Tag Archives: behavior

Dr. M’s SPA Newsletter Volume 16 Issue 4 – Relationships

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Literature Review:

A) “Establishment of the gut microbiome during early life is a complex process with lasting implications for an individual’s health. Several factors influence microbial assembly; however, breast-feeding is recognized as one of the most influential drivers of gut microbiome composition during infancy, with potential implications for function. Differences in gut microbial communities between breast-fed and formula-fed infants have been consistently observed and are hypothesized to partially mediate the relationships between breast-feeding and decreased risk for numerous communicable and noncommunicable diseases in early life. Despite decades of research on the gut microbiome of breast-fed infants, there are large scientific gaps in understanding how human milk has evolved to support microbial and immune development.” (Davis et. al. 2022)

Main Takeaways:

First 1000 days matter a lot for microbial and immune development: Infancy is a critical window when the gut microbiome is assembled and the immune system is learning to respond to microbes and external exposures. Patterns set early can ripple into infection risk, inflammatory diseases, and atopy later in life.

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 3 – Beyond Behaviors Chapter 4


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Chapter 4 of Beyond Behaviors is often read as a continuation of the neuroscience laid out in the first three chapters. That’s understandable, but it slightly misses the point. By the time Dr. Delahooke gets to Chapter 4, she’s largely done making the physiological argument. She now pivots to a far more practical and, frankly, more uncomfortable question: What does this mean we actually do as caregivers?

This chapter is less about how the nervous system works and more about how we work, how we observe, interpret, and respond to children in real time. It’s a chapter about attunement, not theory. About shifting from reflexive reactions to intentional caregiving. About learning to read the child in front of you, not the rulebook in your head.

The first major move of Chapter 4 is the insistence on personalized attunement, ditching the plural child. Or better yet, focused on the N of 1 child. There is no “average child” in her framework. There is only this child, with this nervous system, in this moment, in this space and time. How beautiful! Integrative Functional Medicine’s credo, treat the whole person as you find them and as they are biologically.

Attunement here is not sentimentality. It’s data gathering. Dr. Delahooke asks caregivers to become skilled observers of patterns rather than judges of behavior. What time of day does dysregulation tend to show up? After which transitions? After eating? After playing video games? In which environments? With which sensory demands? With which people? It is sleuthing the underwater potion of the iceberg of behavior.

Importantly, she pushes caregivers to stop assuming intent. The question is not “Why is my child doing this to me?” but “What is my child’s nervous system experiencing right now?” That single frame shift collapses an enormous amount of unnecessary conflict. It moves the adult from adversary to ally. It walks away from shame and blame towards love and support…..

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 1 – Beyond Behaviors Part 3, Mona Delahooke, PhD

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Chapter 3 – Individual Differences

Dr. Delahooke starts Chapter 3 by allowing Margaret Mead to remind us that each child is absolutely unique: “Always remember that you are absolutely unique. Just like everyone else.” This is more than a witty paradox, it is the hinge upon which all effective pediatric care swings. When we take individual differences seriously as neurobiological fact, we can finally stop confusing adaptive survival responses with defiance, stop labeling children as problems, and begin the real work of supporting the mind body systems that shape behavior from the inside out.

Let us review what we have learned in Beyond Behaviors so far – We are invited to descend below the waterline of the behavioral iceberg. What we see at the surface: the tantrum, withdrawal, rigidity, hyperactivity, the refusal to transition is merely a set of observable outputs from deeply personal internal variables. The sensory wiring, physiological states, immune triggers, thoughts, feelings, memories, and the child’s moment-to-moment sense of safety. Without diving into these subterranean layers, we risk treating smoke while ignoring the fire, which is the general state of current pediatric psychiatric medical therapeutics. We mostly treat the smoke. We don’t often ask about the fire. Her central thesis is simple, clinically robust, and profoundly humane:

Children behave according to the state of their nervous system, and their nervous system is shaped by individual biological, emotional, and sensory differences.

Once we understand this, behavior becomes not a moral test but a window into the child’s internal world…..

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 31 – Poly Vagal Theory, Stephen Porges, PhD

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I think that this is an important time to pause and relook at Polyvagal Theory before continuing with Beyond Behaviors.

Polyvagal Theory: Current Status, Clinical Applications, and Future Directions (Porges, S. 2025)

“Social behavior and the capacity to manage challenge are dependent on the neural regulation of physiological state.” S. Porges


When I dove into Stephen Porges’s 2025 review of the Polyvagal Theory (PVT), I felt like I’d stepped into a crossroads where neurobiology, clinical practice, trauma science, and human experience collide. This paper isn’t merely a summary of three decades of work (all of which I have read); it’s a spirited defense of a paradigm that’s been both celebrated (by me) and contested (by others). What follows is an honest appraisal of what the article teaches us, where it sparks real insight, and where it may fall short, especially through the lens of evidence-based medicine and developmental neurophysiology. (I also went deeper into his 2022 paper in Frontiers in Integrative Neuroscience for the biophysiology of the ANS)

At its heart, the article argues that the autonomic nervous system (ANS), through a set of hierarchically organized circuits centered on the vagus nerve, is not just a background player in stress and homeostasis, but a core regulator of social engagement, physiological flexibility, and behavior. Dr. Porges situates his theory as an alternative and expansion to classical views that treat sympathetic (fight/flight) and parasympathetic (rest/digest) branches as functional opposites. Instead, he proposes a three-component hierarchy: the ventral vagal complex (VVC) supporting social engagement, a mobilization circuit mediated by the sympathetic nervous system or fight or flight state, and a dorsal vagal circuit that facilitates shutdown or immobilization under extreme threat…..

Enjoy,
Dr. M

Dr. M’s Women and Children First Podcast #69 Repost – Stephen Porges, Ph.D. – Polyvagal Theory


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This week I sit down with Dr. Stephen Porges, a Distinguished University Scientist at Indiana University where he is the founding director of the Traumatic Stress Research Consortium. He is Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland.

He served as president of the Society for Psychophysiological Research and the Federation of Associations in Behavioral & Brain Sciences and is a former recipient of a National Institute of Mental Health Research Scientist Development Award. He has published more than 400 peer-reviewed papers across several disciplines including anesthesiology, biomedical engineering, critical care medicine, ergonomics, exercise physiology, gerontology, neurology, neuroscience, obstetrics, pediatrics, psychiatry, psychology, psychometrics, space medicine, and substance abuse. In 1994 he proposed the Polyvagal Theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological state in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric, and physical disorders.
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He is the author of multiple books on his Polyvagal Theory: including the Neurophysiological foundations of Emotions, Attachment, Communication, and Self-regulation, as well as Polyvagal Safety: Attachment, Communication, Self-Regulation. His newest book cowritten with his son is called Our Polyvagal World, How Safety and Trauma Change Us. Dr. Porges is the creator of a music-based intervention, the Safe and Sound Protocol ™ (SSP), which is used by therapists to improve social engagement, language processing, and state regulation, as well as to reduce hearing sensitivities.

This is such a fascinating conversation. He brings the worlds of psychiatry and anthropological physiology into union for us to understand the why of trauma reactions and the future unwinding that is now possible. This is a must listen to conversation if you know anyone with trauma history.

Please enjoy my conversation with Professor Porges,
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 30 – Beyond Behaviors Part 2, Mona Delahooke, PhD

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Review of Chapter 2 of Beyond Behaviors
by Mona Delahooke, PhD


“Social behavior and the capacity to manage challenge are dependent on the neural regulation of physiological state.” S. Porges

Top Down or Bottom Up?

“Before We Respond to Behavior, We Need to Understand Its Origin.”

With a deceptively simple observation, Dr. Delahooke reshapes the entire field of behavioral intervention: children’s actions come from two very different places in the brain. Some behaviors are top-down, intentional, planned, thoughtful. But many, especially the ones adults find most perplexing, arise bottom-up from stress responses generated by the body’s autonomic nervous system. We often think of this state in terms of fight or flight, however, it is not that simplistic. It is truly any significant response to the outside environment that leads to a neuroceptive reaction that is not governed by the neocortex, top down. If we don’t distinguish the source, our interventions are guesswork at best and often counterproductive at worst.

She illustrates this through a case, a child whose impulsive, disruptive behaviors were treated as failures of will or desire. School teachers and teams repeatedly urged him to “use his words,” as though language were a faucet he simply refused to turn on. What no one stopped to ask was the foundational question: Was his nervous system regulated enough to access language at all? Was he gated at the level of the amygdala blocking the ability to use his mind consciously and even have the opportunity to respond to a meaningful request? Is he capable of the ask, not in terms of willingness, but in terms of physiological access to the skill itself?
….. and more

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 29 – Beyond Behaviors, Mona Delahooke, PhD


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Review of Chapter 1 of Beyond Behaviors
by Mona Delahooke, PhD


“When we see a behavior that is problematic or confusing, the first question we should ask isn’t “How do we get rid of it?” but rather “What is this telling us about the child?” (MD 2019)


The opening chapter sets the stage for a quiet revolution in how we understand children who struggle. Dr. Mona Delahooke invites us to take a step back from the culturally and medically ingrained belief that children’s outward actions are reliable windows into their inner intentions – or what they really mean and want based on their actions. Instead, she asks, nay implores, us to adopt a more biologically accurate, compassionate, and clinically effective lens from which to view each child as they present themselves. Their behavior is communication from a developing nervous system striving for regulation and often stuck somewhere else, either frozen or in flight…..
Dr. M

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