Beyond Behaviors Chapter 3

I just reposted my interview with Dr. Stephen Porges on the podcast as a timely relisten. Because Beyond Behaviors makes a lot more sense when the frame is right.

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.

 

Chapter 3 begins with the physical body, the earliest and most primal driver of behavior and the first interpreter of experience to the exposome (outside world). Basic sensations such as hunger, thirst, fatigue, pain, constipation, diarrhea, chronic inflammation, sleep cycles, blood glucose fluctuations, endocrine signals, muscular/bone injury, acute illness, reactions to foods: like gluten(celiac disease), synthetic dyes in foods, allergies to peanuts and so much more; they all influence a child’s ability to regulate.

This is not a revolutionary idea to anyone who has cared for children, especially those with ASD. A toddler with low blood sugar becomes irritable, impulsive, and tearful. A child with reflux or constipation becomes rigid, aggressive, or avoidant especially when they cannot verbally communicate. Sleep deprivation is a direct cause of mood instability, bottom up reactionary behavior with tanrums and other unpleasant childhood behavior. The biology doesn’t disappear just because the behavior looks “psychological.” There is a defined reason that requires looking below the waterline.

Drs. Greenspan and Wieder were among the first to suggest that early sensory sensitivities could shape developmental pathways toward other conditions, including anxiety. Their work showed that children with certain sensory profiles were more likely to struggle with emotional regulation, which we now understand is closely tied to behavioral control. Research further indicates that children who are sensory over-reactive are more prone to experiencing anxiety, with these challenges often extending to family distress and disruption. (Delahooke page 70)

The takeaway is one pediatricians know well but society often forgets:

Biological states drive behavioral states.

Ignoring biology and punishing behavior is simply misapplied effort.

The chapter then moves into sensory processing, the great missing link in most behavioral interpretations. Every child makes sense of the world through sensory channels: auditory, visual, tactile (touch), olfactory (smell), gustatory (taste), vestibular (movement), proprioceptive (body-in-space), and interoceptive (internal sensations).

These systems form the brain’s earliest operating system, offering a way to organize inputs, and respond in a way that helps us understand the world and function within it. To explore the world for safety.

Before language, before logic, before conscious thought, there is sensation. This rapid, continuous process allows us to learn, move, adapt, and connect with others. When sensory processing breaks down, the result is Sensory Processing Disorder (SPD), where the brain either overreacts or underreacts to sensory input, often leading to overwhelm, distress, or missed cues, patterns commonly seen in autism and ADHD.

There is an underscored powerful truth: sensory processing is not a niche occupational therapy concept; it is a core determinant of emotional regulation and behavior. Yet most graduate programs, pediatric residencies, and mental health trainings treat it as peripheral or even ignore/discount its reality. This creates a dangerous bias toward top-down explanations (“he’s choosing this behavior,” “she needs better coping skills”) even when the nervous system is clearly dysregulated from the bottom up. Children may over- or under-react in any sensory domain. And in many cases this is normal for them and not disruptive.

The child who instinctively rips off “scratchy” shirts may actually be experiencing nociceptive-level discomfort from textures. Neuroception perceiving abnormality that is disquieting. The child who melts down in loud environments is not “sensitive” in true and important sense of the term. They are in a physiologic fight-or-flight response. The child who can’t sit still may be vestibularly dysregulated rather than oppositional.

The chapter’s clinical pearl is this: sensory triggers are interpreted by the nervous system as either cues of safety or cues of threat, and behavior follows accordingly.

The vignette in the chapter crystallizes this principle beautifully. Here is a young boy whose unpredictable, explosive behavior baffles his parents. He wakes irritable, resists clothing, cries unexpectedly, and erupts during transitions.

The root cause? A severe, painful rash that had resolved physically yet left a sensory memory in its wake. A pseudo PTSD response pattern ensued. This is epigenetic reprogramming of his stress response to touch from an early childhood severe viral rash. It is a way for the system to encode for risk through experience. On occasion that encoding is pathological in its outcome. This is well demonstrated in Dr. Moshe Szyf's work in nature versus nurture stress responses.

(The book contains many case examples that are worth the full read.)

His nervous system had learned, preconsciously, that certain textures meant pain. The body stores this kind of information, it keeps the score of experience. Sensory memories can become “encoded” through neural pathways that outlast the original injury. Thus, even after the rash healed, the sensory system responded to clothing as if danger still existed. Think of the child that limps days after the injury has subsided and you cannot illicit pain on exam. This is memory, not active disease. This happens all the time. The worse the experience the longer the memory response often is. 

This is bottom-up processing in its purest form: the brain reacts before cognition gets a vote.

The lesson is essential for clinicians and parents alike: when a child’s behaviors look extreme, exaggerated, or inexplicable, we must ask, What sensory, bodily, or emotional memory is being activated? Punishing a survival response is both ineffective and deeply unfair.

Every sensory experience is encoded: sensation + perception + emotion = behavior.

A negative sensory trigger (e.g., loud noise, painful texture, bright light) pairs with negative emotional tone (fear, distress, overwhelm). Then perception attempts to make sense and overlays the response. Over time, behaviors emerge not because the child is misbehaving, but because their brain is working to avoid dysregulation.

Delahooke argues that many children labeled as oppositional or defiant are actually executing adaptive defense strategies. Their behaviors are not the problem; they are the nervous system’s solution. It is predominantly non cognitive. They may (rare)or may not (often) have any ability to perceive and respond top down.

On pages 73-78, she has checklists for over, under responsive children as well as a sensory craving style.

The chapter then widens to include emotional and cognitive individual differences. Feelings: The Limbic Lens. This is the place that top down therapeutic interventions can root in for success. Thoughts: Cognitive Biases in Childhood. She gives examples of children revealing their cognitive drivers. One child grappling with negative self-talk and perfectionism, spirals because his thoughts generate physiological arousal. Cognitive-behavioral support helps him name and revise these interpretations. The lesson is not that thinking fixes everything. Rather: thoughts are one layer among many, and interventions must match the layer where the dysregulation originates.

A Team Approach: Complexity Requires Collaboration

Dr. Delahooke closes the chapter by naming the ecological complexity of childhood behavior. No single discipline holds all the pieces. Pediatricians often miss sensory nuance. Psychologists overlook gut dysfunction. Occupational therapists may miss trauma. Educators rarely see immune triggers. Parents miss neurobiological patterns not from ignorance, but because they are living inside the intensity in real time.

When individual differences span body, sensation, emotion, thought, and memory, the child’s care team must be equally multidimensional. This is not luxury medicine, it is accurate medicine. Yet in today’s “treat ’em and street ’em” medical model, it remains uncommon. In practice, this level of care functions as luxury medicine, available mainly to families who can afford time, coordination, and complexity. As uncomfortable as that reality is to acknowledge, it remains reality.

Nowhere is this failure of integration more visible than in PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, the most dramatic illustration of the mind–body connection. Sudden-onset obsessive compulsions, emotional lability, attention difficulties, handwriting deterioration, motor tics, and sleep disruption are hallmark features. These are not behavioral choices; they are pathogen-triggered autoimmune and neuroinflammatory processes hijacking a child’s regulatory capacity. A child in inflammatory overdrive cannot “try harder” at self-control any more than a child with asthma can simply “breathe harder.”

When providers are unfamiliar with the underlying pathophysiology, these children are often mislabeled as psychiatric and sent down a purely behavioral pathway. What they need instead is medical recognition and treatment, often antibiotics, targeted nutritional and microbiome support, therapy, and time. This represents a clear fork in the road: recognition and treatment, or psychiatric labeling followed by deterioration.

This chapter quietly argues for a paradigm shift:

Stop treating behavior in isolation.

Start treating the child’s complete neurophysiological context.

Dr. M