(p. 185) Module 9: Emotion Coaching
(Recommended Length: 1 or 2 Sessions)
Materials Needed for the Module
Forms, parent summaries, worksheets, and handouts appear in Appendix A: Client Materials, located at the end of this therapist guide. You may photocopy this material for your clients, or you may download these items from the Treatments ThatWork web site at www.oxfordclinicalpsych.com/ADHDparenting. For an outline of this and all modules, go to Appendix B: Therapist Outlines.
Home Practice Review from Module 8
During Module 8, parents learned the importance of advocating for their children’s educational needs by developing and maintaining a (p. 186) collaborative working relationship with the school. Parents learned about daily report cards as well as assertiveness, social, and organizational skills that will help them be more effective in working with their child’s school. Parents are still early on in their use of the time out consequence so remember to ask how this is going and address any questions or concerns. In addition, emphasizing self-care is important as the parents work hard to implement new child behavior-management strategies. You can use some of the following questions to facilitate the home practice review:
■Have you had any communication with your child’s school since we met and if so, how did it go? What assertiveness, social, or organizational skills did you need to use in your interactions with the school?
■Have you had a chance to take any action steps that we identified (request for 504 eligibility, contacting teacher about Daily Report Card, etc.)? (if applicable)
■How many times did your child go to time out since your last session? For what behaviors did they receive a time out? How often did you have to give the time out warning after a command (the yellow light step)?
■Was there at least one thing you were able to do to take care of yourself or “charge your battery” this week?
Problem-solve with parents regarding issues that came up regarding the school-related goal. If time allows, check in with parents about their other home practice (Special Time, relaxation, etc.) based on the individual family’s needs.
Make sure to adjust the home practice review based on what was assigned in the previous session. If topics haven’t been covered yet, omit questions about that content from the home practice review. Also, if this home practice review does not include content that has been covered and given for home practice (e.g., if you are doing modules in a different order), make sure to expand the home practice review to include all relevant items.
Overall Module 9 Goals and Rationale
During Module 9, parents will be introduced to the concept of children’s emotion development and the importance of parents helping (p. 187) their children with attention-deficit/hyperactivity disorder (ADHD) to handle strong emotions effectively (and without acting out!).
Parents are the child’s first teachers for how to regulate (or manage) their emotions. In addition to this, parents serve the role of “external regulator” for their children (Gottman & Declaire, 1998). As we have mentioned throughout this book, many children with ADHD are far more sensitive to their environments. Often they will look to their parents for signs of how to react to a situation or stressor. The intensity and manner in which the parent responds set the stage for how the child learns to respond. The goal is for parents to stay calm and collected, modeling effective emotion regulation for their child during periods of stress.
In addition, young children with ADHD receive a high level of negative feedback from both adults and peers in their environment. It is easy for others to forget the biological basis of their impairments and send them messages that communicate that they are seen as lazy or mean-spirited or that they should “know better.” Many parents have expressed frustration when others minimize the influence of ADHD on the child’s behavioral and emotional regulation and when others have the same expectations they would have for neurotypical peers. Parents can also fall into this trap themselves of having expectations that do not account for the child’s ADHD-related impairments. These negative messages from others can influence the child’s self-concept (how they feel about themselves). When parents learn to be emotion coaches, they are more likely to consider the child’s impairments without judgment and decrease critical or invalidating responses.
The goal is to send the message to the child that we all experience emotions (both pleasant and unpleasant) and that even negative or unpleasant emotions are OK. They are indeed normal! By sending this message, parents convey that they are providing a safe space for the child to express their emotions. By serving as the child’s “emotion coach” and labeling emotions, the child also learns “emotion language” so that acting out in response to emotions is not necessary to express how they are feeling.
Parent emotion coaching skills consist of
■ Being aware of the child’s emotions and triggers.
■Validating and tolerating the child’s emotions.
(p. 188) ■ Using emotion descriptions about how the child is feeling and why.
■Setting limits while building problem-solving and self-regulation skills.
■ Being aware of one’s own reaction and regulating emotions to convey calm and support.
You can refer to the book by Gottman and Declaire (1998) for additional reading on parent emotion coaching and the development of emotion regulation skills.
This skill of parent emotion coaching is important not only now, but also as the child moves into adolescence. By setting the foundation as being someone to with whom the child can safely express emotions, during adolescence they will be more likely to share feelings and experiences with their parent(s)—which is critically important during the high-risk teenage years when youth experience an uptick in depression, anxiety, and overall emotionality and may begin to experiment with alcohol and substances. In other words, if parents take time to attend to their child’s emotions when they are young (even in relation to small things), their children will be more likely to share their emotions in relation to more serious issues in the future.
Specific goals for this module include
■Goal 1: Parents will come to understand their role as the child’s emotion regulation model and coach.
■Goal 2: Help parents become more aware of and attentive to their children’s emotions.
■Goal 3: Teach parents to (1) validate, (2) tolerate, and (3) label their children’s emotions.
■Goal 4: Help parents discriminate between times when they should use emotion coaching versus behavioral consequences (e.g., time out, ignoring).
Module 9 Content (Divided by Goals)
(p. 189) To introduce parents to the concept of teaching children about emotion regulation, you can say something like,
Parents are the first and most important teachers in their children’s lives. Children are dependent on their parents for everything at birth and slowly grow and learn to care for themselves. Until they are able to do things for themselves, they rely on their parents to meet all of their needs, including needs for love, affection, and emotional support. This is also true for learning how to behave and learning about emotions and how to deal with emotions in healthy ways. We want you to be really aware of your role as an emotion regulation model and coach because you are always teaching your child, whether you realize it or not!
Sensitively talk with parents about their own emotional experiences and reactions when parenting their child with challenging behaviors and strong emotions. It is likely that parents have strong emotions when parenting their child with ADHD, which can be really stressful. In fact, some people refer to parenting a child with attention and behavior problems as a chronic stressor. As much as the parent loves their child, the child may be hard to like or understand at times. As a result, parents may sometimes lose their cool in the face of frustrating child behavior. They might also worry about how the behavioral and social difficulties their child experiences now will impact the child in the long run. These emotions are normal for any parent to feel and particularly for parents of children with more challenging behaviors.
Here, you can refer back to the cognitive-behavioral therapy (CBT) (thoughts, feelings, and behaviors) triangle. Help parents to see that what they are thinking and feeling when their child expresses emotions or misbehaves affects how they react to the child. If parents put themselves in the role of teacher and model, they will need to manage their experience and use opportunities to coach their child when the child is having a difficult time.
Few parents view their child’s negative emotions as a good thing. However, when the child is experiencing a negative emotion, this is actually an opportunity for connection and teaching (“a teachable (p. 190) moment”). Just as we asked parents to “catch the child being good” in Modules 4 and 5, in this module we ask the parent to tune their radar to pick up signs that the child is feeling a certain way. (See Handout 9.1: Child Emotion List for common emotions experienced by children with ADHD.) Sometimes it may be challenging to know exactly what their child is thinking and feeling. Depending on their age and emotional awareness, the child may not be able to articulate what they are feeling, but we can usually pick up (from their verbal or nonverbal behavior) that they are feeling something.
At these times, it is important for parents to practice empathy: putting themselves in their child’s shoes and seeing the situation from their perspective. This can be incredibly challenging for some parents who are instead focused on the child’s completion of activities or an expected behavior. Parents may quickly see something as not a big deal and dismiss their child’s feelings. Other parents are more naturally attuned to how their child is feeling. Yet other parents may take on their child’s feelings and feel responsible for changing them.
You can bring in the idea of the CBT triangle for both the parent and child in a situation (as the child experiences thoughts, feelings, sensations, and action urges, so does the parent; see Ehrenreich-May, 2018). You can say something like,
Imagine that your child is building something with Lego and is becoming whiny and feeling frustrated. You start to wonder why he just can’t sit and build without so much support like your older child did. You are expecting an outburst any minute. You just know the signs that he is about to blow up. You also begin to wonder how on earth your child is going to make it in school as the work gets more challenging if he cannot even build a simple Lego! You feel your muscles getting tense and are about to lose it. Let’s write out your thoughts, feelings, and possible behaviors in this situation. [Draw two CBT triangles and write the child’s experience and the parent’s experience for the same situation.]
Now imagine that you focus on your child’s feelings. Instead of getting angry and worried about his inability to handle frustration and how this will play out in his future [note the cognitive distortion such as fortune-telling, catastrophizing, or labeling], you say “I can understand that you (p. 191) feel really frustrated because building can be tricky and because you may think you won’t ever figure it out,” and see how your child responds. How do you think he would feel in response to your statement? How does this compare to your thoughts, feelings, and behaviors in the previous scenario where you can feel yourself getting into a negative spiral?”
A “negative or downward spiral” refers to when a lack of positive reinforcement in the environment (such as invalidation) contributes to negative thoughts, feelings, and behaviors, and this creates a feedback cycle resulting in increasingly negative thoughts, feelings, and behaviors that fuel one another (Lewinsohn, Munoz, Youngren, & Zeiss, 1986). Showing empathy for the child’s emotional experience will communicate to the child that having emotions is normal and OK. By acknowledging their children’s emotions, parents are helping them to learn skills that will serve them well for a lifetime. You can ask:
Can you think of a time recently when your child was having an emotion and you connected with them during this time? What about your interaction helped you to feel connected?
After parents increase awareness of their child’s emotion and begin to view it as an opportunity to connect, the second step is to validate the child’s feelings and to label emotions (use emotion descriptions) to help the child express their feelings through words (give the parent Handout 9.2: Emotion Coaching). Pausing to allow the child to have an emotional experience and listening with acceptance provides helpful support when the child is experiencing unpleasant emotions.
You can say something like,
After you notice that your child is feeling a strong emotion, the next step is to say something supportive by using a validation statement. Your words and actions let your child know that it is OK to have strong feelings and that you understand why they might be feeling this way. “You are very (p. 192) disappointed,” “It’s okay to feel angry,” and “I can see why you’d feel jealous” are validating statements that show your child that you accept how they are feeling.
We all have a tendency to try to use reasoning or logic right away, which can be invalidating. You can say,
Imagine you’re feeling very frustrated with a stressful situation at work. How does it feel when someone jumps in quickly and tells you what you should do in the situation? Now compare this to how it feels when someone simply shows that they are listening and that they understand what you are feeling by saying things like, “That sounds really hard,” “I could see how that would be annoying,” or “Wow, that is so frustrating.” Which helps you more in the situation? In which scenario do you feel better understood and supported?
Generally, feeling heard and understood helps us to calm down and feel better much more so than someone trying to logically solve our problem (even if the other person only intends to be helpful). A validating response like this also helps to build a stronger relationship with the other person. Instead of trying to reason, a validating response shows the child that the parent understands them and that their perspective is OK with the parent. For example, instead of trying to use logic to explain why something is fair or not a big deal, a parent can first validate the child’s anger or frustration when the child perceives something as unfair or a big deal.
In Emotion-Focused Family Therapy parents learn to think of their child’s emotional experience as an elevator (Lafrance, Henderson & Mayman, 2020). When a child is experiencing a strong emotion, the elevator may be on the fifth or even tenth floor. However, our ability to access logic happens on the ground floor. Thus, children can greatly benefit from parents first focusing on the child’s emotional experience with validation and empathy before they jump to reasoning or fixing.
Labeling a Child’s Emotions (Emotion Descriptions)
When parents validate their child’s experience, they are using the opportunity to label the emotion. It is helpful for parents to understand (p. 193) the value of labeling emotions and the variety of ways this can be done. Using words to understand and communicate emotions is a very important part of healthy emotion development. By labeling the emotion and why it makes sense the child is feeling this way (the trigger), parents are helping their child to make sense of their experience. In addition to providing validation when the child is upset, parents can use emotion descriptions throughout the day when opportunities arise (see Handouts 9.1 and 9.2). Parents can label their own emotions (in a developmentally appropriate way; e.g., “I am feeling frustrated by all of this traffic”), they can label their child’s emotions during Special Time (commenting on pleasant emotions like feeling proud or happy during play as well as unpleasant emotions like frustration), and they can point out emotions in others and the cues they use to know how someone else is feeling (e.g., “that person is feeling disappointed and I can see they are looking down and frowning”). Talking about the emotions of characters in books and with people with whom the child is not interacting can be another helpful way to help kids engage with emotion identification when they are calm. Parents talking about their own emotions gives children an opportunity to see how the parent is flexible or stays calm when experiencing unpleasant feelings. Parents labeling emotions helps to reinforce the message that emotions can be uncomfortable, but are not dangerous and do not need to be avoided. You can ask something like,
Can you think of a time when you used or could have labeled your child’s emotion (used an emotion description) or taught your child about emotions? What was the situation and what did you say? How did your child react?
Steer parents toward an example that does not involve misbehavior if possible so that it is easier to see the usefulness of validation. Demonstrate how to validate the child’s emotion given the example they describe.
It is necessary and healthy for children to be able to experience and tolerate a range of emotions. By labeling the child’s emotion, the parent is showing the child that they are not judging the child’s emotional (p. 194) experience and it is OK to have strong feelings. Words that label how we feel can be calming (“name it to tame it”). Though this may not be the outcome in-the-moment every time, by consistently tolerating the child’s negative emotions, the parent is teaching them that all feelings are acceptable and that the child is a person who is worthy of love, compassion, and understanding.
An iceberg is often used to demonstrate the idea that the emotion we see expressed outward (the tip of the iceberg) is not the only emotion the person is experiencing. We often see emotions like anger or frustration while other feelings like fear, sadness, or guilt may be hidden beneath the surface. Some children with ADHD and significant anxiety may experience frequent guilt when their ADHD symptoms interfere with functioning. On the other hand, some parents of children with ADHD believe that their child experiences insufficient guilt. This can lead parents to try to induce guilt (or shaming) or be overly critical of their child’s behavior, rather than focusing on skills deficits like trouble with perspective taking and delaying gratification.
For some families, it may be helpful to discuss the parents’ concerns about their child’s ability to take responsibility for their actions and to inhibit behaviors that have a negative impact on others. You can use this opportunity to provide education about these lagging skills and the impact of ADHD on social and emotional functioning. Help parents identify a supportive mindset (you can put these thoughts in the CBT triangle) so that their own critical or anxious thoughts about their child’s behavior does not interfere with their validation of their child’s emotions.
Another important benefit of tolerating children’s emotions is that the parent sends the message that (1) the parent is someone the child can confide in now and as the child gets older, and (2) the child can feel safe and comfortable talking to the parent about any feelings they may have. This is an important message for children to receive from their parents because it influences how well they are later able to talk about their feelings, not only with the parent but also with other (p. 195) important people in their lives (e.g., friends, romantic partners, their own children).
Tolerating: What Not to Do
When discussing what tolerating looks like, it can be helpful to point out to parents what NOT to do (refer again to Handout 9.2: Emotion Coaching). You can say something like,
1.DON’T distract the child from the feeling (don’t give them something else to do so they temporarily forget about being upset): “You’re OK, here’s your favorite toy you can play with.” Getting quiet immediately is not the goal.
2.DON’T minimize or deny the feeling: “I don’t know why you are getting so upset about such a little thing.” “It’s no big deal, you are fine.” Or, for example: Child says “I hate you” and Parent responds, “You don’t mean that.” Or: Child clearly seems scared of a loud toy and Parent says, “It’s just a toy, you’re not scared of a silly little toy.” Denying feelings gives the message that certain feelings are not acceptable or that you don’t accept your child when they have certain feelings.
3.DON’T negatively judge/criticize the child’s feelings (“You’re acting like a baby when you cry,” “Why are you so emotional?”) or suggest how the child SHOULD feel instead. For example: Child: “I don’t want to go to the park!” Parent: “You should be happy you get to go to the park.” Telling children how they should feel does not validate their true feelings. It’s all right if your child is not expressing an emotion you would expect from them given a specific circumstance (e.g., sadness when a friend had to go home early, guilt when they did something wrong).
4.DON’T expect the child to be able to tell you exactly how they are feeling or give a logical explanation for why they feel a particular way.
5.DON’T connect your negative emotions to your child’s behavior (“I feel very sad when you yell at me”). This might make more sense as they get older, when they are cognitively able to understand this (e.g., “I am very disappointed that you broke our trust and missed curfew”). For very young children, statements about how your child’s behavior makes you feel won’t change their behavior in the long-run AND it might negatively affect your relationship and their developing self-concept.
(p. 196) Parents’ Own Self-Regulation
As difficult as it is, it is essential that parents do their best to try to stay calm when their child is upset. Seeing your child upset can understandably be very upsetting to parents (especially when the child is acting out). It is also difficult to not swoop in and solve the problem to make the child’s distress go away. However, it is very important for parents to stay calm and to model for the child that the parent can handle any emotion the child expresses. When parents stay calm, they can communicate the acceptance and confidence that will help their child with self-regulation. Parents can use the relaxation strategies learned in Module 5 to help them stay calm in these situations.
Of course, the parent will not always be able to stay perfectly calm. After all, they, too, are working on managing their emotions. When this happens, validate the parents’ feelings and acknowledge that this is a process for them, too. They should not be too hard on themselves and should recognize their own improvements in this regard. (The thoughts-feelings-behaviors triangle can come in handy here.) When parents do lose their cool, it is helpful for them to discuss this with the child afterward (when everyone is calm) to process the fact that they were feeling upset, and that, although it is natural to feel that way under the circumstances, they should not have reacted in a harsh way.
Some parents struggle a great deal with remaining calm when their child is upset. As difficult as it may be for the parent to engage in the self-care activities we have presented to this point, these self-care skills are essential to the parent’s ability to remain calm. Gently revisit the self-care skills at this point using information about which skills seem to work best for this parent. Problem-solve ways that the parent can continue to incorporate these skills into their daily routine. Remind them how important taking care of themselves is for them to be in the best possible position to provide support to their child who is struggling. They need to “put on their own oxygen mask” before assisting their child!
Often, when children experience an unpleasant emotion, they act out in response to the emotion. The ultimate goal is to teach them to use emotion words (e.g., “I’m mad,” “I’m sad,” or “I’m disappointed”) rather than engaging in aggressive or destructive behavior (e.g., hitting, slamming doors, shutting down) to express themselves, but this will take some time. For this reason, it is important for parents to learn to set limits while helping the child build problem-solving and self-regulation skills. Refer to Handout 9.3: Emotion Coaching and Misbehavior during this discussion. You can say something like,
It’s important to remember that children with ADHD will not always calm down quickly and may not calm down at all. Sometimes your child will need a time out or other consequence if their strong emotions escalate to misbehavior. This is why it is important to remember that you should use consequences if needed.
Make sure the parent understands when to use emotion coaching and when to ignore (or direct in another way). Sometimes parents feel unsure if they should be ignoring or providing emotion coaching. This can be tricky! In general, we suggest using emotion coaching to label the emotion once and to ignore thereafter. If the child displays a behavior that breaks a house rule or typically results in time out (e.g., throwing something, hitting), they can discuss the emotion later, after the negative consequence is given. Preparing parents ahead of time will make it easier for them to be clear on when to attend to their child’s emotions and when other strategies are needed.
It is also likely that the child frequently will not be able to engage in problem-solving with their parent in-the-moment. Calming down and using problem-solving are very difficult skills for children with ADHD to use when they are in the situation and having strong emotions. In fact, many adults have not yet mastered these skills! It is important that the parents have reasonable expectations and think of this as a gradual learning process.
(p. 198) Praise Self-Regulation
It is important for parents to praise any steps the child makes toward self-regulation. That is, the parent should try to catch any attempts their child makes at self-regulation by giving labeled praises. For example
■ “You are doing a great job calming down.”
■ “You had an awesome idea about how to fix this.”
■ “Thank you for using words to tell me how you’re feeling.”
■ “I really liked how you listened to my idea about how to make things better.”
■ “I am so proud of your flexibility and thinking of a plan B.”
■ “Great job sticking with it even though it was frustrating.”
Parents should avoid praising the child for not having a feeling; for example, they shouldn’t say things like, “Great job not getting angry” or “I like how you are not frustrated.” Rather, encourage parents to praise for positive coping actions like staying calm, being flexible, and persisting on a task.
Timing is another important consideration. Often, it is more useful to discuss an emotion and problem-solving or coping skills after the fact, at a time when the child is calm. In other words, it is helpful for parents to “strike while the iron is cold” when it comes to teaching. Provide an example like the following (choose a situation that is relevant for the child and family):
Yesterday you felt really angry when it was time to leave the park. I understand that you thought it was unfair because you hadn’t had your turn on the swing. Today when we go to the park, you may have to leave before you’ve had a chance to do everything you want to. How can we help it to go better today?
It is important that these talks are very brief, being mindful of the child’s attention span. It is OK that the child may not be able to stick with this conversation for very long. What’s important is that parents are providing repeated learning opportunities for the child each time they (p. 199) have these conversations (i.e., taking advantage of teachable moments). No matter the outcome of each talk, parents are showing the child that the parent is capable and willing to talk to the child about any negative feelings or problems that come up in the child’s life. By doing so, parents are building a strong connection with their child.
It can be very difficult for some parents to use the emotion coaching skills they learn in this module. Giving the parent a chance to practice in session can help them be more effective at home, and allowing parents to see how hard emotion coaching can be when things are calm (during role-play) can help them realize how little emotion coaching is probably happening naturally for the family. This role-play activity can be done with individual parents/families or in groups.
Ideas for Role-Plays
1. Ask the parent to describe positive emotions during a short play time.
2. Have the parent validate and tolerate unpleasant emotions during play (frustration with a toy or frustration when the parent does something they didn’t like in the play).
3. Use a situation like homework, dinner, bedtime, or sibling conflict so the parent can practice validating and tolerating the child’s unpleasant emotions in these situations. Ask the parent what the child does in the situation so you can act out the child’s expression of emotion.
Have the parent label their own emotions and use an emotion description such as frustration in traffic, sadness about a change or loss (that would be appropriate for child to hear about), or worry about making a mistake or being late. During the role-play, praise the parent frequently, validate the emotions they may have when trying emotion coaching (such as feeling uneasy, helpless, or unsure), and make sure to let parents know when they do something invalidating or move into problem-solving or fixing.
(p. 200) Home Practice
At the end of each session, distribute the Parent Module Summary and reinforce the fact that the information discussed today will now be practiced at home. Home practice for this module includes
For Emotion Coaching Home Practice
Encourage parents to spend some time noticing which activities elicit strong emotions in their child (Handout 9.1). Examples might include doing homework, completing household chores (e.g., folding laundry), building a challenging Lego, doing an intricate craft, striking out in baseball, or losing at a game (e.g., Sorry, Jenga, Candy Land, Uno). Ask parents to join their children for these activities over the next week to practice the emotion coaching skills: awareness, validating, tolerating, describing, and setting limits when appropriate (Handout 9.2). During this practice, remind parents to use their own emotion regulation skills (e.g., relaxation) to stay calm and serve as an effective emotion regulation model and coach for the child. They can also take opportunities to practice emotion labeling when they themselves are experiencing an emotion that is appropriate to share with the child (“I’m feeling disappointed that my plans were cancelled”) or to point out emotions for characters in books, shows, movies, or for other people. You can refer them to Handouts 9.1 and 9.2 for examples of emotions and how to respond.
■Raising An Emotionally Intelligent Child, by Gottman (1998).
■Meta-emotion: How Families Communicate Emotionally, by Gottman, Katz, and Hooven (2013).
■How to Talk So Kids Will Listen and Listen So Kids Will Talk, by Faber and Mazlish (2012).
■What to say to kids when nothing seems to work: A practical guide for parents and caregivers, by Lafrance and Miller (2020).