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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 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