In November, ACAMH will host a two-part short course Assessment Tools and Interventions for Emotion (Dys)Regulation: Practical Approaches.
We caught up with the course leader – Dr. Alessio Bellato, Lecturer in Children and Young People’s Mental Health at the University of Southampton – about the topic itself, his career, and his hopes for the event.
What first got you interested in emotion dysregulation, and how did you come to specialise in it?
When I started working as a psychologist, I quickly realised that how we learn at university – a lecture on ADHD, then a lecture on autism, then on mood disorders, and so on – doesn’t reflect what it’s actually like working with children, young people, and families. The reality is that child and adolescent mental health is never that neatly categorised.
I became particularly interested in the very high co-occurrence of ADHD and autism, which led me into doing a PhD and becoming a researcher, in areas including emotion regulation.
Who do you hope will attend this short course?
This course is designed for a genuinely broad audience: clinicians, psychologists, psychiatrists, and allied health professionals, but also teachers, educational psychologists, SENCOs, and social workers. Parents could certainly also attend and find it useful.
The case examples we use will reflect both clinical and educational settings, and I’ll make it useful for practitioners working in lower-resource environments too, including internationally.
When a child is struggling to regulate their emotions, what is the key to a good assessment – and what practitioners most commonly miss?
Too often, people miss the ‘why’, when assessment focuses on how often a child throws a tantrum or how severe it is, without asking why it’s actually happening. What problem is the child trying to solve? In which situations does it occur? Is it happening at home, at school, or both? These are fundamental questions.
I’d also point to the physical dimension. Emotions aren’t just abstract feelings – they are bodily sensations. Some children experience emotions so intensely, so physically, that their body is essentially overwhelmed. And yet when we assess emotion dysregulation, we rarely ask parents what they see in their child’s facial expressions or posture during a meltdown.
You’ll talk in the short course about choosing and personalising interventions – what are the most important factors in this?
This is a field that is evolving fast – research is exploding, which is exciting. But there are so many interventions available that it can be difficult to identify which is right for your setting, your resources and your population. My job in this short course is to try to cut through that: to map what’s available in an unbiased way, and help practitioners make evidence-informed decisions based on their own context.
I feel strongly about personalisation and adaptation. In clinical practice, you never apply an intervention exactly as it is written in a manual. You take one piece of this, one piece of that, and adapt it to the child in front of you. If the child isn’t on board, or the family isn’t, it simply won’t work.
Interventions for emotion dysregulation tend to focus either on the child, or on the parent, or on the environment – but in reality, all three matter. The skill is understanding, through good assessment, which mechanisms are most in need of support, and then selecting and adapting accordingly. My goal for this short course is not to hand people a recipe, but to give them the understanding and confidence to make those judgments themselves.
There’s growing focus on school attendance and issues like Emotionally Based School Avoidance (EBSA). How does emotion dysregulation fit into that picture?
When a child reaches a point where they’d rather stay home alone than go to school – even though their friends are there, even though they want to learn – that tells us something significant is happening. In many cases, school has simply become too much: too unpredictable, too crowded, too overwhelming for a nervous system that is already struggling to regulate.
It’s also important to say this isn’t a UK-only issue. Children across the world are facing similar challenges. Some of that reflects real changes – school has changed, the world children inhabit is faster and more complex than it was a generation ago. Some of it reflects the fact that we are now more aware and more willing to talk about it. Either way, the question we need to keep asking is: why? What is the child’s emotion dysregulation telling us about what they need?
What do you hope people will take away from this short course?
What I hope people take away is not a checklist, but a framework – the ability to look at a child who is struggling and ask the right questions, choose the most appropriate tools, and adapt their approach based on what they actually find. The evidence base in this area is moving quickly, and my aim is to give people the understanding to keep pace with it, rather than just telling them what to do today.
Find more content on emotion dysregulation and other child and adolescent mental health topics on ACAMH Learn, our completely free, online learning resource.