novelty activates the brain’s alerting systems and can enhance memory formation (see sources below)—and children often jump at the opportunity to create their own learning space. So urge clients to share their ideas, and display their artwork or writings from sessions in rotating, themed displays. For example, when I decorated the office with artwork by my client Jenny, age 6—who has obsessive-compulsive disorder and autism spectrum disorder—she overcame her struggle to focus on therapeutic tasks. She even offered to create floorplans to change the room design on a larger level. Another client, Mya, age 5—who has an orofacial myofunctional disorder—thrived on a hide-and-seek game I played with her at the beginning of each session. Mya had to locate hidden toys, pictures or stickers while simultaneously working on maintaining proper oral rest postures.
Seating. As SLPs, we have likely all heard the expression, “stability proceeds mobility,” and, yes, posture matters. Children with articulation problems, feeding issues and orofacial myofunctional disorders need seating that adequately supports the trunk, which in turn aids oral structures for fine-motor movements. Their feet need to rest comfortably on the floor, to ensure postural support and feelings of safety. Also helpful for posture and muscle tone are active seating arrangements—involving medicine balls, wedges and therapeutic cushions.
Sensory supports. Certain objects or spaces can offer children a feeling of internal organization and calm when they feel out of their skin or out of place. These can be store-bought, handmade, and all shapes and sizes. For instance, children overstimulated by sights and sounds may benefit from a “safe” space (such as under the table or in a tent) to dampen the stimuli. Children with sensory sensitivities are more willing to explore, learn and interact when they feel safe. To help them stay on task in a fun way, provide an accessible container with various fidget items to pull, squeeze and twist.
These items will also help replace inappropriate sensory-regulation behaviors, such as thumb-sucking—the case for Lily, age 8, who came in with tongue thrust pattern, open bite and sleep-disordered breathing. To treat her, I needed to eliminate the thumb-sucking, which escalated during times of worry and at bedtime. Luckily, Lily took to fidgets like a pro, and the thumb-sucking subsided in a matter of weeks.
Lighting. Many of us can relate to that uncomfortable, blinding, “in the spotlight” feeling. We’ve also likely experienced lights so low that we feel sleepy, due to the impact on our pineal gland. Neither scenario invokes optimal learning in children. To help, open curtains and blinds, and move furniture near windows: Natural lighting can improve cognition and mood (see sources). I see this happen when I seat children near clinic windows.
Scent. For some children with anxiety, aromatherapy may foster the sweet smell of success. Some studies indicate there may be calming benefits of citrus and lavender (see sources). Introducing pleasing scents into the clinic is quick and easily achievable with an essential-oil room diffuser. However, before bringing in new smells, ensure that children can tolerate them.

Given the interplay of stress, emotions, executive functions and speech-language performance, it’s critical that we support children’s emotional needs.

The emotional climate
These changes to our clients’ physical environment will do much to ease their stress. But to truly help them out of their limbic systems, we also need to establish a positive emotional climate. Watch for indicators that a child is operating in their limbic system and customize emotional accommodations accordingly. Apply these various methods at the start of a treatment session—or throughout—as needed.
Inner calm. Feeling settled can promote problem-solving and help a child generate new ideas, maintain focus and recall previously learned information. Try promoting inner calm through methods like emotional barometers, gratitude practices, humor, breathing exercises and advising a good night’s sleep. Consider the case of Eli, an 8-year-old client of mine with language-processing issues and related anxiety. He dreaded making mistakes and berated himself when he made them. This fear often rendered him unable to respond, perform, practice new learning or ask questions when he struggled.
To combat this “limbic sticking,” I introduced emotional barometers—check-ins on his feelings. I told him that he was allowed to have any feeling he needed to have in my room. We wrote down his feelings on index cards, and he posted them as they changed throughout our sessions. In just one session, his cards morphed from worried and scared to happy and excited. (Feeling charts and visual thermometers also work well as emotional barometers.) Because Eli often did not recognize or appreciate his many strengths, I also introduced gratitude practices to help boost his positive affect and well-being (see sources below). I had him share something he had been grateful for that day, track his improvements in treatment and keep a gratitude journal. These steps helped Eli begin to appreciate his strengths, let go of fear of mistakes and ultimately take risks in learning.
Feedback, praise and a growth mindset. Feedback is essential to creating a positive emotional climate and most benefits children when it is developmentally appropriate, positive, behavior-specific and timely (see sources). Praise that focuses on a child’s efforts rather than abilities bolsters their confidence and motivation because it is something within their control, fostering what Stanford University psychologist Carol Dweck calls a “growth mindset.”
On the other hand, praise that focuses on abilities conveys that what matters is predetermined skills and talents—and is not within their control. This ability-focused praise fosters instead a “fixed mindset,” as described by Dweck in her book 2007 book, “Mindset: The New Psychology of Success.” Incorporating a growth mindset helps children recognize that they propel development of their own abilities, effort determines outcomes, and mistakes are opportunities to learn instead of experiences to avoid. In Eli’s case, we worked on moving him from a fixed mindset to a growth mindset so he would draw on self-determination and resilience when confronted with challenges.

Brain-targeted intervention develops children’s creative thinking and problem-solving skills to help them defuse their anxiety—and boost their learning.

Movement and play. Providing a physical outlet for children is also key to bolstering their mood and learning: Movement increases vagal activity, reduces stress and increases levels of “feel good” neurotransmitters like serotonin (see sources). Although space constraints are a reality for many SLPs, try some creative ways to increase space. Occupy a bigger treatment room when possible, or rearrange furniture, remove items and fold up tables so kids can exercise. Another option is simply taking clients outside for (at least part of) sessions. With Eli and others, I have integrated “walk and talk,” in which we walk about and talk out anything troubling for five minutes before starting treatment. This activity allows me to simultaneously foster a positive emotional climate while gauging conversation and social communication levels.
I also integrate Eli’s treatment into “obstacle courses” that include, for example, spinning chairs, scooter boards, tunnels, stepping stones and a mini trampoline. These activities help him release energy after a long day sitting through classes and riding in heavy traffic to treatment. On especially fidgety days, I bring in “freeze dance,” involving movement (for example, jumping jacks, twists, crab crawls), Eli’s favorite songs, and Eli freezing when I turn off the music. Add other games and imaginary play activities to treatment to defuse stress and build engagement.
By using these and other practices that promote a positive emotional climate, SLPs can help optimize children’s learning as they head back to school this fall. Brain-targeted treatment serves as a springboard to connect emotions to learning in meaningful ways. Drawing on the wealth of knowledge from the neurosciences, SLPs can help move children out of a limbic world—into one of endless growth and possibility.
More Ways to Foster a Positive Emotional Climate

Easing children’s anxiety goes a long way toward helping them learn, and this is especially true for those with special needs. There are myriad stress-relieving strategies speech-language pathologists and other professionals on the IEP team can use with students—and can work collaboratively to implement.

Be predictable. Share treatment goals that connect to the big picture, outline expectations in the clinic and at home, integrate routines with a beginning, middle, and an end, and use visual schedules and timers to ease children’s negative emotions surrounding uncertainty.

Offer choices. Whenever possible, help establish a sense of safety and autonomy. The choice can be as minor as allowing the child to choose a chair or as big as letting them choose an activity. Many children are leery of letting clinicians near their mouths. Let them choose to do something less-invasive first.

Laugh. Elicit laughter to boost children’s intake of oxygen-rich air, promote release of endorphins, stop distressing emotions and shift perspective, and aid in muscle relaxation (see sources below).

Get nosey. Nasal breathing may be calming, stress-reducing and anxiety-relieving (see sources), particularly for children who mouth-breathe during the day and have sleep-disordered breathing at night.

Chew on this. Offer snacks. Chewing food has been shown to lower stress and regulate alertness and executive function (see sources). For a similar effect, use chew tubes for non-nutritive chewing tasks.

Become mindful. Incorporate mindfulness tasks in children’s daily activities to help bolster their resilience in the face of adversity (see sources).

A helping paw. The presence of a dog can help to regulate stress in children while reading aloud or during routine treatment sessions (see sources).

A good night’s sleep. Talk with children and parents about the importance of quality sleep and bedtime routines. An obstructed airway during sleep can negatively affect mood and classroom behavior the next day.

Limbic System Signs

Children might be stuck in their limbic systems if they exhibit some of these physical, behavioral, sensory and language signs.

Physical
  • Increased respiration

  • Increased heart rate

  • Sweaty palms

  • Dry mouth

  • Muscle tension

Behavioral
  • Tantrums

  • Irritability

  • Reduced eye contact

  • Limited participation and/or refusal to participate

  • Lack of motivation

  • Parafunctional habits (for example, non-nutritive chewing)

Sensory
  • Steers clear of touch from objects or people.

  • Avoids eye contact/struggles with bright light.

  • Avoids, rejects or gags on certain food textures.

  • Responds to odors that others may not notice.

  • Covers ears or becomes frightened by noises.

  • Shuts down and/or avoids social interaction.

Language
  • States “I’m scared” or struggles to access feeling words.

  • Is reluctant to talk or engage in conversation.

  • Looks to caregiver to speak for them.

  • Prefers to give yes/no responses.

  • Struggles to make choices or answer open-ended questions.

  • Talks excessively and/or asks a lot of questions.

Sources
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1 Comment
September 4, 2017
Linda D'Onofrio
The Why Behind the What
Thank you Nicole for reminding all of us to look beyond our patients' behavior to the underlying stressors and to spend time in each encounter improving the parasympathetic. Thank you for concrete signs and symptoms to look for and applicable strategies to employ in clinic.
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September 2017
Volume 22, Issue 9