(Stanley Greenspan MD Inc. does not support DIRFloortime or its licensor ICDL, read more….)
It is said that children on the autism spectrum and autistic individuals live in their own world, or often retreat to their own worlds, especially when under stress. For adults who choose to have alone time, and/or meet their own needs, wants, and desires the process is different than it is for a young child. A child’s brain is still rapidly developing, and it is open to new experiences. While an adult’s brain is too, those new experiences are more difficult to access and can take longer to learn from. As adults our perceptions of these types of experiences have been reinforced over and over and over, whereas for a child, they’re still forming these perceptions and beliefs. While it’s important we are respectful of each person’s neurodivergence, it’s also important that we as a community collectively discuss what respecting neurodivergence means. Does it mean we never challenge a child to do something that is a little difficult for them? Does it mean we never intervene and support a child to do something that they might naturally have difficulty doing and don’t want to do because of its difficulty? Before neurodivergent respect was even a talking point, Dr. Greenspan identified the most important early childhood experiences necessary for developing social-emotional health and a child-centered way to access them. Helping a child learn something they are not naturally developing is less about IF we challenge, push, or encourage a child to do something new or difficult, but it is more about HOW the learning experience is supported by the adult and perceived by the child.
Achieving social-emotional health requires the development of certain capacities allowing us to be adaptive and access a full range of social and emotional experiences in the world around us. These capacities are not simply to help us be ‘functional’ members of society rigidly following rules and paying taxes, but to be meaningful members of society and experience a full range of emotional fulfillment from our lives. Some of these capacities are things like,
- Empathy, the ability to engage with and understand the feelings of the people around us,
- Communication, the ability to express ourselves and understand what other people are sharing, both non-verbally and verbally,
- Social Skills, our ability to form relationships and read, respond, and adapt within those relationships,
- Creativity, being able to generate new ideas and think outside the box and abstract,
- and many others.
While many children struggle to develop these capacities, almost every person on this planet has the potential to develop and/or strengthen these capacities, even with a diagnosis like ASD. In order to do this, the first thing we must do is establish relationships and social connections. It is through these relationships that the learning process begins. Dr. Stanley Greenspan found that these relationships created a shared world in which a child and a caregiver could explore the use of these capacities together, nurturing the fundamentals that allow us to explore more complex robust experiences later in life.
This leaves the question, what do we do when a child is in their own world and how do we treat this in a neurodivergently respectful manner?
- Do wait and observe and allow the child to exist in their own world until they choose to let us in or come out of it?
- Do we take a behavioral route and bribe or force the child out of their world?
These solutions are at polar opposite ends of the decision spectrum and have each been shown to be ineffective at supporting the development of the above social emotional capacities. So, what do we do?
The first thing we need to understand is why a child engages in these activities. Most habitual rigid behaviors develop out of the participant receiving some sort of ‘reward’ from the experience. Everyday habits activate the same reward pathways in the brain as drug abuse (https://www.psychologytoday.com/us/blog/striving-thriving/202110/the-neuroscience-habits). Many of these self-stimulatory repetitive self-involved behaviors present like addictions. Engaging in addictive behavior provides the participant with a temporary relief from their desire, need, or stress, but requires continued access and discourage adaptive long term self-regulatory. Also, acute and chronic stress can increase ones’ reliance on habitual strategies. This has been found in both animals and humans. (Schwabe L, Wolf OT (2013): Stress and multiple memory systems: From ‘thinking’ to ‘doing.’ Trends Cogn Sci 17:60–68). These behaviors manifest and increase during times of ‘stress’, like sensory and emotional over or under arousal. While children engaging in habitual self-involved behavior are attempting to regulate themselves, this becomes a rigid and maladaptive form of self-regulation. The only type of experiences shown to lead to long term self-regulation and social emotional health are co-regulated interactions (read full article).
According to most developmental professionals’ current understandings, these behaviors develop instead of co-regulated interactions as a result of the child’s sensory, affect, and motor systems not working in sync, not integrating. If these rigid, self-involving, hyperactive, and/or anti-social behaviors are a result of poorly integrated elements of our nervous system, then we need to make sure they are being addressed in a manner that will lead to integration. According to OT’s, Zoe Mailloux and Heather Miller Kuhaneck, who summarized Dr. Jean Ayres key elements to Sensory Integration, to achieve integration a number of elements must be present within the intervention, including “The therapist engenders an atmosphere of trust and respect through contingent interactions with the client. The activities are negotiated, not preplanned, and the therapist is responsive to altering the task, interaction, and environment based on the client’s responses. (Understanding Ayres Sensory Integration® , https://www.researchgate.net/publication/289758466_Understanding_Ayres_Sensory_IntegrationR)”. As you can see from this therapeutic requirement for integration of these systems, the therapist should neither ‘wait and observe’ nor be directive, rigid, or intrusive.
While it’s important to respect a child’s unique developmental profile and their neurodiversity, whether a child seeming ‘likes/wants’ or ‘dislikes/avoids’ something shouldn’t be our only consideration when supporting and challenging them. There are certain experiences that are objectively beneficial and good for all human beings and others that can be harmful or bad for us. All human beings, including those with ASD and other social emotional delays, are social beings and benefit from manageable social connections. To help a child build these connections (relationships), the first step is to see each child, and adult, as an individual person, and to understand their unique developmental social-emotional profile. Developing this understanding will require some observation, the observation should take place while we are trying to play and be social with them, and not sitting there quietly on the sidelines. This process will help the adult identify what the child needs to help them engage and interact.
One of the primary goals during any type of learning experience, especially social-emotional learning, is making sure the child is actively engaged. Learning cannot take place efficiently if a child is not activley choosing to engage with their caregiver. Also, the only type of engagement that matters is a social-emotional engagement, and not engagement with an object or activity. We have seen over the last 20 years while working with families on 4 continents, that every child has the potential to develop the capacity for emotional connections and engagement through child-centered enjoyable experiences, even in cases of severe ASD. This requires understanding and supporting a child’s needs and sensitivities, while helping them develop new preferences and habits though high quality socially interactive play with nurturing adaptive caregivers. However, the idea of waiting and observing, while not supporting the child’s needs or engaging and interacting, is now being overused to the detriment of the child, even during some types of other ‘floortime’ sessions.
To achieve engagement, most children are being exposed to 1 of 2 extreme options,
- Behavioral methods that bribe and reward, or force children to look at them can sometimes achieve eye contact, but this is not actual engagement. The child ends up staring at you or through you, instead of truly connecting with you reading your subtle emotional facial expressions. Eye contact is then seen as ‘work’ and is rarely generalized.
- Waiting and Observing until the child engages or initiates with you. This can happen very slowly, and often not at all. While waiting you are reinforcing the child’s sensory dis-integration and antisocial tendencies.
Unfortunately, these techniques are ineffective at encouraging and strengthening the child’s sustained ability to consistently emotionally connect with those around them, i.e. engage. While the issues with the behavioral methods are obvious, the issues with waiting and observing are less obvious. In order to understand why it’s counterproductive and potentially detrimental, you first need to understand some of the main goals within the Greenspan/DIR Model. One of the things Dr. Greenspan always said is that we ‘Follow the Child’s Lead’ to join their world and help create a shared world encouraging engagement. We get down on their level, we do what they’re doing, we play with their toys to show them that we’re interested in them and what they’re doing, i.e. their world. However, most children with ASD struggle with this type of connection, especially when they’re going from small visual objects, pictures, puzzles, books, and then having to connect with and focus on a human face, which is dynamic and subtle in its expressions.
Most children are interested in these visual activities because of their sensory integration difficulties. Their visual system is being used to such a high degree while not integrating with their auditory and other systems. They are not able to look and listen at the same time in the presence of these visual objects and activities. When we attempt to join a child’s world by following their lead, we first need to see what they’re doing. Next, we approach them, and we are on the doorstep of entering/joining their world. However, simply standing there waiting and observing, or even commenting and narrating, doesn’t mean that this child will know that we’re there (at their door). When you are at the door to their world, how do you encourage and entice them to open it and let you in?
Think about the child’s world metaphorically as being their house. If I’m going over to a friend’s house and I’d like them to let me in, waiting and observing on their doorstep is probably not going to let them know I’m there. Typically, a rational human being would ring the doorbell or knock. Both are providing my friend with sensory stimulus (sound) that lets them know I’m there, allowing them to respond. When they see it’s me, they usually lock the doors and turn the lights off! ?Hopefully not. Hopefully, they come and let me in. However, because of some children’s difficulties in engaging and interacting due to the poor integration of different parts of their nervous system, being able to effectively perceive a simple sound to know that someone is ‘knocking on their door’ and wanting to come have fun, is not yet a consistent ability of theirs. Instead, we use the principle of ‘Knocking on the Door’ by adding more sensory and emotional stimulation to it!
Announcing our presence with enthusiastic playful language and in a multisensory manner with things like tickles/touch, as well as sounds and movements provides the child with multisensory and social-emotional stimulus. This stimulus will help them regulate and experience a fully integrated moment. These moments allow us to engage and interact with those around us beginning a co-regulated interaction. The more of these moments we have and enjoy, the more consistently we are in a fully integrated and regulated state, the stronger the wiring in our brain develops, and the more we can maintain that state of equilibrium. This happens most rapidly when done consistently and intensively, and when the child is having fun.
The opposite is true as well. The more time we allow a child to self-involve and spend time hyper focused, fragmented, or withdrawn, prior to mastering engagement, then the poorly integrated parts of sensory system will become more difficult to integrate as we’re only utilizing one part of our sensory cortex at a time, the visual system. The visual system is continuing to get stronger, more and more intricate wiring, while the rest of the systems are being left out, making it more and more difficult to eventually integrate them. Unfortunately, the simple act, which comes from an empathetic place of waiting and observing, can actually reinforce a child’s antisocial self-involved states. This same concept applies to other activity and task focused interventions as well. Teaching a child to play with toys and using sensory strategies that are self-involving like rice and beans, shaving cream, or bubble tubes, can all lead to a child’s continued issues with integrating their nervous system and the social emotional world around them.
Mant therapists and advocates say that these children need more alone time, and while it is true that the more you give them, the more they will want, the opposite is also true. When children begin to see that relationships and fun manageable co-regulated interactions are rewarding and fun, then the child’s preference begins to shift. One of the main indicators we share with caregivers is that when a child plays on their own, in a self-involved state, they rarely smile, laugh, or exhibit that they are having fun. However, when we successfully help the caregiver join that child’s world and create a shared world, often using the technique of ‘Knocking on the Door’, the child ends up smiling, laughing, and genuinely enjoying themselves within a meaningful co-regulated interaction. This should happen the first time and every subsequent time a caregiver applies Greenspan Floortime®. The more consistently they have those rewarding caregiver-child interactions, the more quickly their preference shifts, and they begin to independently develop new pro-social behaviors.
Are you a parent/caregiver who wants to help their child strengthen their social-emotional capacities? Learn how to correctly apply The Greenspan Floortime Approach®. Register for the Caregiver/Parent Course at www.stanleygreenspan.com/floortimeu/. Parents can also receive Greenspan Floortime® Expert tele-coaching with video analysis and feedback.
Professionals, begin your certification process in Greenspan Floortime®. Learn how to correctly apply The Greenspan Floortime Approach®. Register for the Professional Course at www.stanleygreenspan.com/floortimeu/
For in-person Greenspan Floortime® based OT, SLP, and Social Group programs, and coaching contact The Floortime Center®, www.thefloortimecenter.com.