Beyond Behaviors

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.

As someone who has spent decades in pediatric practice watching children attempt to navigate an increasingly dysregulated world, I find Delahooke’s reframing both scientifically grounded and refreshingly humane. Chapter 1 lays out the central premise: challenging behaviors are not willful misdeeds; they are the body’s signal flares, generated when a child’s neurophysiology is overwhelmed. If we want to help them, we must address the physiology, not punish the flare.

Delahooke roots this argument in what she calls the “developmental iceberg.” Above the waterline lie observable behaviors, what we call tantrums, defiance, withdrawal, aggression. Below the surface lie the true drivers: sensory ractivity, autonomic threat responses, mismatches between demands and capacity, and unmet relational needs, lack of connection. Just like an iceberg, the small portion above the surface draws our attention, yet it’s the vast structure below, hidden from immediate view, that carries the real meaning.

Traditional behavioral models tend to focus entirely above the waterline, attempting to manipulate the visible outputs. The problem, she notes, is that an iceberg does not move because you chip away at its tip. Children don’t either. Everything below the waterline matters, yet, modern medicine does not look under the water frequently enough to make a meaningful difference in the child's mental health experiences.

It is critical to understand the value of looking beneath the surface before deciding whether a behavior even requires intervention. Many behaviors children display: movement patterns, fidgeting, pacing, or self-made rhythms, are adaptive strategies that support regulation or concentration. When adults misinterpret these as deficits or target them for correction, we risk disrupting the child’s natural attempts to stay organized and calm. Delahooke urges educators and parents to approach these behaviors with curiosity rather than reflexive modification. Especially in neurodivergent children, what appears odd or problematic may in fact be a vital regulatory tool.

Rather than viewing behaviors as intentional choices to be corrected, Delahooke aligns with affective neuroscience and Dr. Porges' polyvagal-informed developmental science. She highlights that the brain’s primary mandate is not learning, compliance, or meeting adult expectations. It is safety. When neural circuits detect threat, even subtly, the child’s capacity for social engagement and problem-solving evaporates. What we call “misbehavior” is often a survival strategy. This maybe misguided but it is active and directional. The directionality is a huge issue when it misaligns with a teacher's or a parent's wants/needs. This is the true place for relational struggle.

For clinicians and parents conditioned to think in terms of rewards, consequences, and compliance charts, this chapter can feel paradigm shifting. Yet Delahooke presents the shift not as ideology, but as physiology. She shows that the idea of “choosing” one's behavior presupposes a regulated nervous system, a luxury many struggling children may not have in the moment or ever depending on the chronicity of their lack of safety. In this sense, behavior is not a moral referendum.

It is a stress response. It is real.

And to the child, it is their life.

The Developmental Iceberg picture on page 17 crystallizes this concept visually. Behavioral challenges sit at the very top, but they are anchored to deeper layers: sensations processed in the brain and body, emotions, developmental skills, memories, thoughts, and ideas. These layers interact constantly, shaping how a child responds to stress, novelty, or interpersonal demands. By tracing a challenging behavior downward toward what the nervous system is experiencing rather than what the child appears to be choosing, we gain a far more accurate understanding of “why” the behavior is happening.

Where the chapter becomes especially powerful is in her call to reinterpret behavior through the lens of compassion. Not soft compassion or permissiveness, but a clinical compassion grounded in relational neuroscience. When a child’s nervous system is dysregulated, their higher cortical networks are offline. Attempts to reason, lecture, or enforce rigid behavioral expectations only widen the gap. The opportunity is not to correct, but to connect. Not to extinguish behavior, but to co-regulate the system generating it.

This is the most critical theme of the book: the behavior is not to be the focus of the parent or provider, it is merely a window into the dysregulated nervous system.

The focus needs to be the why the behavior is present and how to co-regulate with the child to provide a safe environment from which to find peace in the storm of emotions.

She challenges the long-standing tendency in education and medicine to categorize children: oppositional, resistant, inattentive, manipulative. These labels, Delahooke argues, are not descriptions of character but misinterpretations of stress physiology. A child described as “manipulative” is often one whose only available tools for securing safety are primitive and reactive. A child called “defiant” may simply be overwhelmed and unable to access cooperative circuitry, thus, in effect, stuck in an unhelpful behavior.

To an integrative pediatrician, this framing resonates with what we see across conditions—ADHD, anxiety, sensory disorders, developmental trauma, chronic inflammation. The body speaks before words arrive. When a child hits, hides, screams, or shuts down, the behavior is a manifestation of neurobiological distress. If we treat the action instead of the distress, we miss the child.

KEY: The chapter also acknowledges a painful truth: adults often misread children because we ourselves are dysregulated. We react to behaviors rather than respond to needs. Delahooke gently reminds us that our ability to serve as co-regulators hinges on our own state of nervous system balance. A parent or clinician operating from stress will inevitably default to control rather than connection. The invitation is to slow down, observe, and ask: What is this behavior protecting? What physiological state is driving it?

Dr. Delahooke ends with a fundamental reorientation: success with children who struggle comes not from tightening structure or increasing consequences, but from cultivating safety. Safety is not a slogan, it is a neurochemical state. When children experience safety in relationship, the brain begins to rewire. Flexibility increases. Learning becomes possible. Behavioral change emerges from within rather than being imposed from outside.

In the ecosystem of modern pediatrics, anxiety rising, sensory input overwhelming, developmental demands accelerating, this framework is not just kinder, it is more effective. Delahooke guides us away from surface-level behavioral management toward deep developmental support. She asks us to trade judgment for curiosity and efficiency for attunement.

Chapter 1 is a call to practice medicine and parenting with eyes tuned to the nervous system beneath the behavior. It is an invitation to meet children where their physiology actually lives. And ultimately, it is an example of what happens when development, neuroscience, and compassion converge: a clearer path toward helping children thrive.

This book is so good, thus, I will review many if not all chapters for you. This stuff is fundamental and required parental learning in my mind.

Dr. M