What is a Developmental Social Pragmatic (DSP) intervention?
A Developmental Social Pragmatic (DSP) intervention integrates principles from developmental psychology, transactional models of language development, and social pragmatic models of language acquisition. Developmental psychology follows a typical developmental trajectory where in language development, you target joint attention, engagement, and reciprocal interactions before considering targeting words or putting words together.
In transactional models of language development, we think about not just looking at the child in isolation, but looking at the parent-child interaction or two children interacting. What are both parties doing to support and enhance the child’s communication? And finally, the social pragmatic model focuses more on the child’s intent, why the child is communicating, and how the child is using language in meaningful ways instead of looking at grammar, for instance.
The social pragmatic models are interested in the child using meaningful language and whether or not they are able to use their language in different contexts, with different people, and for different purposes. This is about communication: how the child uses gestures, facial expressions and body movements in meaningful and appropriate ways within their interactions to fit their context before you start mapping language on to it. Language develops through these foundational capacities.
What does a DSP intervention entail?
Amanda and her colleague had a specific method to search publications about interventions that targeted communication in preschoolers with autism. They noticed that there were many publications that described their interventions as DSP although some would not actually meet the criteria of a DSP intervention. They wanted to have a really good understanding of what DSP interventions entail.
Once they identified publications that claimed to use DSP interventions, they wanted to determine if they met the criteria of DSP interventions: a typical developmental trajectory that aligns with developmental psychology, looking at the dyad of parent-child interactions which aligns with the transactional model of language development, and whether or not they were using the social pragmatic elements that focus on meaning and functional language use, rather than on grammatical structures and words.
Categorizing interventions as DSP or not
If you click on the link to the publication here, you will find that Table 1 outlines the criteria for which interventions qualify for DSP. It includes the list of interventions that publications identified as being DSP. One of the criteria is whether or not the intervention occurs in a naturalistic setting, for instance. Amanda says it’s important to note that they added ‘use of explicit or indirect prompts’ as a criterion because the focus of DSP is about reading the child’s intent and using language in functional ways.
This is fundamentally different than prompting a child to use expected outcomes. For instance, saying “A dog goes ___” or “Say please!” gives the child only one correct way to respond versus scaffoldingto support the child’s spontaneous generation. In this case, if you say “Ooo, look at the doggie! Woof woof!” the child could respond by saying “Woof woof!” or by moaning if they don’t like dogs, or pushing the representation of the dog away. This would be more in line with DSP interventions.
Integrating Behavioural and Developmental Approaches
There’s a push towards integrating behavioural and developmental models as there’s more and more support for using developmental models, particularly with younger children, where you have to work on foundational capacities before you can work on language, Amanda says. So, it’s very important to think about what pieces of developmental models to bring into behavioural models. If we are thinking about what elements of different interventions really support children, then we need to dissect what explicit prompting is doing for communincation and language development.
Do we want to use explicit prompting to support early language development or use more indirect prompts? Amanda says it would be interesting to look at the core features of DSP interventions to figure out which of their core strategies we should be thinking about if we are looking at the recent Naturalistic Developmental Behavioural Interventions (NDBI)models. For example, should we be responding to child’s intent regardless of the goal? DSP interventions will respond to the child’s intent regardless of the goal which NDBI strategies typically do not do.
Evidence for DSP interventions
Table 1 helps compare apples to apples showing which interventions meet the criteria for the category of DSP. Later in the paper they look at what evidence exists for the DSP interventions. They found that there was compelling evidence that DSP interventions support early foundational communication capacities such as joint attention, social referencing, initiation and reciprocity, for example.
The findings for the child’s language post-intervention were interesting. With the typical standardized language tests used to evaluate the language, they did not find consistent positive findings for the child’s language post-intervention, but these tests test things that DSP interventions don’t target, such as grammar, etc. so it wasn’t surprising.
However, in the studies that evaluated the child’s language post-intervention using natural outcome measures that closely models what actually happens at home or school, such as natural language samples or natural video-taped interactions, positive results were found. This makes sense as language would be generalized when learned in natural settings.
The review also looked at what parents were being coached on that was connected to positive outcomes. Parent responsiveness drove improvements in language as well as synchronous behaviour: really joining in with the child’s interest. As a profressional, Amanda finds this informative in that she can help support parents to read the less noticable intentions that the child is communicating and show them how to join in with the child’s interests.
Amanda says that besides examining the features of DSP models that are effective to combine with behavioural approaches like the current wave of NDBIs, future research should also test the mechanisms of the interventions to see what is driving the change for the child so we can better individualize the intervention for each child to support their communication development.
Thank you to Amanda Binns for taking the time to discuss the systematic review paper. Please download your copy at the free access website. If you found this post helpful or informative, please consider sharing it on Facebook or Twitter and feel free to add comments or relevant experiences in the Comments section below.
Until next time, here’s to affecting autism through play!
Clinical psychologist and DIR Expert Training Leader, Ira Glovinskyreturns this week to discuss factors affecting self-regulation, the development of it, and a number of things we can do about it. This follows our discussion from last time on The Foundation for Regulation and highlights some points Dr. Glovinsky made during a presentation at the STAR Institute in Colorado. So, what is regulation? What factors affect our child’s regulation and what can we do about it? Let’s see what Dr. Glovinsky has to say…
Focusing on Regulation with Dr. Ira Glovinsky - YouTube
As we’ve discussed with Dr. Glovinsky before, when our children get dysregulated, we tend to focus on their behaviour, which causes us to be more rigid in how we deal with situations. When someone’s having difficulty regulating themselves, it’s their physiology, not them being ‘difficult’ or ‘misbehaving’. We need to focus on the Relationship to remedy the situation. We need to look at how we focus on regulation. What do care providers and parents do? We have to include the adults who are with the children in the moment when we discuss regulation.
There are rudimentary ways they can regulate when they are overstimulated. They may avert gaze, close their eyes, hiccup, or sneeze. But they need caregivers around them to develop the capacity for regulation.
Self-regulation is not a category, it’s a dimension. You can’t just look at the child, but have to consider the care providers and the context.
Dr. Ira Glovinsky
So self-regulation develops dynamically. It’s really dependent on the adults with the infants, along with the context, to develop inner self-regulation. As we think about treatment and interventions, we can’t partial out the adults who are with the children, and we can’t partial out the context. It all has to be considered.
Regulation is either when there’s not enough going on internally and externally, and we need to increase the amount of stimulation in order to activate the child into an optimal zone of arousal. When a child is over-aroused, we try to lower that stimulation level into that same optimal zone of arousal, or ‘window of tolerance’. A main characteristic of what we mean by regulation is a person being in a state of ‘alert inactivity’: we’re attentive to our surroundings and we’re able to take in stimulation, process stimulation, and problem-solve.
Regulation is an individual difference
Self-regulation is not a category, it’s a dimension. You can’t just look at the child, but have to consider the care providers and the context.
Dr. Ira Glovinsky
Dr. Glovinsky did a study looking at children who presented with A.D.D. symptoms. The results were interesting. When they looked at brain activity, there were three distinct groups that emerged.
The first group of kids had the classic definition of A.D.D. with hyperactivity. These kids were bouncing off the walls. A second group could be diagnosed with ADD without the hyperactivity. These kids were quiet but internally and distracted, but not very active.
But the third group had activity levels that were very high but they had wonderful attention levels. They cannot function well without the high level of stimulation that activates their movements. They were very regulated kids, but just needed more activity to regulate.
Regulation is a dimension, not a category. We have to be aware of this when intervening and focus on the Individual differencesof the children–and of the parents, too–and individualize the recommendations.
There are some people who regulate by being in a state of alert activity. Ironically, these kids often get a diagnosis of hyperactivity or attention deficit disorder (ADD).
Dr. Ira Glovinsky
Different cultures have different regulating strategies as well. The prescription is going to be different for every single child and family with regard to regulation.
Gaining an awareness of inner sensations
Dr. Glovinsky also points out that many kids are often misdiagnosed. One factor that contributes to this is interoception, which we referred to in our last podcast with him. We also need to pay attention to a child’s interoceptive system: the sensations going on inside their bodies. Some children and adults don’t have awareness of the experiences going on inside their bodies, which has strong implications for regulation.
Dr. Glovinsky told us about interventions he’s heard of from clients where they ask the child to “Catch your angry feelings at the very beginning by taking deep breaths“, but Dr. Glovinsky learned that some children don’t have the feeling of anger until the moment they explodes. When they are told to use these techniques, they sound good, but they don’t tend to work. Other children tell Dr. Glovinsky that they register feelings in their bodies but they don’t know what to label them.
We need to figure out what’s going on on the inside, and what’s going on on the outside. Some children and adolescents don’t even know when they are hungry or tired. If you don’t have those inner experiences, how do you regulate yourself? Kids have to learn about their bodies first, Dr. Glovinsky believes. Then they can attach those sensations that they have an awareness of. Then we can talk about emotions, then we can talk about what to do about it.
We’ve discussed mentalization with Dr. Glovinsky briefly before and today Dr. Glovinsky talked about how it can factor in to regulation. Mentalization is about holding concepts in our mind, which requires the capacity for symbolic thinking. When you can hold a symbol in your mind, you can use this to self-regulate, such as when a child understands that his mother has left the house, but will return later.
Dr. Glovinsky stresses that when adults see this overwhelmed behaviour in a child, we want to watch, wait, wonder and be curious about it rather than rushing in and focusing on the particular task in the moment. See the child as being dysregulated: their heart rate and blood pressure has increased and their breathing is shallow and rapid, so you want to focus on the child breathing from their belly and slowing down. Focus on helping the child get regulated rather than teaching them a lesson, or getting compliance.
Focusing on behaviour creates a ‘reactivity dance’ where a parent moves in which increases the child’s reactivity, which increases the parent’s reactivity, which causes someone to explode before they can regulate. Rather, let’s focus on a ‘we’ project where the adult is supportive, nurturing and helpful which helps develop secure attachments, synchrony and attunement, creating a sense of safety and security which has longterm effects, rather than being punitive and ‘teaching the child a lesson’ in the moment.
Dr. Glovinsky finds that often, parents use disciplinary methods that their own parents used on them, which they believe will, in turn, work on their child. But your child is not you, and what may have worked for you won’t work for your child, Dr. Glovinsky says. Support, scaffolding, and help rather than reactivity can help more kids than not–even with kids who have been referred for very serious mood disorders and being ‘out of control’.
There isn’t a toolbox
I provided Dr. Glovinsky with an example or my son’s latest dysregulated behaviour of dumping bins of toys or clearing off book shelves. He responded that there isn’t a toolbox and every child is different. If you function from the toolbox technique, by the time you use the toolbox, the child shifts and is into something else. We have to think of us instead of tools. We have to feel comfortable and regulated to help the child.
What does this mean? ‘Dr. G’ gave us some examples. A child in his office started dumping toy bins and Dr. Glovinsky felt that if he tried to stop it, he was going to get a tantrum, so Dr. Glovinsky joined him and dumped another toy bin then said “Oh no, what are we going to do?” He and the boy were laughing together. Dr. Glovinsky suggested to the boy that he would clean up the space toys and asked if the child would clean up the others. It worked.
Another child was dumping bins and Dr. Glovinsky asked the child to hold out the emptied bin and said he wanted to see if he could throw the toy into the box. Within a short period of time, they were in a turn-taking game with him, the boy, and the boy’s mother, throwing the toys into the box. As a classroom teacher years ago, Dr. Glovinsky had a child who kept falling out of his chair, which would set off the other kids. So Dr. Glovinsky went over and asked the child how he did that and got on the floor crawling. Then he got all the kids crawling to get their ‘sillies’ out.
The main point
Can you feel comfortable being with a child who is dysregulated and feel that it’s going to be OK? Can you think to yourself:
“What can I do with this child at this time of day that is playful rather than rigid to get the child on my side to work together?“
This is our challenge as the adult with a dysregulated child.
So in his examples above, Dr. Glovinsky did a few very important things:
He JOINED the child. He was PLAYFUL and CALM. He was regulated. He got a CONNECTION with the child.
It’s more about understanding the child’s capacity in that minute, even though the child cognitively knows, if he were in a calmer moment, that he shouldn’t behave that way. Later on when everyone is calm you can reflect by normalizing the situation, “You had a hard time stopping yourself from dumping those toys.“
Dr. Glovinsky points out the importance of being PRESENT in the moment as well. You can be happily playing trains or struggling putting on a coat while in a hurry to get out the door. He suggests not to think positively or negatively about the situation you’re in, but simply that this is what you’re doing now, in this moment. You have to be just as creative in the ‘putting-on-the-coat’ activity as in the playing trains activity.
Dr. Glovinsky might say “Oooo! Oooo! Let me help you put on the coat!” and put the arm’s coat on the child’s leg (being silly/using nonsense) or put his own coat on inside out to help the child SHIFT. Taking the time for a little humour can be helpful. Would you rather have a 40-minute tantrum or take 10 minutes to help get the coat on with a happy child?
What we CAN do
I pointed out that my son would get dysregulated if I put his coat on the wrong way. He might yell, “No, Mama! It goes here!” Dr. Glovinsky said that he might respond with, “Oh can you show me?” I usually say, “Oh silly Mama! What was I thinking?” As the adults, we need to work on our reactions to our children and why they don’t work. Our work is not working with our child in the moment, but realizing that we get dysregulated very quickly when our child does these things.
Parents vary in the amount of patience they have with their children’s behaviour. And parents say, “I can’t. I don’t have time. I’m tired. I’m rushed.” Practice when you actually HAVE time in Floortime play with your child, so when it happens in the moment, you feel a little more prepared to handle it. We can do wonderful training in calm moments, but we need to act in harder moments, so in Floortime, you can practice tolerating frustration playfully.
It can be overwhelming to think about many things at once. We can start with baby steps. We can pick something to focus on for the next two weeks, for example. Figure out, “What can I do to calm myself down when I notice myself getting dysregulated when my child gets dysregulated?” Then focus on how to co-regulate with your child.
In the moments when you do have time to think, reflect. Think about this morning when you lost your patience, and wonder where it came from. Dr. Glovinsky says there’s a history of how we react to problems. It’s related to our history and as adults and parents we need to think about our histories. After explosions of emotion or tantrums, going over what happened and thinking about what we could do next time is helpful.
As parents, we often don’t get to see how other parents react during dysregulation in the privacy of their own homes. Video taping helps us reflect on the outcome of how we were in the moment. We can see how we reacted and the effect it had on the child, and how the child reacts. We might pick up things we did not notice about ourselves.
Dr. Glovinsky says that he has heard from children that after they finally calmed down the teacher or parent wanted to talk about what happened and that puts them right back in the crummy mood. Dr. Glovinsky suggests that when reflecting about what happened and the child eventually getting regulated, instead ask “How did you do that? You are so calm now but you weren’t before. How did you do that?” This plants a seed to talk about and develop strengths, and to build the capacity to self-regulate in the future.
Keep in mind what's important
How can I nurture the Relationship: A sense of safety and trust, and being able to rest in the attachment.
Thank you to Dr. Glovinsky for taking the time to speak with us! If you enjoyed this podcast and found it helpful, please consider sharing it on Facebook or Twitter and feel free to offer Comments in the section below. Next time, Speech and Language Pathologist, Amanda Binns will return to discuss her latest publication, a review of Developmental Social Pragmatic (DSP) approaches to autism.
Until next time, here’s to affecting autism through play!
Occupational therapist, DIR Expert Training Leader, owner of A Total Approach in Glen Mills, PA and the new Maude Le Roux Academy, Maude returns this week to discuss a topic that is important to consider when planning an approach to support the person you care about: Remediation versus accommodation. Please enjoy the video or audio podcast, and/or the blog content below!
Remediation vs. Accommodation with Maude Le Roux - YouTube
In the world of developmental difference and different approaches and supports, we know that the brain has plasticity which allows for change and growth. We have different strategies that we use in different modalities, including DIR/Floortime, and we want to know how much of the strategies that we are using accommodate the system versus remediating. People in the industry confuse accommodation for remediation.
Accommodation means that I’m doing a bypass around the child’s challenge and using something external to accommodate for what the child requires. Remediation is working on that pathway that is not in place and mobilizing it to get into place, knowing that if we keep accommodating, we might not get to remediation. But doesn’t remediation imply that something is wrong with my child and aren’t we learning now that neurodiversity is about differences and not about aiming for neurotypicality with our children?
Developmental Delay or Developmental Difference?
Maude believes that the term developmental delay has a significant meaning and it need not be negative like the way the word ‘behaviour’ is considered negative, when in fact everything we do is behaviour–positive or negative. When we look at Dr. Greenspan‘s six functional emotional developmental capacitiesthat children move through, there are age ranges associated with those stages. If a child is not meeting those milestones at that age range, Maude says it is not negative to say there is a developmental delay–it is what it is.
You can say that a child has a developmental delay. He’s not on par with his peers. But he doesn’t have to be. It’s just a measurement for Maude to target so she’s not working in the dark, has objectivity, and can plan in an objective way. But in the therapy room, she is always focused on connecting by joining the child.
DIR/Floortime is about connection and empathy. Along the spectrum of approaches it is among, if not the most, client-centered, relational-based approach that is nothing if not respectful.
We need to ask “What do we remediate? How do we remediate? Why do we remediate? Why do I want to remediate?” In the DIR approach we want to promote the child becoming more communicative, more relational, more a part of what’s going on around him, and using his natural curiosity and intelligence by opening these capacities up for them, Maude says. In order to do this, we are comparing him with developmental milestones–however, we are not harping on the child not being there. Maude believes that semantics can take the attention away from things we should be working on to support and promote development.
In the Individual Education Plan (IEP) that a child in special education has, there is a section for specialized instruction, and within that there are instructions for different roles such as the teacher, the psychologist, the occupational therapist, etc. These instructions are accommodating for what we have found in the evaluation that the child may have an individual difference with. An accommodation might be that instead of sitting in a chair, the child can sit on a therapy ball.
Many children have prescribed sensory diets where they are provided accommodations to allow for their sensory differences, but Maude says that doesn’t change the brain. She wants to work on his brain in a way so that he’s not needing the accommodation that he is needing right now. Maude stresses that this is not about changing who the child is or remediating you as a person. What we want to remediate is the brain pathways that disallow you from showing who you are.
When Maude works with a child she is not thinking about whether or not he is autistic. She is thinking about their developmental ability and how to mobilize this child so he will problem-solve, so he won’t avoid the very things he’s going to need in life.
If a child is banging his head against the wall, Maude wants to remediate the pathway that stops him from having to bang his head and get him out of hurting himself, biting himself, scratching himself, saying to himself, “I’m dumb. I don’t know what I’m doing. I don’t belong.” But if the child’s system is giving him such a hard time just adapting to his environment and he’s really having a tough time with it, he’s going to avoid the very things he might enjoy!
What does remediation look like?
When considering remediation, Maude considers how the visual system is operating, how the auditory system is operating, are they are working together, are they correlating with the vestibular system, how does the child use touch to engage in their world, what does the child avoid, and what does the child seek?
She then wants to switch that around so that the child will not feel an intense need for something beyond the learning that the child might want to do but can’t. You can see from the child’s behaviours when they are frustrated at not being able to do something they want to.
But you can’t do any of this without assessment and performance standards that you can measure yourself against. Maude developed a Functional Developmental Autism Assessment Protocolthat we discussed in a past podcast that looks at all of these pieces. Maude says that many current assessments conclude that a child is impulsive, rigid, or controlling but they never explain why. Nobody pops out of the womb and says “I’m going to be a behaviour issue.”
When we talk about remediation, we aren’t saying remediate the person or remediate the autism, but remediate some of the individual differences that are stopping you from being your true self.
Maude Le Roux
Maude says there’s an environmental consideration, a consideration of nature/nurture, pieces of relationship, pieces of sensory, pieces of individual differences that have to come together. And if we don’t analyse every step of this developmental continuum–where these pieces have fallen in place, and maybe where they have not fallen in place then we may be beating around the bush instead of going through the bush and building the tunnel. If I do it I can feel successful and I’ll do it again. If I don’t feel successful, I’ll avoid it like the plague.
Maude starts by working on Foundational stage which includes regulation, typically seen in the first two years of life. Next they work on Organization on top of the foundation, which is your timing, sequencing, and integration pieces, and then comes the Executive stage. Her assessment looks at all the pieces then they determine what is holding him back the most? Development hasn’t changed. What we expect from development has changed, but development hasn’t changed. We all follow the path of development.
You’re building the pieces through the child’s wanting to be with you. That’s true Floortime. And as soon as you get that want, you have intrinsic motivation which is like bells going off inside of the brain. And when the brain fires, that’s remediation. The nervous system is firing in a way that causes growth to happen.
What remediation is really about is if you can respectfully harness the core of a child so that the child will follow the developmental trajectory himself because intrinsic motivation has been captured and you’re working on neural system activity to make the nervous system fire so we have a changed system, but not a changed little guy or girl.
Thank you to Maude for taking the time to share her expertise in the area of remediation. For more information about Maude’s services please visit A Total Approach or the new Maude Le Roux Academy. Please feel free to comment, ask questions, or share your experiences below and please consider sharing this post on Facebook or Twitter.
Until next time, here’s to affecting autism through play!
DIR Expert Training Leader, Clinical Psychologist, and co-author of Respecting Autism, Dr. Gil Tippy, returns this week to introduce his latest project, a developmental transition service called Dirty Hands Developmental Alliance in Sonoma County, California which is appropriate developmental support for post high school. Dirty Hands Developmental Alliance offers an ongoing opportunity to foster developmental growth and preparation for increasing independence. Please enjoy the video or audio podcast.
Dirty Hands Developmental Alliance - YouTube
Dirty Hands Developmental Alliance with Dr. Gil Tippy
Whatever developmental model you like, what’s important to Dr. Tippy is to think developmentally, meaning that first a child does this thing, then they do this thing, then they do this thing and these things build on each other. We all drop developmentally under stress, but people make progress. Our students with developmental differences are not on the same time scale as neurotypical students and they may not follow the same path. Having a developmental difference or challenge means that the window stays open, and you can continue to develop.
The mission of the Dirty Hands Developmental Alliance is to create an appropriate developmental space to help members of the ASD community bring their full value to society. On small, family-owned organic farms, in economically challenged communities, while providing nutritious foods in food deserts, with the support of at-risk teens and young adults, Dirty Hands will foster appropriate developmental growth, while supporting each individual as they explore their thoughts, feelings, interests and desires, at their own pace.
Dr. Tippy says that there is plenty of time to work on developmental challenges. Second, they want to be socially responsible. It is important to society, to the business owners, to the workers, and to the consumers. Organic farmers are a great choice because they are more socially responsible than corporate farms. While there are exceptions, such as Jean Martin Fortier in Quebec, the average organic farmer is a small farm under assault and struggling financially. So the goal at Dirty Hands is to continue education in the context of helping a group that needed help.
How it works
Dirty Hands model takes place on an already established organic farm, renting space where they will provide an educational setting for continued developmental growth, offering DIR/Floortime support, occupational therapy, physical therapy, speech and language services, and mental health support.
Dirty Hands may also offer work on the farm. Everyday they will come together as a group about planning, being able to think abstractly and moving forward developmentally amongst a diverse group with wide neurodiverse profiles in the context of having really great clinical support.
They may be putting together community-supported agricultural baskets for consumer subscriptions and they will be the group that distributes that to the next group of people. And since many lower income people living in a food desert do not have access to organic produce, Dirty Hands will offer store fronts in these compromised areas.
While it may require some resources from our society up front, in the long run getting someone to where they are fully functioning and independent individuals, living the lives that they want to live, from the pieces that grew within them, is much more cost-effective and much more valuable to the society than not actually supporting them through their whole development and then getting them to a place where they’re still in a position where individuals still need a tremendous amount of support.
Dr. Gil Tippy
Dirty Hands participants will be supporting the farm, getting good developmental transition services, and supporting people in nutritional need in the community. In addition, they will bring in nutritionists to hold cooking classes for consumers supporting a depressed economic zone that the Dirty Hands participants will be involved in.
Flipping the script on autism
Neurotypical people need this group of neurodiverse people to be in our society. Dirty Hands is designed to flip the script on developmental challenges in general. We are going to come to the aid of society and begin to contribute to some of the problems out there. The Dirty Hands logo, designed by Milkshake Studios in Brooklyn, features the rolling hills of Sonoma County .. that’s the group that’s contributing to the benefit of our community, rather than thinking about the autism community only as a group always asking for support.
Dr. Tippy has noticed that very often in transition programs there is an end product. There are many cupcake bakeries, for instance, and the focus is to make the cupcake. This means that the individuals in the transition program are brought through the steps to complete a product. But with Dirty Hands, they don’t want this to be a requirement. In DIR/Floortime, the work is allowing the space–holding space and time for a person–to let the individual realize that they have thoughts, and that those thoughts can be acted on, and that you need time to process this. You cannot do this if a cupcake has to be made.
At Dirty Hands, the farmers will already have the production planned. If they can offer help, that may happen, but it won’t be necessary. Dr. Tippy also wanted to make sure that these services are offered in an environment that avoids environmental toxins like pesticides and herbicides, so organic farms made sense.
Dirty Hands will depend on some publicly funded streams, but their program is designed to have zero overhead. It’s only the modest rent of the buildings that already exist on the organic farms. The bulk of the cost will be for salaries of the clinical support. Dr. Tippy will ensure that these supports are great, all DIR-trained and sensory-integration-trained occupational therapists, for example. But there will only be about 8 participants at each site. Costs will also depend on where the sites are located as others around the country are showing interest in offering similar programming.
An official diagnosis of Autistm Spectrum Disorder is not required. Do you come with a developmental challenge that stopped you from making the progress that you have wanted to make in your life and will a developmental way of working be of benefit to you? If that is the case, then you are in. Since they are a not-for-profit and there will be charitable support, there will be a sliding scale for tuition costs. It will be a day program to start, with thoughts going forward of offering integrative housing options in the future.
You can get more information about Dirty Hands Developmental Alliance on their website where you can sign up for updates by email. You can also reach Dr. Gil Tippy at his website and check out his developmental blog here. His materials are all developmental, open source resources if you want to set up an alliance in your area. Just contact Dr. Tippy! They hope that when people see the Dirty Hands logo, they’ll realize this is that group doing good work supporting society.
Thank you to Dr. Gil Tippy for taking the time to introduce Dirty Hands Developmental Alliance to us and we hope that we can help spread the word about this wonderful new model for developmental transition. If you enjoyed this post, please consider sharing it on Facebook or Twitter and/or enter your constructive comments, ideas, thoughts, or experiences below in the Comments section.
Until next time… here’s to affecting autism through play!
Mental health counsellor and DIR Expert Training Leader, Gene Christian joins us from Spokane, Washington this week to share how adults with extreme developmental differences can benefit from DIR/Floortime. I was introduced to Gene in ICDL‘s Floortime for Adults course. His description of how to bring out the early social-emotional capacitieswas really enlightening to my experience having only previously considered Floortime with children. I hope you’ll tune in to hear from Gene’s wisdom and experience.
Gene began studying under Dr. Stanley Greenspan in 2001. Previously he had been using positive behavioural supportwith adults who had behavioural issues and they adapted DIR/Floortime in a respectful way. The adults he worked with were unable to show intent in a way that was clear to their caregivers. Dr. Greenspan always emphasized that without the ability to interact with other people and co-regulate with others, we are subject to inner emotions that we surely don’t understand and can’t control, which is what people call behaviour problems.
To facilitate development, Gene’s focus is on the first four Functional Emotional Developmental Capacities (FEDCs) whether it’s a baby or a 45-year-old man. Today Gene’s focus is about adults who are isolated. They might have been in an institutional setting for years and never had a real meaningful interaction with anyone as caregivers come and go to feed or change them, etc. These are people who are locked in their own sensory processing systems. From what he has seen, this approach really helps people feel better about their lives and their environments because they begin to use Relationships.
Gene gives a fantastic description of the functional emotional developmental capacities describing how at engagement, a typically developing baby “zaps into the mother’s eyes“. This is pre-verbal gestural signalling and non-verbal communication that sensory differences can prevent from taking place. Autistic individuals may not zap in and make that critical connection that starts forming the sense of self. So how can we make that first connection? Gene says it is always about following that person’s lead.
Gene describes how emotional isolation really creates turbulent emotions and the person lives locked in a world which results in what we tend to call problem behaviour. But in the engagement period there’s two parties to a relationship which moves into intent. The primary caregiver responds to the baby as much as the baby responds to the primary caregiver, in typical development. You don’t get regulated without using other people when you’re learning initially, then when we’re older we learn our own ways to self-regulate. Gradually we become intentional because we delight in the power of being an active participant in what’s going on.
As we move through engagement and back-and-forth interactions, we reach the fourth capacity where all of these things we have developed in the first three capacities helps us be able to stop when we see signals from others indicating our actions might not be socially appropriate in that moment. This fourth capacity is about practicing the ability to solve problems with others, having a sensitivity to other people, empathizing with others through emotional signalling, and developing a sense of self as we solve social problems when we come up against the reality principle, Gene says.
We have to have the ability to conceptualize ourselves and the others around us, which we can’t do well without the thorough fourth capacity which means interacting in a calm fashion through frustration and conflict and all the things the world throws at us. These skills flower in the fifth capacitywhen we symbolize in our own head ‘me’ and ‘you’ and other things in the world and we then tie together ideas in the sixth capacity.
The biggest mistake we make with people in these first four capacities is trying to get them to do things that are not yet in their repetoire that they’re not developmentally prepared for yet.
We can counter the sense of isolation using Floortime with non-verbal adults who have extreme developmental differences. Severe processing issues prevent them from entering these interactions so we want to work on this, which is hard when they struggle with regulation. But we can begin by mirroring what they do, being mildly playful, and creating little problems appropriate to where the client is developmentally. For example, if I’m slapping hands with somebody I might miss their hand one time entirely. This is the level of obstruction and nothing more.
Connection can be slow, but once you’re consistently able to engage in 10 circles of communication in a row on a regular basis, it seems that people can experience real shared regulation, engagement and beyond. Our goal with circles of communication is to get the client to open the circles, or initiation of back-and-forth interactions. Too frequently we expect more of people than they’re able to do developmentally and we tend to want to focus on organizational, analytical, linguistically-based thinking when these folks aren’t in that world yet. They’re still in their own inner world.
When we work on getting the back-and-forth capacity, we of course want the client to initiate but even if we clap with them, we might stick our hand in between their clap. They might get really frustrated and if so, we respect that and back off. But they may get really playful and close that circle by moving their hands up higher, or grabbing our hand. This is where we are really challenged in our DIR world. How do we get people who are struggling in the first four capacities to begin to open circles.
The affinity of a relationship can often pull a client in to interactions, but it’s really hard to get administrators to understand this because this is all ‘pre-verbal stuff’. We don’t remember navigating the first four capacities ourselves because we don’t have the symbolic strength to label and file them yet at that developmental level.
Gene Christian on IQ Tests
“I really question the idea of even beginning to think about the cognitive evaluation of people who are still struggling with the first four capacities. They’re unable yet to respond to questions, they’re not able to go through all of the little pieces of any kind of IQ test and so we jump to the understanding that, “Oops! Cognvitively they’re really challenged.” Well, they’re really challenged by their processing system but we really don’t understand what’s going on inside. They might have a whole sense of how the world functions and their potential is something we just don’t yet know.“
Once engagement begins to happen, the person will naturally move in to being intentional: Realizing that they can impact the behaviour of other people with their own behaviour.
Fully complete as you are
Gene refers to Martin Buber’s “I Thou” way: “You are a really important person, you intrigue me and I want to learn what I can about you.” and about Maslow’s seeing people as being whole, complete, and perfect in and of itself. “The only way as folks will really change is if we treat them as being fully complete as they are.“
Greenspan always talked about giving people control and respecting their boundaries. The adults we’re discussing have been handed demands of various kinds that they really don’t understand day in and day out. Getting past that and realizing they’re safe and that you’re not going to interfere with their plan, which might just be a regulatory motor plan (such as a stim), builds the trust. You’re not there to make them do anything.
Following their timeline
One of the phrases Gene often has to counter is, “I really want to move him to the next capacity.” Gene says, “No. You are not going to move him to the next capacity. You’re going to be with him and engage in the Floortime and watch him do his own moving at his own pace.”
Developing a sense of self through our interaction with others
Without navigating those first four capacities effectively, the emotional issues that we didn’t resolve in the fourth capacity come back to haunt us. How many of you have seen a person get angry and just leave a conversation because they can’t do it anymore? We want to see a person be able to navigate all of these emotions while continuing to interact. None of us truly masters the fourth capacity, but it really leads into the fifth capacity, our sense of self. When we realize that we all develop and go through these stages, putting ourselves in their shoes, we can really begin to try to understand what another person goes through.
The fourth capacity is about learning to become a human being in a pre-verbal way. it’s in the fourth capacity that we learn to not walk up to a group of people and start talking about our favourite thing without checking in on them. Checking in on them is a pre-verbal thing that we have. You might walk up to a group and want to make a joke, but then you can access that something serious is going on so you decide not to bring it up because it wouldn’t be appropriate.
We really learn to get very sophisticated when we’re navigating the fourth capacity in terms of our emotions when we interact and engage with other people. That’s when we really learn to modulate. Negative pre-verbal signalling is getting mad and melting down when we enter the fourth capacity. But as we begin to develop the ability to sense it, we begin to develop more control over how we modulate our expressions of emotion, and that is really a fourth capacity function. It is about compromise.
Decrease in behavioural outbursts with Floortime
Gene shared with us very vivid examples of the types of problem behaviours he has witnessed from adults trapped in their own sensory systems and how these behaviours decreased with a DIR approach because the adults moved from dysregulation to intent when they were finally able to communicate with others in the pre-verbal ways described above. Please see the video podcast for the graphical representations of his team’s data.
Thank you to Gene Christian for taking the time to discuss his presentation about moving adults from dysregulation to intent using DIR/Floortime. If you have any comments, questions or stories to share about today’s podcast, please consider putting them in the Comments section below. Also please consider sharing this post on Facebook or Twitter and telling a friend who could benefit from Gene Christian’s experiences.
Until next time… here’s to affecting autism through play!
Following up from last week’s podcastabout supporting the development of self-regulation, this week’s podcast takes it a few steps further into adolescence where we have a slew of new developmental processes to support, especially when our children begin to experience puberty. Dave Nelson returns this week to shed some light on this topic.
Dave Nelson is a Licensed Professional Counselor (LPC), a DIR Expert Training Leader, and the Executive Administrative Director of The Community Schoolin Atlanta, Georgia. He’s with us this week to discuss puberty and how we can best support our kids in a respectful way using a developmental approach. He shares with us a fantastic presentation I attended in the Floortime for Adults course this past fall through the Interdisciplinary Council on Development and Learning (ICDL). Dave’s presentation made me feel equipped to handle whatever comes. I hope you appreciate it and find it as helpful as I did.
Dave says that the Developmental, Individual differences, Relationship-based (DIR) construct and Floortime approach give us a way to think about and approach issues because we’re not going to have the answer to every problem that comes up, nor will we necessarily be able to plan in advance. This developmental framework really helps us start to think about issues in an anticipatory way rather than being reactive. It helps us put things in context and help the people we’re supporting think about their development in a more ‘big picture’ kind of way. Take a listen!
Dave says that as we are supporting people with challenges who are becoming adults and as we’re getting better at understanding the importance of self-advocacy and identity for the people we support, sexual identity becomes a really important part of that. Dave lays out three core ideas that guide this presentation:
How an understanding of an individual’s unique differences (how our bodies experience the world, our family influences) and functional emotional developmental capacities (how easily and comfortably we are able to engage with others, how interactive we are, how good our ability to engage in social problem-solving and logical thinking with others is) affect the sexual development and education processes, which happens even when the rest of our systems are not maturing at the same rate.
How to reduce the risk of individuals being either victims or perpetrators of sexual mistreatment. People can inadvertently become perpetrators and not realize it while being a victim at the same time.
How to help caregivers and support team members become effective supports to an individual’s sexual development. It’s quite challenging because we don’t always want to talk about it and the individual may not be comfortable with getting support.
A Challenging Topic
Differing moralities make this topic challenging for us. But also, for those we support, discussing these ideas requires complex language and an ability to know oneself. Some find it challenging to connect their physical feelings to ideas. You have to know what you feel and then control the behaviours that come from those feelings. If you struggle with self-reflection or complex ideas, it makes it challenging to address in a sophisticated way.
Sexuality is an essential part of being human, so it’s important to support an individual’s ability to understand their feelings and experience relationships as much as possible. Dave says as we get better at understanding that we are helping people to become the people that they can be, not the people we want them to be, then that does demand that we support people in expressing themselves sexually even if we’re not always entirely comfortable with how that expression might look.
Sensory profilesIt makes sense that if your sensory processing system is extreme in some way (under- or over-reactive) that affects how your sexuality develops: what kinds of sensations you seek out or avoid, and how you try to meet those particular needs. For people who have a lot of variety in their reactivity, they might attempt to stimulate themselves too aggressively and hurt themselves physically, etc. Physical touch, hand-holding and kissing are all affected by our sensory profiles as people move into adult relationships.
Motor planning and sequencingHow people move in personal space, how you touch somebody or be close to somebody, how those behaviours might be interpreted as aggressive or welcome and friendly, and reading and processing cues such as reading rapid non-verbal signalling from others all affect relationship-building. Somebody struggling to read those cues accurately and rapidly will find it difficult developing relationships that then allow for healthy expression of sexuality when it gets to that.
The DIR Framework
Dave says that the DIR model does well is it helps us stay focused on always strengthening the capacities, even if we are having to manage behaviour in some restrictive ways. Really what we’re trying to do is help people get better at managing their own behaviour because at some point people are going to be out in the world trying to manage their own experience and that’s what’s going to help them not only be safe and not get into trouble, but also to have meaningful, successful relationships.
The DIR framework reminds us, Dave continues, of strengthening someone’s developmental capacities so that over time they can begin to self-regulate and self-manage. That is a moral imperative: to help people be as autonomous as they can be. It’s also what allows people to be as independent as they can be from caregivers, because if you can get to the point where someone can manage their own emotions and sensations, and self-manage their behaviours, that’s going to be a lot more successful.
When people are struggling in their ability to relate, communicate, think and problem-solve, those aspects will really affect our relationship development and sexuality expression. If we are very rule-based and concrete, black-and-white or aren’t good social problem-solvers, it will be harder to connect and flirt with people, to meet and develop potentially romantic relationships with people, and then to figure out how to express ourselves in gradually more physically overt ways.
Dave says this is as much about someone’s ability to develop relationshipsas it is to express themselves sexually. It’s really about how people connect and relate to each other. The better we are at maintaining relationships, the more context there will be for the sexuality pieces coming into play. Rather than managing a set of raging hormones, we’re using their ability to form relationships to help them with their experiences and feelings.
There are three phases of the intervention. It’s what you do before the crisis happens. It’s what you do to support developmental growth to help and support people. There’s what you need to do in the heat of the moment when the difficult thing is happening, and then what do you do after-the-fact to debrief, reflect, and recover. Please listen to the podcast or watch the video podcast at the 36-minute mark to hear Dave’s example of situations he’s encountered and how they intervened.
Before Provide a lot of play-based Floortime to help the person get better at reading social cues and beginning to manage impulses. You can do this by playing a tickling, hide-and-seek, or peek-a-boo game works on this by having them want something, but not being able to get it right away, i.e., stop and start games.
During The trick is to set firm limits while remaining compassionate and connected, which is hard when we are feeling personally threatened or when the behaviour is disruptive. You can set firm limits if you believe that the person you’re supporting is a good person. You can stop someone from touching or staring, but try to frame that for them so you can validate the feeling they are having while not shaming them. You’re normalizing the feelings, while alerting them to the reaction of others. “Wow, it seems like you really like this person, and they seem to feel really uncomfortable about you touching them because you didn’t ask them.“
These are the ideas you want to convey with your tone, affect, and body language, which can be challenging if language is limited. As much as possible, you also want to begin a conversation to fulfill those needs. “It seems like you really like this person. Let’s talk with them about how you can get to know them.” You will also need to be flexible about having these conversations and repeating themover and over again.
It’s very important to not get fatigued, judgmental, or despondent that the person is not learning quickly enough. It’s better to take the position that they are learning, but it’s hard to control these powerful feelings. You can also provide a lot of co-ed peer interaction practice. Please see the video podcast for Dave’s helpful slide describing the suggested strategies.
After You want to make sure that you’re having an ongoing discussion that’s focused on the positive and celebrates this person’s interest in other people and celebrates their desire to be connecting to other people then focuses on healthy ways to do this. You might need to continue to closely monitor and support that.
You want to keep the individual at the centre of the process, and that can be a challenge when you’re not all on the same page.
Dave provided us a nice example of how our young adults can become victims or perpetrators at the 46-minute mark. The intervention involves helping the person develop secure, peer relationships with the opposite sex in a safe community, helping the person get more physically comfortable which involved helping the person better understand and advocate for their sensory needs, and generally supporting self-confidence and ego-development.
You can also make sure you’re non-judgmental and be supportive of what they are doing and give them information to be safe, whether it was about safe sex or helping them navigate what might be going on with other people. It helped make the supporters seen as a useful resource. You can also debrief a lot about what might have happened focusing on what went well rather than things that may have gone wrong. You can also use a past crisis as a talking point for discussing the ideas of romantic relationships.
Setting up a supportive team that can communicate in an inclusive and respectful way is important. Everyone on the team needs to communicate regularly so everyone can work from the same story to avoid confusing the person by sending mixed messages. This can be achieved by looking at the big picture and focus on what everyone agrees upon: shared goals of safety, autonomy, and legality.
Dave suggests that the most important thing people can do in a school setting is to have as many people develop trusting, secure relationships with the individual as possible because the more the young person trusts the people they are around, the easier it’s going to be to manage behaviour. It’s very important to avoid shame. So when people are engaging in behaviour that’s not public and should be private, you need to try to create privacy so they see the need for privacy, and label that behaviour as private time since it’s very difficult to physically control behaviour.
It’s important that staff work with the parents to support the child in helping them have their needs met at home if they are uncomfortable at home and are instead engaging in these behaviours at school. It’s also about helping the person realize how others perceive them. It might be that the person hears it makes other people uncomfortable, but is not yet able to manage the behaviour. The longterm goal is to help the person regulate the behaviour later.
Getting them to just stop won’t help them to self-control the behaviour later. This is not about condoning or not condoning the behaviour. It’s about–practically–how are we going to create the most self control the most respectfully and the most quickly as we can. We’re supporting people that don’t fit into the middle part of the bell curve.
Dave Nelson, The Community School
Thank you to Dave Nelson for taking the time to share this wonderful presentation with us! If you found Dave’s presentation helpful, informative and useful, please consider sharing this post on Facebook or Twitter! If you have anything to add, question, or an experience to share, please consider leaving a Comment below.
Until next time… here’s to affecting autism through play!
Amanda Binns has worked with the Developmental, Individual differences, Relationship-based (DIR) modelfor a number of years now and was one of the speech and language pathologists in the study at York Universitythat gained Floortime so much attention in Canada in 2012. Her latest co-authored publication aims to bring a framework to speech and language pathologists (SLPs) to not only understand self-regulation, but to provide strategies that allow them to incorporate self-regulation into their work. This publication is also very helpful to other professionals and parents as well.
Amanda has seen the DIR modelhelp support all children she’s worked with and during her years of work, the term self-regulation seemed to only be a concept discussed in the developmental community. It has since become more recognized, even appearing as a category on school report cards. However, how self-regulation is defined differs greatly, as pointed out by Jeremy Burman in his co-authored paper with Christopher Green and Stuart Shanker. Amanda wanted to take a look at this, and put SLPs on the same page about how they define self-regulation and use it to support communication.
The three authors looked at the goals of self-regulation. It helps children attend to and learn from the social interactions that they’re engaged in, which is so important to the development of communication. Self-regulation helps children work towards achieving academic and personal goals. It also helps to develop empathy and acting in socially responsible and caring ways. They kept all of these ideas in mind in developing the framework. But they also wanted the readers to understand how self-regulation develops, so that the framework makes sense.
Children’s ability to attain a state of regulation is integral to attending, engaging, and learning from their environment.
Self-regulation develops through co-regulated interactions. This is backed up by a large body of empirical research. In order to self-regulate (recognize, monitor, and manage your internal stress levels, emotions, etc.) you need to have executive functions which develops much later. Children’s pre-frontal cortex doesn’t develop until adolescence so we need to start with co-regulation (how people regulate each other’s behaviour).
When we first start co-regulating children, the adult takes on the bulk of the work. It’s not about what you say. The child picks up on the tone of your voice, the intonation you use, and it doesn’t even matter what you’re saying as much as how you’re saying. When we say “It’s ok“, we are diminishing a child’s reality. We really mean “I want you to be ok.” In order to co-regulate, we want to be attunedto the child’s level of stress. Similar to Self-Reg, the paper sees stress as impacting systems integral to regulation. Eunice Lee discussed with ushow we want to be proactive and look for the signs of dysregulation. We want to pick up on the stress before we hit the tipping point.
It’s much easier to co-regulate at that moment rather than waiting until the child is completely alarmed. We also need to check in on our own states so that we remain regulated ourselves. In the publication, Figure 1 outlines the paper’s framework for how to think about supporting a child’s self-regulation as just described. There are a number of other strategies listed in the paper in Table 2. It’s a dance of trial and error to help the child feel safe and regulated, especially when children cannot communicate their stressors to us. As the child becomes more engaged in the co-regulated interactions, co-regulation becomes more balanced towards socially-shared interactions.
Walking Through an Example
Amanda gives an example of visiting a child in a classroom setting. She might have a report from an occupational therapist that says the child has sensory sensitivities. She would start by observing the child in different contexts: at school, one-on-one, and at recess, for example. Next, she’d start to apply some of the strategies. She might work on quieting the environment for the child, and think about how staff are supporting the child’s interactions.
The child might be more dysregulated during math, a very cognitively taxing time, for example. So Amanda might suggest using simplified language or visuals to help the child understand the concepts being taught. Before moving on to the next step, she always wants to make sure the child is developmentally readyfor the next step, which involves executive functioning and meta-cognitive skills. The end of the publication features a few very helpful case examples of applying the framework.
A Developmental Approach
Amanda’s example highlights the developmental approach. I pointed out that many people might think of an SLP working on articulation and speech production, but she supports the development of communication as a whole. Even when working on speech production, though, Amanda focuses on the child being able to generalize what they learn. The child needs to have the meta-cognitive ability to reflect on what they learn in the speech and language session in order to generalize pronouncing “th“, for example.
For example, does the child recognize what it feels like to put their tongue between their teeth and to notice if they are doing it or not in a given moment? Working on supporting self-regulation at this level is a higher level where the SLP can then scaffoldto support foundational skills. At this higher level Amanda would collaborate with the child to co-construct goals, checking in with their learning goals, asking what they want to work on next, when the child would like to work on the goal (at recess, in the classroom, etc.), and reflecting on what worked best and why, which helps them develop self-awareness that will allow them to carry over their skills to other situations. If the child is not there yet, we need to focus on the early social-emotional development as described here and here.
The speech-language pathologist’s role in supporting the development of self-regulation: A review and tutorial
Amanda V.Binns, Lynda R.Hutchinson, and Janis Oram Cardy
If you have any questions or comments for Amanda, you can reach her via the contact on the publication link. Thank you to Amanda Binns for taking the time to discuss the helpful and informative, reader-friendly publication with us and we hope you enjoyed hearing, watching and/or reading about it, and that you will use the framework and useful tables as a helpful guide yourself. Please share this podcast on Facebook and Twitter and leave us a related comment, question, or experience below.
Until next time, here’s to affecting autism through play!
Dr. Glovinsky wanted to create this video series because of the many educators in the Fielding graduate program in the U.S. and internationally who kept bringing up over and over again that there are very young preschool age and kindergarten children in the classroom who are really not ready for group participation because they really haven’t mastered the foundation skills of regulation in individual parent-child environments. Coming into a preschool, the expectation is that they will be able to function in a group setting and they don’t have the skills to do it.
The teachers are saying that in their training programs they’re really not getting the tools they require to be able to work with these kids. They have lots of coursework, but when they’re confronted with dealing with a classroom situation, they are quickly overwhelmed. At a conference in Amsterdam, Dr. Glovinsky heard that they’re experiencing the same things in Europe: “What do we do with dysregulated kids?” So he decided to concentrate on developing a program at his Center that would hit on the critical areas that are necessary to provide the foundation for regulation.
We've covered the topic of foundation skills before:
In the Developmental, Individual differences, Relationship-based (DIR) model, we talk about the six core functional emotional developmental capacities (FEDC’s). Dr. Glovinsky says that any one of those levels can be an umbrella term. If you take the first one which is Self-regulation, for example, you can think about attention and calming, but what’s the process that a parent or a teacher has to go through to get there?
Dr. Glovinsky referred to work of Myron Hofer at Columbia University who found that ‘attachment’ is an umbrella term and there are hidden regulators that help form attachment. You can take each of these component parts and look at them individually, and then when you put them together you come up with attachment.
Working with mothers and very young preschoolers between ages 3 and 5, it hit Dr. Glovinsky that there are tools that an ‘ordinary good enough mother’ uses with her baby that may still be necessary with older children due to the enormous variations in individual differencesin children. He began to look at what these component parts were and identified them with parents in the office. He calls them ‘balloons’. When they identified one of these balloons he worked with a parent psycho-educationally so the parent understood the concept on a visceral level.
Targeting Educators and Caregivers
Recall from our podcast with Dr. Stuart Shankerthat he discussed the process of targeting educators with the process of Self-Reg in order to help them have a visceral sense of what Self-Reg is before they could apply it to their students. Presenting the theory and having them understand it all cognitively had not worked. Similarly, Dr. Glovinsky shares that his video series is for educators and parents because you can only work on these capacities with children to the extent that you can do it yourselves.
The visceral sense of what it feels like
“I have a feeling for this concept” was the goal. Dr. Glovinsky had the mother and the child come into the office and the mother would work on this part with the child. What he began to see is that when they worked on these processes, they had some really good outcomes. He gave the example of a 5-year-old boy who had a severe attention problem and in his attention with his mother, the back-and-forth just wasn’t there. One morning in his office the boy was talking about the toys and his mother was not really focused on him so the boy looked up at his mother and said, “Mom when we’re talking to each other, you’re supposed to pay attention to me!” Dr. Glovinsky says he had a visceral sense of what attention is supposed to feel like.
Dr. Glovinsky began to look at these visceral processes that are vital to the infant-parent-toddler relationship. He was interested in what was most important to focus on in interactions, particularly with dysregulated kids. They need adults who will move in when they are dysregulated, rather than deal with it behaviourally, who will support and scaffold the child, and work on developing a relationshipwith the child. This is a critical piece that’s been missing.
With the autism spectrum, we have a wide range of kids who are presenting behaviours that Dr. Glovinsky puts into this category. With the DIR approach, many of them can make significant strong, powerful gains in treatment when we focus on these processes and when parents are aware that this is something that they need to work on with their child because it will make a difference.
Young children need adults who will move in when they are dysregulated, rather than deal with it behaviourally.
Dr. Ira Glovinsky
The First Video
Dr. Glovinsky’s first video can be seen on his Center’s Facebook page. The video describes some critical components in the parent-child relationship. He sees Attention and orienting towards each other as the critical first component. If you develop the capacity for attention, it’s feeling the attention on a visceral level rather than a cognitive level. Your body feels you are really attending to each other and this leads to another component, Attunement. It’s being able to develop the capacity to be able to recognize a feeling in another person and get a sense to feel like what it feels like to be in another person’s shoes. (See the Theory of Mindpodcast with Maude Le Roux.)
When you feel that this is what my partner in this interaction may be feeling, then you can develop the Synchrony. This is the idea that we are moving and flowing together at the same pace like a table tennis game where I serve the ball at a particular speed and then the ball is in the other person’s lap and that person can hit the ball back faster or slower than I served it. What I have to decide to do is get into a back and forth at a pace that is comfortable for both of us. In order to collaborate we have to flow together. When people are not in ‘synch’ together, they feel it. You can feel being pushed or pulled off balance by the other person’s pace or tempo and that’s not being in synch. “I want to flow with you so we feel comfortable with each other” is important.
The next component is Contingency which means that when I say or do something, your response is connected to what I did or said. Dr. Glovinsky gave us an example that if he says to me, “Good morning“, I might say “Good morning“. If I say “Don’t say that to me!” that’s not contingent. Or if I said, “Ooo, look out the window. There are birds flying around that tree!” that’s not contingent. You want to look at how you are relating in that back and forth.
What you find that in early infancy is that in the time frame between the mother and the child, the ‘back and forth’ is very close together. As babies get older and get into toddlerhood, that time frame between back and forth isn’t the same anymore. It enables all of us to develop a sense of a differentiation from one another. It’s that “I know that you are doing this and I am doing this and now I know the difference between me and you“. The idea of beginning to form my identity different from your identity comes from contingency not being as close together.
Marking We want to remember an experience, and for you to remember this experience as being very important, one might say “Wow, that’s great!” after a toddler does something. That’s marking that behaviour. The receiver gets the message that that’s an important thing that just happened between us and I want to store that in my memory system. Those processes really form the component parts in the development of a healthy relationship. Dr. Glovinsky says that children showing emotional dysregulation need more of that input than kids who are developing the capacity to regulate and relate.
Co-regulation is really in the interaction. I’m regulating me but I’m also regulating you by how you’re going to respond back to me. On the receiving end, you’re regulating you, but how you respond to me is co-regulating me. In a sense what we do is it’s no longer you and me, but it’s ‘we’. Dr. Glovinsky wants that to come across to a child.
Attachment is feeling safe in a relationship with a parent. The above components define secure attachment versus insecure or avoidant attachments.
As parents today, we’re so distracted with so little time at home, and then when we are at home we’re looking at our cell phones. I asked Dr. Glovinsky about Attention and Marking, saying that Marking isn’t really marking if you’re saying “That’s great!” while you’re looking at the cell phone, not really paying attention nor attuned to your child. He agreed and mentioned that he recently saw a new word ‘technoference’, defined as the interference that all of us get by focusing on our iPads, cell phones and computers which gets in the way of the development of healthy relationships. We can’t be attuned nor in synch with someone in a healthy relationship if we are looking at screens instead of interacting.
The 9th capacity in the DIR model is Self-reflection. In the mental health field there’s a real strong movement, particularly with people who are working with families, infants and doing home visiting, to have people endorsed in reflective practice and supervision. Outside of the mental health field, this reflective thinking is much more scattered although there are some movements toward it in speech & language and hearing associations and we are seeing more in the area of occupational therapy.
In the area of parenting there are some people who are developing programs where they’re teaching parents to ‘hold the baby in mind’ which relates to teaching the caregivers how to be reflective, Dr. Glovinsky says. This involves reflections such as, “Gee why do you think that Joey just did what he did?” It causes the parent to not just focus on what they’re going to do to change the behaviour, but trying to understand the behaviour. That can be tricky for a lot of parents who just want to get their child to behave. It’s hard to make that shift to ‘why’ when they might think that it doesn’t matter why because the child must behave.
Self-reflection is really hard to do when you’re in red brain and triggered by your child’s behavioural outbursts, though. Dr. Glovinsky referenced Psychoanalyst Selma Fraiberg’s workin the field of infant mental health where she refers to ‘ghosts in the nursery’. That is, how we respond to our children is not only dependent upon what they do, but on our own histories with similar experiences. Each of us will respond differently to our child’s behaviour, which has something to do with our own memories and unconscious experiences from when we were young and how our parents related to us. We may not be aware of it at all, but our responses are not isolated responses. They have something to do with where we came from.
To reflect on an experience rather than react to an experience will always be challenging, and it’s important to recognize it as a first step.
All of us come into the world with our own biological and physiological baggage and when we come into the world we immediately meet these big people who have their own biological and physiological packages, so we have to look at the goodness of fit. Does my biological physiological package fit with yours? They don’t have to match. What’s your approach to a new situation? Some of us approach, some withdraw. How long does it take us to adapt? Adaptability is another temperamental variable. You may have a high activity level and I may have a low activity level, but I might be a person who really appreciates a person with a high activity level, so it doesn’t mean it’s a bad match. It’s about the goodness of fit.
Dr. Glovinsky also considers the physiology. When a child is misbehaving, we see what that child does rather than focusing on the child’s increased heart rate or blood pressure, or that they’re breathing really fast. That has to be addressed initially before you can expect the child to regulate. Also, does the child understand your language? Can they keep up with the pace of your language? Does the child have the capacity to pretend? Can they use their imagination? It’s a wonderful way to learn about and navigate the world. We need to help parents, teachers, and children to celebrate imaginative play because it’s hooked up with moods, feelings in the moment, and wanting to share joy with others. “I want to use my imagination with you” gets us into Relationship.
Thank you to Dr. Glovinsky for taking the time to speak with us! Over the next few months, Dr. Glovinsky plans to continue with the video series and we hope to speak with him periodically going forward. If you enjoyed this podcast and found it helpful, please consider sharing it on Facebook or Twitter and feel free to offer Comments in the section below. Have a very happy holiday season and ‘see’ you back in 2019!
Until next time, here’s to affecting autism through play!
The new app that is a Connection Coder at the iTunes store helps you to look at, track, and think about how to improve connection and engagement, tracking along the DIR Model’s first four Functional Emotional Developmental Capacities. The app trains you in just a few hours, which is incredibly simpler than and more efficient than other video coding approaches. Dr. Feder points out that you don’t even have to understand the capacities to use the app and reflect on your connection with your child.
Expression of gratitude...
Dr. Feder extends his gratitude to the graduate students at Fielding University, to Devin Casenheiserwho filled in while Dr. Feder was overseas in overseeing the app’s development, the clinicians and video coders, his tech company Symplay, the UC Irvine human computer interface program, and the families who participated in this work.
Dr. Feder discussed the importance of regulation, connection, and flow of interaction in our efforts to help people with developmental challenges and how this simple video coding paradigm can give helpful feedback to parents, teachers, clinicians, and researchers to guide intervention. Dr. Feder gives credit to other doctors and researchers who have mentioned and worked with video coding to study such interactions.
We can’t get anywhere if we can’t be regulated. We discussed this with Dr. Stuart Shanker a few months ago. Sometimes compliance is mistaken for regulation, but compliance is not regulation. If you’re only complying because you’re overwhelmed, you’re not likely to learn from the interaction. We aren’t regulated when we’re hungry, angry, lonely/anxious or tired (HALT). Dr. Feder’s goal with this app is to see the real back-and-forth in a mutually collaborative interaction.
But our interactions are frequently interrupted by everyday life if the phone rings, or if we have internal bodily functions disrupt us. Through the interactions and interruptions, infants learn that you’re separate people and that you can come back, which is the beginning of resilience–the ability to bring somebody back. Taking from that, Dr. Feder’s Fielding team thought that they need to look at the length of connections. Longer connections imply that it’s meaningful. They also work at how much work people are doing in the interactions, and the balance of effort: who is doing most of the work in the interaction.
The coding app looks at degrees of connection with well-timed back-and-forth interaction with shared emotion, possibly mutual social gaze, balanced effort, and an ease of interaction being the best score. The app has a high correlation with the CARS (Childhood Autism Rating Scale) and also has training for coding reliability that takes less than a few hours. With this ease of coding, there is no need for a whole team of researchers like other coding research uses.
Dr. Feder says that there are already Fielding graduate students using the app in research projects. We’ll be eager to follow up in a few months to see what kind of feedback Dr. Feder’s team received from users and I would like to try it out, myself, with my son as well and provide some feedback to their team! If any readers try it out, please contact us or Comment below to give Dr. Feder’s team your feedback about using the app.
Dr. Feder's new medication handbook
You may recall we did a podcast with Dr. Feder about autism and medication. Well, Dr. Feder has co-authored a new book that is now available for professionals and the general public called The Child Medication Fact Book for Psychiatric Practice. Dr. Feder points out that they are not influenced by the pharmaceutical industry, taking no funds from them and reviewing medications independent from their influence. Highly recommended!
Did you find today’s podcast interesting and does it inspire you to download the new connection coder app to reflect on the connection you have with the children you love and/or play with? If so, please consider sharing today’s blog post on Facebook or Twitter and feel free to offer any insights, experiences, or feedback in the Comments section below! Stay tuned for another video podcast with Dr. Ira Glovinsky in two weeks!
Until next time, here’s to affecting autism through play!
Browse more DIR Model books to help your understanding and practice of Floortime:
Maude Le Roux returns this week to discuss Theory of Mind: what it is, why it’s important, and how to foster its development in our children with developmental differences. Maude is an occupational therapist who runs a DIR clinic called A Total Approach in Glen Mills, PA and she is also a DIR Expert Training Leader who presents around the world on DIR/Floortime and other topics that she has advanced credentials in.
Theory of Mind is the ability of my mind to interact with what I’m getting from your mind, then flexing my mind to what your mind is thinking and feeling. We want to ask ourselves, “Can your child assess your emotional state?” That can easily become a cognitive activity: “I can see you’re mad.” But can your child negotiate their own emotions/emotional state with an adaptive response because they’ve read your emotional state? That’s the complexity of theory of mind.
It’s easier to test the cognitive part and some tests only do that. The beauty of the Developmental, Individual differences, Relationship-based (DIR) model is that it allows us to test the emotional part. Theory of mind is really and fully grasping that your mind is something different than my own and what you are experiencing, thinking, and feeling can be different from what I am experiencing.
I presented Maude with an example of my son hitting dad playfully over a year ago. Dad reacted the way most of us would with an emotionally charged, “Stop! We don’t do that!” Now since Dad is introverted and typically has flat affect most of the time, seeing this emotional response became a goal for our son.
It has become a game where our son will walk up and smack Dada yelling “Aow!” in order to see this reaction from his father. He follows that up with a very playful, “Dada, are you ok? Are you happy, Dada?”
Maude had told us that our son is asking those questions because he wants Dad to participate in the game again, not because he understands that he hurt Dada and understands how Dad might feel. He is not being malicious or hurtful. He just likes to see the reaction, and he is noticing that it has an effect.
Maude had suggested that Dad say “Aow!” with a lot of affect and keep our son in that moment as long as possible, in order to foster our son’s recognition of the effect he’s having on his Dad, but Dad’s not comfortable doing that.
What Dad was comfortable doing was lay on the bed with a sad state on his face for an extended period of time, saying “You hurt me” in a calm, sad voice. This made our son quite uncomfortable and so he continued to hit to try to get a reaction out of Dad. It frustrated him that Dad didn’t get worked up.
Since our son does not yet possess theory of mind where he would emotionally understand that what he does might have a serious effect on another person, he is hitting, poking, or kicking to see the reaction from others. Maude tells us that while he may not have theory of mind yet, he is noticing that his actions do have an effect on others. Recall that we previously discussed how his cause-and-effect play has progressed to the social realm.
We also previously discussedhow our kids often need to practice and repeat something to figure it out. Maude says he is experimenting with what happens when he kicks his Dada, hits him, and does it harder or softer. So now what we’re doing to support his development is extending the moment so our son can be aware and can focus on that awareness, feeling what it feels like inside of his body to stay in that uncomfortable moment where Dada reacts differently and acts sad.
In that awareness comes that neurological firing of the brain of, “What do I do now? What do I do with this? Why is Dada doing this?” So now the cause and effect makes him negotiate something different. Challenging him in this way promotes his growth and development. Problem solving plays into this theory of mind piece as well. Maude says it’s important to practice this as a scaffolding ladderinto theory of mind. Now he has to negotiate, “Let me try something… Let me try something. I’ll try what I tried before, but it’s not working anymore. Now what?”
“We hang it on a hanger“
Maude uses the term, “We hang it on a hanger” when we put something new out there for the child. He can take it down or not. See if he’s going to be able to figure out a new way to respond. That’s where the complexity starts. That’s what we want to see, Maude says. If you quickly erase the moment (by scolding or directing his behaviour, for example), you can easily move on and he will be relieved of this moment.
The fact that he’s feeling it means that something in there is cooking and that’s what you want to hold because he needs that time: much more extra time to really sit with something (new). Now he has to regulate his own state in that moment. He has to say “My cortisol/adrenaline is coming up. How am I going to solve this without running away or going to a meltdown? How do I get to that threshold?”
At the same time, he is also working on emotional inhibition which is a later executive functioning skill. It’s so far beyond social perspective taking and social problem solving. Last year or so, our son wouldn’t have been able to stay in that moment when Dada changed his response. He would have given up and walked away.
If you go home and tell your partner all about what happened today as you vent and he listens, then he says to you, “By the way I’m going to that game on Saturday“, you say “What? Did you even hear what I said?” He completely mismatched where you are at in that moment. In that moment, you were not held in that moment which causes stress for you.
The risk of not staying in that moment
What happens if instead of staying in that moment we do that typical parent thing of yelling, “Cut it out! Stop it!” or some other form of behavioural discipline. Most of us were raised this way, so it’s second nature to us to react this way when our children hit or kick us. But this is where we could be doing Floortime. But perfect parents don’t exist. We have to forgive ourselves when we do something we feel we shouldn’t have done.
Sometimes it is appropriate to get firm. Maude is not a fan of doing one thing for one specific incident. If we only do one thing we aren’t promoting flexibility. We’re still stuck in “If you do this, then this will happen!” That’s not really what we do in a spontaneous social setting. Sometimes it’s appropriate to say, “Sit down until I tell you to stand up.” It’s also appropriate to hold your child in that awareness. It’s asking your child, “Do you have that interoceptive ability to see what’s on my face right now and relate that to how you are feeling?”
The behavioural discipline works and has worked for many generations with neurotypical kids. For our children who struggle with meeting the developmental milestones the behavioural model is not always understood in the way that the parent is meaning. If the child doesn’t get why he must be sitting when his body is asking him to move, his focus is in a totally different place than the parent. So you have a mismatch which doesn’t help anyone because now the parent is concerned that the child is not doing what they want him to do or that he’s out of control, while the child wants to be in control and how will the two meet?
If parents keep with the behavioural model, they just find they have to do the same thing over and over because it doesn’t have meaning for the child.
Maude Le Roux
Daniel Siegel talks about the neurobiology of emotion. The right brain is emotional and the left brain is logical. If we use firm motions and words to control a child’s behaviour while our child is already upregulated, we’re trying to connect our emotion through the left brain but the child is only in the right brain in the moment. Is your method of using words really getting through to the child and helping him to down regulate? Are we chasing that ‘why’?
Maude says to decide what’s going to work in this moment, considering the developmental level of the child? If you feel like you’ve messed up by scolding the child, then you go find yourself a space to collect yourself. When you come back you can say “I shouldn’t have said it that way. I’m so mad that you did that, but that’s not how I should have dealt with it.” But if they don’t understand that, show acceptance and hug them.
In that moment when they aren’t understanding you and you’re scolding them, they will only be feeling, “I’m going to lose my mommy, my mommy’s mad, somehow I have something to do with it, and I don’t know what to do.” So first, you have to repair the Relationship. You can do the words later when they’re ready to hear that. The repair tells the child they are safe, and that is what’s so important. Maude recommends Dr. Shanker’s Self-Reg book that discusses the process of ‘learning to speak limbic’ when our children are under stress.
Or to Floortime?
What I Did
I told Maude about our experience at a huge indoor play centre with arcade games, bowling, rock climbing, and big gym blocks, etc. Our son loves when his father covers him up, building a fort around him with the big, soft, gym building blocks. He loves to get up and knock it all down. Our son headed towards there right away but we were on high alert because there were kids building a tower and he would want to knock it down.
Well, we weren’t fast enough and our son ran and knocked down the kids’ castle. The girl building it was so upset and started crying. Dada immediately firmly stated, “That’s it! We’re going!” grabbing his hand and pulling him away, but I said, “Wait! Wait! Wait!” I picked our son up like a baby and carried him over to where the girl was crying next to the collapsed castle and said calmly with great concern, “Oh no! Look what happened! The girl is so sad! She’s crying. She’s soooo upset. She worked so hard to build that tower!”
As I spoke slowly with a comforting tone, I continued, “You didn’t mean to make her sad but she’s so sad!” He was listening to everything I was saying. I think that part of it was going in and some of him was still unaware. He responded, “I knocked it down. I want to build it again!” I squeezed him and asked, “Is there anything you want to say to her?” (rather than directing him about what to say). He said, “Sorry, girl.”
Maude said that I put up the hanger. I put it up and there will come a time when he will be able to take it down and assimilate it. He was trying to compartmentalize it and it didn’t fit, but he knew enough that he had to apologize. It’s that superficial first layer. He is probably understanding the cause and effect, but does he really know why he needs to be sorry? It felt so good crashing it down for him, after all.
In his experience, centralized on himself, that’s the most important thing. We’re taking that sense of self that he has accumulated and trying to turn it to what another person is thinking to invite empathy out. He has cognitive empathy. The girl is sad. But he may not feel it. It’s when you really understand it without talking that the true empathy happens. If I come back from this great vacation then I come in and you don’t look good, I can switch and change that emotion and say “Hey, what’s up?” to reach out, while suppressing my own need to share my excitement of my vacation.
Parents have the most power to create that intersubjective response–getting each other without having to talk. You’re sitting at a dinner party and someone says something and you can look at your partner with that knowing glance and know what each other is thinking. You feel and “get” each other. If anyone can put that message into the child’s mind, it’s the parent. We have this power as parents.
I told Maude that I did spend a good amount of time in the next hour and the next day explaining, “When you’re a little bit bigger you’ll be able to stop yourself when you want to knock down the tower, but you won’t want to make the girl sad.” I was ‘planting the seeds’ for the future of knowing what is socially appropriate. Maude suggests that if you’re going to use words, keep it short. Choose your language well, at the child’s level, and don’t do too much of the logical brain because we’re dealing with emotional pieces here.
The body drives emotion and emotion drives the body. He was in emotional brain in that moment, not in logical brain. He’s still working on that transition to the logical brain. You’re not going to get that emotional piece using a lot of words. You can say, “I know that felt good. The girl was sad. One day you will be able to not do that.” For another child you just might acknowledge what happened saying, “Hmm… so sad… girl was sad… you’re ok.” and then hug the child.
Theory of mind is a process that can take a lot of time. FEDC 3 to 4is the hard transition developmentally. With the third developmental capacity, you’re still working on that two-way communication, stretching it, using playful obstruction and simplistic problem-solving. Once you get into the fourth capacity you’re looking at abstract thinking, fantasy vs. reality, and early imaginary play. When there’s meaning behind it, that’s where level 4 is so robust. You start to abstract in 4, your ideation comes at 4, and you don’t master 4 until 60% of your ideas come from yourself.
You deepen the plot in the fifth functional emotional developmental capacity (FEDC 5). In the 4th capacity, you have all of this emotion. You have to be able to ideate about what it is you might be feeling in order to respond to that at the fourth capacity. Autistic kids have a phenomenal way of trying to figure out how to get what they want, so the parents think, “Well he is so smart, he should be able to understand” when they get frustrated about inappropriate behaviours.
What he’s smart about is what his own body and needs want. He is looking for who else can be an extension to satisfy his needs. He’ll take you by the hand and get you to open that for him, for instance. It’s still about ‘me’. It’s when we enter the space of letting go of one’s own needs in place of another’s needs that we move into Theory of Mind. We need a moral standard and an internal standard. We get that from how discipline plays out at home. All of these pieces are modelled in the early years of life.
Maude says not tot be afraid if it takes a year, or multiple years for your child to master the fourth capacity. She’s seen it happen over and over. The biggest key is consistency rather than going from one thing to another. You might be working on something for a long time right before you see the developmental jump because children keep processing in the moment and out of the moment. When they go to the next situation, they bring that process with them, and the next situation builds on that. They still might not yet have the skill to show us what they have figured out, but in the meantime the brain is putting it together.
Consistency with flexibility
Be consistent with flexibility–that is, not rigidly responding the same way every time–and think about what each experience is really about for your child. What does it feel like in their body? How are they experiencing what I’m experiencing? Practice. Read stories and make those..