Affect Autism: We chose play, joy every day

by Affect Autism

This Week’s Episode

My returning guest is Dr. Colette Ryan, an Infant Mental Health Specialist who is an Expert Developmental, Individual differences, Relationship-based (DIR) Training Leader and who is part of a group starting up a new Floortime school in Toyko Japan as the Floortime Supervisor. Today we are covering a topic near and dear to Colette’s heart, parent self-efficacy, the topic of her recent PhD dissertation. She recently presented on this topic at the 2024 ICDL DIRFloortime conference. 

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Working with Parents

Colette is putting her Floortime into practice by interacting with parents daily as parents drop and pick up their children from the new school, but she also does 1:1 sessions with families on the weekends and an online class for parents every two weeks about DIR topics, supporting parents in learning the DIR model and supporting their ability to feel successful with their own child. 

DIR is new to most of the families, but Colette has been on this journey in Toyko for 2.5 years now, so has met and worked with many of the families. The school has now been opened for over 7 weeks and parents are already reporting positive experiences whereas they did not have success with school in the past.

Parent Self-Efficacy

Colette’s dissertation from Fielding Graduate University title is “The Use of DIRFloortime to Support Parental Self-Efficacy in Japanese Mothers“. She chose this topic because she loves working with parents. When ICDL started the DIR Home Program during Covid and developed modules for learning for caregivers, Colette took parent’s ideas about what they needed to learn about their own child. Part of the success of the home program was that Colette and the other coaches were providing knowledge that the parents needed to be successful with their own child.

Parent self-efficacy is the ability for a caregiver to feel they are successful and capable in supporting their child to grow and develop. With predictably developing individuals, Colette says, most parents feel pretty successful. They understand their child’s cries and cues. With a neurodivergent child, that might be a little bit harder, she explains. When caregivers are not successful with their child, it’s hard to want to play that game again if it hasn’t worked. 

If your child can’t play peek-a-boo, you’re going to stop playing peek-a-boo, Colette says. What we get to do as Floortimers to support caregivers is to help them see that maybe the child can’t reach their arms up to get picked up because motor planning is a challenge for them. Maybe peek-a-boo is hard because they’re uncertain as to where you go when you’re behind that blanket, so maybe we just hide behind our fingers instead. Maybe if they want to be picked up but can’t lift their arms up without falling over, you can get down on their level and maybe they can reach their arms straight out instead.

When a parent is successful, Colette stresses, they want to do it again and again. I shared that Brooke Barracks talked about this a few podcasts ago where her son was unable to lift his arms up to get picked up. She was able to pick up on her son’s cues to see that he wanted to be picked up, even if he couldn’t signal it the way that his twin sister did. When a parent can read a child’s cues, it makes all the difference in the world. It is very powerful when you recognize how to communicate with your child in non speaking ways and notice their communication cues. 

Supporting Parents

Some parents need more support than others attuning to their child and reading their cues. One of the gifts that Dr. Greenspan gave us, Colette shares, was understanding attunement, which is about getting a good fit with your child and understanding that just-right fit. As Floortimers, we can support caregivers in finding that just-right way to be with their child, Colette says. Dr. Greenspan did say that he never found a baby who he couldn’t engage, even if they ‘seemed’ to be in their own world, by adjusting the tone of his voice, by moving slower or more quickly, etc.

Colette suggests that we imagine that parent who is so stressed because they have not yet been successful with their child and how hard it would be to try to interact in all of those different ways and still not be successful. After awhile, self-preservation tells you to stop, she says, and parents get dysregulated. The results of her dissertation study found that if you want to support parental self-efficacy, you have to Floortime parents by supporting safety and regulation in parents.

Colette continues that we have to be able to engage with parents and support their ability to use intentional communication. We have to be able to support them in problem-solving and having ideas, because if they don’t have those, they’re not going to be able to do that with their child. Colette asks us to imagine trying to support a child through symbolic play when you’re not even regulated yourself. It is not fun because it’s too hard. I shared that in Episode 6 of Season 1 of We chose play is Colette coaching me through a video, retroactively, supporting me in self-reflecting. 

I was so overwhelmed with how much my child protested and cried, but at least he could always be soothed by picking him up and providing him with movement, which is why it was so hard for him to go to sleep and be still. Colette says to think about the effort it took from me to find that just-right thing that my child needed, and now think of the thousands and thousands of Floortime families out there and providing them with that ability to figure out that just-right way of being with their child, which can be totally exhausting. As a Floortime community, she continues, we need to hold our parents and go on this journey with our parents. 

Family and Community

Colette shares that John Bowlby, the father of attachment theory, said that if a community really values their children, they need to cherish their parents. Dr. Stanley Greenspan talked about Floortime as a family approach and how you really are ‘treating’ the entire family. Parent self-regulation is huge. If you can’t be regulated, you can’t co-regulate with your child. The person who gave us parent self-efficacy was Albert Bandura, Colette continues. In her dissertation she talked about the child, the family, and the community.

She got her information about the child from Dr. Greenspan, talking about development, reminding us about individual differences, and reminding us about relationships. She got her information about the family and supporting the family from Bandura. Urie Bronfenbrenner gave her the idea about the community that supports the family. Colette says that Floortimers support caregivers by talking about following the child’s lead, about attunement, and other practices. What I hear a lot of parents saying is that the community piece is missing. 

They don’t have any Floortime providers in their area, and this is the value of parent support meetings where parents can connect. I found that parents really listen to each other. They want to interact with the people who support them–the DIR coach, but they also respond so well to that community aspect. All three layers that Colette talked about are so important. Colette continues that when we think about community in Bronfenbrenner’s ecological systems theory, we talk about the extended family, the school, religion, culture, politics, etc.

We have Floortime families from all over the world in so many different cultures. Colette works in the Japanese culture where they have a term, ‘meiwaku‘, which is the desire not to cause anybody else discomfort. As a community, most individuals within the Japanese culture try to make sure they don’t cause anyone else any bother. If their neurodivergent children are yelling, screaming, or having meltdowns, that would cause other people bother, so the Japanese caregivers might have difficulty understanding their part in that community. 

That’s the piece that Colette gets to do in Japan, but this is happening in all cultures. Each culture has things that help you to fit in, she says. We, as Floortimers, need to support individuals in different cultures to support how their community would be able to support their family. 

Cultural Considerations

Colette has learned so much working with different families about different cultural practices. Before the war in Ukraine, she spent a week in Kiev working with families and practitioners and understood more about that culture, but since the war happened, she was suddenly supporting families going through this huge traumatic event where they were fleeing their country in the middle of the night. She had to do something different to support those families.

There are some cultures, she continues, that don’t have a word for ‘affect‘ and Floortime coaches need to support caregivers in those cultures in understanding what affect is. Culture really comes in to the whole idea of parental self-efficacy. Colette says the question is about what it feels like for a parent to feel self-efficacy in this culture?

Floortiming the Parent

You really have to Floortime the parent, meeting the parents where they are at, taking account into the parent and family individual differences, how sensory systems clash, perhaps, and building that relationship with the family. It’s hard, Colette says. And there’s such a difference working with a family in person versus virtually. Colette explains that when you’re in person with a family and you can see the anxiety building up in the caregiver because their child is doing something that they don’t want someone else to see.

In those moments, Colette might let the child do what they’re doing as long as they’re safe and sit with Mom or Dad or caregiver and talk about something other than what’s happening to help them to organize. They use this method when they do intensives at the DIR Institute in New Jersey, she says. In those moments where parents might become dysregulated, one of the training leaders at the intensive will keep the child safe while the other one talks to Mom and Dad. They might talk about the great toy in front of them, or about the sleep the night before in order to regulate again.

Once the parent is regulated, it’s easier to regulate the child. The adult brings the calm to the child’s wavy seas, Colette says. We want to make sure the parent is on the calm seas before they attend to the child on the rough seas.

Floortime Coaching

I asked Colette about working virtually with parents where you get to interact with just the parent while the child is at school or with the other parent, and you get to see that more reflective side of the parent. They might have insights that they can’t have in the moment when they’re overwhelmed with their child. Colette responds that families allow themselves to be vulnerable with Floortime coaches, given all of the experience the coaches have with parents and families.

Colette says here is where they can be supported in reflecting and talking about different practices like pacing, for instance, if they’ve never heard of it. The coach can describe about how the sensory system processes information, and how if we just slow down, it might help. Maybe following the child’s lead has been misunderstood by the parent, so you get to have that conversation. When Colette presented at the 2024 ICDL DIRFloortime conference she talked about supporting parents in parent self-efficacy with different Floortime practices.

Colette likes the four Ls: Less Language, Longer Latency. Using less words, slowing down, and waiting longer. Maybe we need to use gestures more and less language to conserve that brain energy for play rather than on processing the words coming at us. We slow down so a child can keep up with us. If we move really fast, they might not see everything because it happened too fast and they couldn’t process it all. I gave the example from We chose play of Dr. Tippy talking about Dad being ‘very athletic’ and seeing if he could slow down so our son could follow and participate in the play with Dad, otherwise he’s so anxious because he wants so badly to play with Dad but he’s moving too fast. 

We can slow down our body, our actions, and our affect, Colette explains. The coaching really helped Dad use anticipation to get those longer interactions happening. Colette said that she bets that in that moment, Dad felt successful, versus when he was moving really fast, which felt less successful. We’re always focused on the child, but Colette brought it right back to the parent. We can look at how successful the parent felt as well as looking at the child’s capacities as a result of that.

A parent who is successful will do it again, Colette repeats. A parent who is not successful may not have the brain energy to do it again and again. That’s what we get to do as Floortimers, she stresses, is to provide success. There are so many recent studies on parent-mediated models in early intervention and with that, came a lot of research on parental self-efficacy, she says. 

Think about what it meant to be able to provide support for their child and play ball with their child, to get their child to eat their lunch, or to be able to get their child in the car seat successfully because they were able to slow it down. That’s real success for families, she insists.

Success with Transitions

Colette made me think of transitions talking about the car seat. Autistic Self-Advocate Kieran Rose talks about monotropism and having to be sucked out of a black hole during transitions. Colette says to imagine if someone came to your door, and they grabbed you and put you in their car and started driving away. You can verbally tell your child where you’re going, but they may have no idea where they’re going. If we slow it down, Colette says, and show pictures of where we’re going, and have a transition device–whether it’s a picture or a stuffed animal, the child might then know that ‘this thing means we’re going in the car‘ then the parent can be successful.

I use a technique to transition my son to the car by getting him to think about the things he likes about driving in the car–our playlist of songs that he likes to listen to. I figured out how to change songs on the playlist through the Bluetooth feature in the car. Colette points out that I found success, so I was willing to do it again and again. I added that he’ll still protest and want to stay home and play all day, but setting firm expectations helps while shifting the focus to the fun things in the car, and of course this is very different with an adolescent versus a preschooler.

An Impromptu Coaching Example

I had Colette walk me through an exercise that she does with parents. The latest challenge I’ve been having with my regulation is that my son talks non stop and bombards me with questions over and over again, and often they are the same questions repeated. They are typically questions he knows the answer to. He just wants to keep the interaction going. He will also go through a list of birthdays for each month of the year and continue to ask whose birthday is in each month. 

Colette said that it’s not about the birthdays. I am his favourite person in the world and he wants to keep it going. She asked if the birthdays are written down. We did write them on the calendar. Colette said that these birthdays mean something different to him than they do to us. He wants this interaction with me, too. Colette wondered if I can shift talking about birthdays to talking about the person. When he brings up Grandpa’s birthday, we could wonder what Grandpa’s real name is, and what Grandpa liked as a child, etc. Let’s make Grandpa more than his birthday, she suggests. 

We can expand on each person by adding something new, Colette suggests. Maybe we’ll be talking about Grandpa’s real name over and over for awhile, but it’s a shift. I could also make a birthday book where we have a page for each month. Colette pointed out that he keeps the conversation going and going because I am his most favourite person and he never wants to let that go.

I shared that I ‘should’ know all of this, but like other parents, even knowing about Floortime, we still get stuck on what to do with our own child, and this is the value of Floortime coaching. It supports us to have ideas. Dr. Tippy said I can answer that I don’t feel like talking about birthdays. Maude also told me to respond in different ways each time. Vary up the responses. I thanked Colette for the additional idea of how to respond when I am bombarded with birthdays. Also, I pointed out that I like biographical facts about people I know, too, so I can understand how these facts are important to my son.

I thanked Colette for helping me feel energized with these new ideas. She mentioned that I’m probably feeling regulated, too, and will be ready to engage and interact. I shared that this is a benefit of parental self-efficacy. I shared that things might not work, too. I might feel deflated if my son isn’t excited about the new ideas, but a coach can help you brainstorm that, too. In conclusion, Colette just pointed out that Floortime supports parents and parent self-efficacy!

This week let’s identify where we feel success and where we struggle with our child. 

For example: Figure out where you are successful in feeling connected with your child and note the environment and what you may have done to promote that. Next, take stock of when things are tough with your child, and again think about the tips Colette gave: Are you moving too quickly, using too much language, focused on your agenda versus following their interest, or does the child have sensory or other demands they are dealing with? Try to investigate the ‘why’ behind the challenge and using some of the Floortime techniques discussed, see if you can alter that interaction for the better.

Thank you to Dr. Ryan for taking the time to dive in to parent self-efficacy with us. I hope that you learned something valuable and will share it on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

This Week’s Guest

Dr. Robert Naseef is a clinical psychologist in Philadelphia who co-runs a fathers support group for fathers and male caregivers of autistic individuals at the Drexel Autism Institute. He is the father of an adult 45-year-old autistic son.

This Week’s Topic

There’s been a lot of talk about how autistic girls are not recognized and diagnosed and on social media around many women being diagnosed as autistic after their children are diagnosed. Dr. Naseef has been diagnosing children and adults with autism since 2008 and especially after the pandemic, he has seen an increase in females seeking diagnosis. This episode we discuss diagnosis and examples of autism in girls and late-diagnosed women.

by Affect Autism

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Diagnosing Autism

Before the Pandemic, Dr. Naseef would diagnose 1 or 2 adults per month, and in the pandemic it increased to 1 or 2 per week, averaging about 1 per week since. His process evolved slowly. Some of the boys he diagnosed, whom he sat on the floor with, grew up and became adults. Some went to college and some went to residential placements. Having been through the process with his son, first of all, then as a clinical psychologist, he knew what it looked like in adults, but the reason 80% of those diagnosed are male has been true for decades: the girls have less outward behavioural symptoms. The diagnosis rates by sex are shifting, but there isn’t a lot of data yet, he says.

Boys tend to have the classically autistic behaviours–flapping and behavioural dysregulation, often with high intelligence, often with low support needs, Dr. Naseef says. Very few girls have the outward behaviours and if they did, may have been diagnosed with a behavioural disorder. Most of the girls he sees are quiet, mostly introverted, have a friend or two, and have done well in school. They don’t cause problems for other people, and their suffering is internal. They may have past diagnoses of depression, anxiety, OCD, or attention deficits, and they come to him saying they’ve been reading about autism because none of their diagnoses descried who they were. 

Even though most of the females Dr. Naseef diagnoses have friends, they struggle making friends, keeping friends, and socializing with people they don’t know very well. Those are some of the core differences between the males and females he sees in his practice. I wondered if the internal experience is the same in both sexes, but just manifests differently outwardly. Dr. Naseef emphatically agrees. He uses the same instruments on both sexes and their answers are very similar. Some of the female sensory profiles are more extreme than he’s seen, but they’re inside, hidden from the outside world.

Dr. Naseef adds that he has observed an increase in late-diagnosed autistic females in his practice as well as in the online forums. Many find it to be a relief and even transformational in that the diagnosis is a lens to understand their life story. Some will continue to snuggle with their co-occurring mental health issues. Others have the same or similar questions and begin their journey of reflection and psychoeducation through reading and possibly working with a therapist. Many get accommodations in the workplace because they now have a diagnosed difference that may also be a disability.

Masking in Autism

I shared that I’ve been making my way through the book Autistic Masking. It seems like girls are really socialized to keep it all inside and that masking is what impacts their mental health as they reach adolescence and adulthood. Dr. Naseef says that there’s a good questionnaire that measures the extent to which individuals mask and breaks down all the behaviours that go with it such as matching the voice and mimicking the body posture of the person you’re talking to. Like autistic boys, autistic girls learn through logic versus intuition, Dr. Naseef explains, but they’re socialized to learn masking quickly. Everyone says boys will be boys when their behaviours that emerge are different, but nobody says girls will be girls when they don’t behave in a neurotypical or allistic way.

Everybody masks to some extent, Dr. Naseef says, but autistic people mask to the extent that their very identity is hidden and the pressure of trying to fit in is overwhelming, mentally and emotionally. Kieran Rose defines it as a trauma response. It’s different than impression management where you present your best self at a job interview or on a first date. Masking is a survival mechanism where you have no choice but to mask, he says. Dr. Naseef agrees. One of the things that comes up with diagnosing individuals is that it’s often a relief to know that there’s a way to understand what the individual has gone through and that they’re not defective. They’re different. 

They don’t have to keep apologizing for being different and don’t have to tip toe everywhere for being different. They also figure out if there are behaviours or things they want to stop masking. The question is personal and sometimes it’s as simple as not wanting to pretend around the people they know the best, Dr. Naseef says. They want to take breaks when they need to take breaks, or if they flap when they’re excited, they will flap. It’s never that they want to go to work and unmask everything, but it is about being more of their authentic self whenever that’s possible, he adds.

Widening or Dividing the Spectrum

Dr. Naseef and self-advocate, Dr. Stephen Shore co-wrote an article entitled, We’re all on the same side: Unite the Spectrum. In it, Dr. Naseef shared how Dr. Stephen Shore talked about how he had the same characteristics as Dr. Naseef’s son, Tariq, who is non speaking. That was Dr. Naseef’s most powerful case not to divide the spectrum because all of the autistic speakers Dr. Naseef has met talk about the needs of all autistic children and adults. He adds that finally children of colour are being diagnosed at the same rate as white children for the first time since statistics have been kept. In his practice, he’s also seeing more and more women of colour. He said they would have had no chance of being diagnosed before.

Kieran Rose talks about there being over 100 co-occurrences with autism including ADHD, anxiety, sensory processing disorder, and others, some of which occur at a very high rate, and in women they may come in with diagnoses of bipolar disorder, borderline personality disorder, anxiety and depression. Regarding this notion of widening the spectrum, the spectrum has always been wide, and that is finally being understood. Now we’re seeing that a lot of these co-occurrences are under the umbrella of an autistic neurotype. Depending on the co-occurrences that someone comes in with, they may require lower or higher supports needs. In the case of Dr. Stephen Shore, his current support needs might be more invisible, which is certainly the case for many autistic females, too.

Dr. Naseef will ask the females he diagnoses how they will feel if they get an autistic diagnosis or not. They often say they don’t care what the outcome is. They just want to know, whereas men and boys don’t seem to want to know, for different reasons since they might feel defective because of how they’ve been treated. The other thing about the world of girls, Dr. Naseef shares, is that the world is supportive of girls being quiet and different. The world of boys is very competitive. One of the problems that girls and women have talked to him about is having a different best friend every year where that friend becomes a special interest and it wears them out, and then they make another friend. It’s a common pattern that he hears about.

Specific to Females

A lot of autistic women feel they’ve been ‘too much to handle’ in their lives, which can impact self-esteem because you’re not trying to be difficult. Dr. Naseef says that having a child (or other family member) diagnosed and realizing that you share essential characteristic makes them question themselves. With social media, you no longer have to read academic papers to find other people who are speaking their truth, and you recognize yourself. He has others who say that they haven’t looked on the internet and don’t want to talk about other people but wonder if they are neurodivergent.

There are a lot of autism advantages, Dr. Naseef says, including being direct and having attention to detail, having great loyalty as friends and a strong sense of justice. Regarding bipolar, borderline, and obsessive-compulsive disorder (OCD), Dr. Naseef explains that if you have difficulty regulating emotions and it causes relationships to go bad, it’s very easy for someone going by the DSM to conclude that you’re a borderline. If you have wide fluctuations in mood, trouble with mood regulation that could be driven by sensory differences, it’s very easy for someone going by the DSM to call it bipolar disorder.

If you have repetitive activities that interfere with relating and communicating, are they really OCD, or can they be OCD in some cases, and just repetitive activities in some cases? Yes, Dr. Naseef asserts. The dividing line for OCD is that you do something because if you don’t there’s impending doom and disaster. For autistic repetitive activities, they’re soothing and self-regulating. That’s how these misdiagnoses of co-occurrences occur, he continues. It’s not looking at the big developmental picture, and not looking at the person you’re talking to as a unique human and just matching up what the doctor or therapist hears with the Diagnostic and Statistical Manual (DSM).

The whole movement around neurodiversity is really like a social justice, humanistic movement to just look at people as people, Dr. Naseef states. We are deep into this now, and there have been great contributions to this way of thinking that’s really taking hold including Barry Prizant’s book Uniquely Human and Steve Silberman’s book Neurotribes, along with many autistics who have led the way.

Monotropist Thinking

In the Autistic Masking book, they discuss Monotropism, which is not only about intense passions, but also about the way one thinks. I gave an example of perseveration of thoughts and Dr. Naseef says that it is autistic whereas obessive-compulsive disorder is about having to wash your hands 50 or 100 times a day or you think you will die. You have to go back and check that you turned off the gas on your stove for the 5th time or your house will blow up while you’re at work. 

There’s many more variations in OCD, but they have a different feel, and are all connected with some disaster, Dr. Naseef explains. Perseveration of thought in autistic people who are likely to miss social cues and feel the need to be prepared is not OCD. If the perseveration is after the fact, second guessing events over and over is about wishing things were different than the way they really were. While it’s human to question things, the perseveration makes it autistic, Dr. Naseef says.

Uniting the Spectrum

I asked Dr. Naseef why a parent could be late-diagnosed as autistic and have relatively lower support needs than their autistic child. He said it’s because we’re all different in our essence. We’re all made up of many genes and neurons. The world needs many different kinds of brains and there’s wide variability. There’s some non speaking individuals who communicate fluidly in other ways by typing, spelling, or using different devices like the Proloquo2go. Sometimes it leads to more spoken language. Some just speak late. There are many variations in autism, but they share the same core characteristics of difficulty socializing and communicating, sensory differences, and passionate interests, he says. 

This is how we understand it from a humanistic perspective, Dr. Naseef continues. From the medical perspective, you have to get a label to get accommodations and require a report about how you meet the medical label, when really, you’re just a differently and uniquely abled individual and human being. This is how our system works, he laments. Everywhere in the world where autism is being diagnosed and studied, the incidence seems to be the same, which is about 3%.

I posed the question to Dr. Naseef that I hear some parents say: You don’t speak for my child. Dr. Naseef understands what some parents are saying and what some kids are saying. Dr. Naseef was a second opinion on a diagnosis of a boy who was autistic in a regular classroom and who was very verbal. The boy said, “But I’m not like those kids in the autistic classroom. I’m not like them.” Dr. Naseef replied, “You actually are, but you have some skills that they don’t have, and you don’t belong in that classroom.” Now, some 7 years later he proudly tells everyone he is autistic. If we had adequate supports, we could make a big dent in education where nobody deserves being in that segregated class.

Adult autistics can shed light on why autistic children behave the way they do. The DSM really describes the stress response of autistics more so than characteristics, I added, and comparing that to a neurotypical norm. Look at the Double Empathy Problem where autistics seem to socialize fine with autistics and neurotypicals fine with neurotypicals but not when they’re mixed. Dr. Naseef says that there is so much we can learn from autistics who can can express and share what it’s like to be autistic. Dr. Naseef learned so much from Dr. Shore when they met about 30 years ago. 

Dividing the spectrum dilutes the power that we can have united, advocating for everybody’s needs whether they’re low support or high support. Everybody needs the support they need. Disability is a function of society’s ineptitude of including people in the social fabric.

Who says that suffering is a competitive sport? Dr. Naseef says that we all function and roll the way we roll. It’s really important throughout the community at every way of functioning to look at and focus on the strengths because the society that we live in has chosen to focus on the weaknesses. When we focus on our strengths, accepting how we are, that’s how we grow, according to our individual abilities, and getting the supports we need along the way, which is really the DIR way, he adds.

I presented another argument I see around adult late diagnosis: “There are lots of people with problems in the world. You’re just having some other difficulties. Everybody has struggles in life. Aren’t you taking away from others who need the help? Isn’t it a privilege to know yourself better even though you never really had a problem with it?” For other autistic mothers I know, that self knowledge helped tremendously with their support needs and being able to request for the support they need. To diminish another’s reality and refuse to validate someone’s difference that makes living in this world more difficult and more trying seems inhumane to Dr. Naseef. Alcoholism and eating disorders are very common co-occurrences with autism as well, Dr. Naseef adds.

The Medical Model Hasn’t Caught Up

This week I had the privilege of co-presenting the following presentation at ICDL’s 2024 International DIRFloortime Conference: Lived Experience Matters: What We Can Learn from Autistic Floortime Mothers and Daughters. The mother of two autistic daughters shared that she had severe post partum depression (PPD) that she now believes was autistic burnout. The medical model hasn’t yet caught up with the lived experiences of autistics, she stated. The way they treated her PPD was not helpful at all. Cognitive Behaviour Therapy (CBT) to her felt like she was gaslighting herself. The autism diagnosis gave her the self-knowledge that helped her understand her support needs.

To be effective, treatments need to be adapted to the individual, Dr. Naseef explains, and that’s often not what’s happening. We can’t really wait for the medical model, Dr. Naseef says. We have to just go forward as best as we can. I shared that the information on neurodiversity online is exploding and Dr. Naseef agrees, but says that we do have a long, uphill battle with the medical model and he has to have a foot in both worlds to make a difference. Diagnosis is just a label and identity is understanding who you are and how you experience life, and many have intersecting identities including gender, ethnicity, and faith, and differently-wired brains is just one of them.

It’s very common in autism as well to have different gender identities. Dr. Naseef says that gender non-conforming identities occurs at least twice as much in autistics. I acknowledged that as a DIRFloortime person, myself, and Dr. Naseef having a foot in the DIRFloortime world, we may not be as cutting-edge as some autistic self-advocates sites are, but we are allies and we are learning. It was an enjoyable conversation!

Autism in Girls

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This week let’s think about people in our life that we grew up with and wonder about neurodivergence. 

For example: Can you remember classmates or relatives as a child who exhibited neurodivergent signs? Did you interact with them? Were they discouraged from being who they were or were their differences cherished?

Many thanks to Dr. Naseef for sharing his experience of diagnosing females with us. I hope you found it as helpful as I did and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

This Week’s Podcast

I am absolutely thrilled to have returning guest, Educator Kasheena Holder back, who is a DIR-Expert and Training Leader with the International Council on Development and Learning and owner and director of Legacy, an inclusive school in Barbados where about 60 percent of her students are neurodivergent and about 40 percent are neurotypical. I would like to consider this episode a part two to three difference past episodes. 

First is my previous podcast with Kasheena called Creating Opportunities for Co-Regulatory Support, the second being the last episode on Gestural Development, and the third being the episode about Gestalt Language Processing because these topics are all so intertwined, and there’s so much buzz around Gestalt Language Processing. We want to distill it down for the DIR folks.

by Affect Autism

Bonus Insights

DIR Parent Network click HERE

We will never share your e-mail.

Reviewing Co-Regulation

I began this episode with a quick review of my first podcast with Kasheena in 2022 about Creating Opportunities for Co-Regulatory Support. Kasheena made many subpoints in that podcast as well, but this is basically what Brookes was talking about, too, last episode with the gestural communication.

Co-regulation is the process of connecting to our child’s emotional state and supporting our child to feel heard and understood so they feel safe in their emotional experience and can be calmed through our connection.

What I liked in our first podcast was the focus Kasheena put on us, just like Dr. Stuart Shanker talks about in self-reg, and just like when we do the sensory processing profile on ourselves first. She talked about checking in with ourselves with how we’re feeling in the moment and accepting that it’s ok because that allows us to activate our co-regulatory capacities.

Our parents weren’t really nurtured in that way, and their parents were going through world wars, I pointed out. But being in that space is what Greenspan focused his whole theory on: his affect diathesis–avoiding those catastrpoic emotional reactions by co-regulating off of our caregivers through preverbal affective signalling.

The Beginning of  Co-Regulation

That’s such a powerful place to start, Kasheena states. So much of what we do and who we are is at the foundation of our affective signalling, she says. She always thinks of T. Barry Brazelton and how he’s looking at afterbirth and how infants are in that space of practicing their innate regulatory capacities. At the point where the stimulation–internally or externally–is more than they’re able to organize around, they start to give stronger signals like crying, or changing their affect, so the caregiver can come in and support them by co-regulating.

That connection supports them to becoming more regulated and organizing that capacity to develop regulation, Kasheena explains. It highlights how relationships are essential, and as human beings we’re looking to make connections and support ourselves in being robust affective signallers and signal receivers though our relationships. In the work that we’re doing, Kasheena continues, the journey is thinking about how efficiently and effectively that other person is taking in our affective signals. 

I pointed out that when we see a baby in distress, we have the DNA in us to reach out and calm them with baby talk. We’ll even see grown burly men be nurturing. And I think it was Dr. Robert Naseef, who co-runs a father’s support group out of Drexel University, that said that with men you’ll often see that kind of affect with their animals. They might feel uncomfortable showing that nurturing affect around humans but will do it with their dogs, for example, saying “Here, boy! C’mon, little fella.“

Affect Before Language

When our children get verbal, we tend to rely on the words and forget about that preverbal signalling. If our children are not speaking, we can tend to think we’ve tried everything so we stop communicating with them when they don’t respond. That might be changing now as there are so many more neurodiversity-affirming families emerging because there’s so much on social media about Gestalt Language Processors, but when we talk about infants–are they processing affect in scripts and chunks?

When we talk about affect, maybe we can put aside the language processing–not that it’s not important, because we will respond differently to Gestalt Language Processors to promote their language development. Overriding all of that, though, is the affect that we share to make that child feel understood so they do feel like they have power to communicate with us, verbally, or not.

As an Educator, Kasheena says her foundation is not in the type of language processor a child is, even though she wants to be aware of what the child’s individual communication style in order to support them in regulating and developing. But as an educator, when she connects with her kids, and talks to parents, she asks them to think about how they are connecting affectively with their child to make meaning. That early affective reciprocity is the foundation for the understanding for making meaning, she asserts.

It starts in the affective state–that preverbal phase, Kasheena insists. We want to think of it as a consistently evolving thing. We still rely on our affective cues and anchor our relationships in our affective signals long after we are verbal and symbolic. Kasheena and I were not telling each other, “Let’s add some more words” in our conversation. We were aware of each other’s affective signalling as we were recording this podcast. We were responding to each other’s affective cueing.

Relationship Building

Kasheena continues that in times of distress where the world is too bright or too loud, when a child feels their caregiver’s voice more deeply, there is this affective presence that child can connect with. That’s where she meets her children at on the first day of school. She’s focused on how her and the children read each other’s affect as they build their relationship. And she points out that if the reading and sending of signals is not strong, then the future capacities in development will be harder on that child’s nervous system.

Kasheena says we must ponder how does the affect make me feel and how do I respond to it? We want it to build to meaning making and language acquisition. She doesn’t think about what type of language processor a child is in the building phase of the relationship. She wonders if Gestalt Language Processor are reading affect and signals in chunks during language acquisition. If so, then if we, as caregivers, do not give affect in this scripting way, then maybe the Gestalt Language Processor is not understanding and connecting with us. 

We want to support the development that’s needed as a child comes along and develops a relationship with us. In the Developmental, Individual differences, Relationship-based (DIR) model where we support an individual to move through the Functional Emotional Developmental Capacities (FEDCs), Gestalt Language Processing (GLP) is part of the “I“, or the unique differences of each child. We aim to meet each child where they are developmentally, through our relationship.

Neurodiversity-affirming research and the way autistic children develop is starting to explode. What I see is a lot of the children whom the medical model would say are in their own world, not making eye contact, but let’s think about the relationship. I gave the example of the movie Something about Mary where Cameron Diaz’s character had an autistic brother and her friend, Ben Stiller’s character, was the only one who could connect with her brother due besides her, due to the relationship they formed as children.

Struggling with Affective Signalling

I told Kasheena that parents may wonder how they can do affective signalling if their child is never looking at them? Especially when we do Floortime and follow the child’s lead, we can practice these affective cues. I shared that I recall being super aware as a young child of things going on around me that I ignored because it had no interest to me. I don’t say that this is representative of all children, but I do know that when I see kids who seemingly have no reciprocal interaction with their caregivers and I say something of great interest to them, they look at me and pay attention, listening more intently.

This is when you can practice this affective signalling. Then, when they get flustered and overwhelmed, they will have that capacity to co-regulate off of us through this affective signalling. But I stressed that we are not blaming caregivers who might say that their child has explosive emotional reactions despite trying to do this. It sounds very insulting of us to suggest that we just have to do a lot of affective cueing and eventually the child will co-regulate with you and everything will be just fine. We are not saying that! Autistic kids do develop differently.

Kasheena says that she tells parents that this is a journey. We are bringing two nervous systems together–and she might not use that language with parents. She’ll say that they are getting to know their child and their child is getting to know them. Sometimes you’ll get it, and sometimes you’ll miss it. That’s when we wonder what I missed and think about that for next time. It’s a process. We want to hold ourselves accountable in the journey of learning more about the human being whom we’re with, which might be more intricate than another family with a predictively developing child.

The Development of Co-Regulation is a Process

Kasheena says that the more we see developing co-regulation as a journey or a process rather than a ‘fix it’, we will come to a space of more acceptance of the stress it can bring, and we will feel a lot more open and safer as we’re navigating where the ‘just right’ nuances are to support another’s nervous system. We don’t have the exact tools or script. As a teacher in a classroom, she sometimes feels she is really gelling with a child and sometimes she notices that it just didn’t work. This makes her wonder about why the connection wasn’t there.

I mentioned that certain kids feel comfortable around certain people. It’s about that Relationship. Maybe sometimes two people just don’t gel, but there are things we can do to facilitate that connection so the person can feel safe and doesn’t have to keep their guard up, Kasheena offers. When Kasheena thinks of matching up a caregiver and a child, it brings up thinking about being open to the reflectiveness of the journey and the authentic discovering of who we are within the R we are in. Then, we will be more open to the nuances that impact that other nervous system, she says.

If we’re not in the space of, “What affect do I have? What’s in my body language? What’s in my ‘energy’ that I’m offering in this moment to this other nervous system that might not be matching?” then it’s difficult. If we really reflect on ourselves and adapt, making the internal affective changes–not cognitively thinking about it, but reflecting in that emotional space–then we can better connect to that other person’s nervous system so they can feel safer in that relationship to support their development, Kasheena shares.

Being Reflective about Connection

When we think about reflection in DIR, we talk about watching videos of playing with an individual, and in those clips you can see things you weren’t aware of in the moment. Certainly we all have different degrees of self-awareness, but when we’re watching we may see cues that we missed. It’s why in DIRFloortime, we suggest going over videos with a coach and it’s why we do reflective practice and supervision. I gave a less abstract example to relay the point.

Think about when you run into someone at the grocery store. Do you cower and think, “Oh no… there’s that person. I don’t want to say hi to them” then avoid them or are you really happy and excited to see them? How does your body feel? What is your affect telling you? Our kids are experiencing that. It doesn’t mean it’s black and white. That is, it doesn’t mean every time I see that person I will be annoyed or happy, as there are many factors that impact how we feel including if we had enough sleep or if we’re in a hurry, etc. This is why Floortime is so hard for some people because it can be so abstract.

I talked about the latest video from Yuji Oka who does adapted spiral praxis about the affective connection he has to make with his clients to work on feeling more comfortable in their body. In the video they say that this is not something that’s instruction-based, and you have to feel your way thorugh it. It seems like such a soft science, but we have that intuition about feeling connected or not with another person.

Practicing Co-Regulation

In our last podcast, Kasheena talked about reflecting and practicing affective signalling when we have time, instead of only thinking about it only when we are in a stressful situation. We need to nurture relationships as we go along. She says that in an affective relationship, children are gathering meaning through our tone of voice, through our intonation, through our gestures, through our expressions of self and emotions, and the more we do that, the more they are building that understanding. 

We want them to build that understanding because if they can read another’s affect and emotional state, and are learning to understand their own, then they can lean into that other person’s emotional and regulatory capacity when they feel catastrophic emotionally.

In Kasheena’s experience, children are more catastrophic because they aren’t able to read a signal of co-regulation in that distress. If they’re regulated and it appears they are reading each other’s affect well, but then they become distraught and the signalling is not as strong, it leads her to wonder how robust it was initially and how she can help to strengthen it by giving big gestures, holding them for longer, and sending clear, emotional, affective signals. She will wonder if she needs to have more nuances and subtlety in her emotional expressions so they can still read subtleties in connecting and reconnecting.

I pointed out that Dr. Stuart Shanker, among others, also mentions that there’s always something that lead up to that catastrophic reaction, so we can try to determine clues about what happened. Kasheena said that being a detective is difficult, though. Looking for all of these nuances is work, and can we really notice everything? Probably not. So, when we think about ‘being with‘ and having that affective connection, and we didn’t find that cause, we can still receive that affective signalling in a way that each nervous system is sending the message that I need you, I have you, we’re together, regardless of the solution.

This even goes into thinking about the fourth Functional Emotional Developmental Capacity (FEDC 4) where it is the journey of the problem, the wondering, and the discovery, Kasheena says. ‘We’ are not the solution. So when Kasheena thinks about self-regulation, it’s not always about discovering the trigger. It’s about feeling supported through this wave of emotion, and as the individual is supported, their nervous system is learning about how to feel supported over time, regardless of knowing the trigger.

This is the innate ability to share in these experiences together in a way that’s anchoring the maturity of it, so that if something unexpected comes, we’re still able to connect and co-regulate, Kasheena says. Of course, seeking the triggers is still helpful, but in the event that we cannot, there is still that connection and that affective attunement supporting the relationship. I thanked Kasheena for saying that, especially for parents who have a child with a Persistent/Pervasive Drive for Autonomy (PDA) who can have unpredictable catastrophic reactions.

I shared that I will be co-presenting with two other caregivers on October 21st and encourage you to attend! The presentation is entitled, Lived Experience Matters: What We Can Learn from Autistic Floortime Mothers and Daughters.

What Kind of Engagement is Necessary for Affective Signalling?

Kasheena said it’s key that our children can often cause us to think that they’re not taking in information because they’re not giving us the social cues we’re accustomed to, such as eye contact. She has long learned differently as a teacher. She has kids who are not comfortable with that direct, central, visual engagement, but they take in a lot of information through their periphery, and it’s enough to support their nervous system because clear and precise is too much for their nervous system. They are taking in the world differently. 

We need to feel comfortable in that space and accept that they’re engaging with us, Kasheena states. Also, are we only in reciprocal back-and-forth if we’re visually enagaged with a person? We have to be in the space of presence, attunement, and ‘being with’ versus ‘doing for’ as we build our capacity for that reciprocity, signal sending, and preverbal interplay. She’d also say that although it’s difficult at times where it appears we’re doing nothing such as laying together in a cuddle that’s more intimate, sharing time next to each other, that those are the moments where we’re practicing that preverbal affective signalling in the early stages, and we can build from there. 

It may feel as if you did nothing, but that’s ok, Kasheena says, because we’re helping the nervous system experience feeling comfortable in the proximity and presence of another nervous system. In that space, she says, we’re still sending those affective signals of care, warmth, and safety. These are the early foundations of reading each other’s affect that we want to strive to not forget, and to still hold very relevant in the big journey and process of affect signalling.

I added that you might feel like you have the connection with the visual contact, but if you sigh impatiently, your child hears that and it will set their nervous system off negatively versus making a positive auditory noise. ‘Being with’ is so important. Laying together might be giving your child’s body proprioceptive input. They might need to run around together having a dance party to feel relaxed and connected with you. We focus too much on vision and doing stuff, and forget about the rest.

This week let’s practice just ‘being with’ our child and feeling that emotional connection and attunement. 

For example: Let’s try to not use any words and be with our child when they are in a relaxed state. Notice how you feel without the pressure to do anything or have your child do anything. Notice how they are feeling. Notice any tension. Notice any emotional cues that they might be sending or any that you might be sending, such as a smile.

Thank you to Kasheena for reviewing this essential component of the DIR Model with us and really diving deep into the topic. I hope you found it as helpful as I did and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

Photo by Ketut Subiyanto

This Week’s Podcast

Brookes Barrack is a Speech-Language Pathologist and DIR-Expert Training Leader who has a clinic just outside of Kansas City, Kansas with Occupational Therapist Emily Tritz called Kansas City Developmental Therapies where they offer DIR services. This summer they became an official accredited DIR Organization. She originally trained in Floortime at ‘the Bunker’ with Drs. Greenspan and Wieder in Washington, D.C. and in the PLAY Project with Dr. Rick Solomon back at his home. This episode we are discussing Gestural development : The D, The I, and The R.

by Affect Autism

Bonus Insights

DIR Parent Network click HERE

We will never share your e-mail.

Setting the Stage

I set the stage for this episode by referring to the podcast I did with Gene Christian on Preverbal Affective Signalling and how important it was to Dr. Stanley Greenspan in his teachings of DIRFloortime. Brookes says that gestural communication is something she barely touched on in graduate school. Until she had the gift of Floortime training, especially with her mentor Sherry Cawn, doing video reflections, she truly didn’t understand the importance of gestures.

Brookes’ mentor would always say, “Tell me about his gestures” and she would wonder why it was so important because for years, as a working speech-language pathologist, she would check off the boxes on a standardized assessment during a language assessment talking to families hearing that kids weren’t waving or pointing, but didn’t do anything with that information. It didn’t lead her to further wonderings until Brookes started diving deep into DIRFloortime.

Brookes slowly realized that she was missing so much by excluding gestural communication and even now in her practice, she has a lot of field work graduate students who also say they haven’t learned much about gestural development. A lot of caregivers notice that their neurodivergent or autistic child wasn’t gesturing in the same way as siblings, for instance. Brookes says that looking at gestural development can help us support language because there’s a lot that gestures do for communication, and also to support working memory and long-term memory.

What are gestures and how do they develop?

Brookes explains that a gesture is just a movement of the body or limbs that expresses or exercises a feeling or idea. It’s an image in material form and she wants us to remember that definition for later. In predictive development, Brookes explains, it’s at between around 7 to 9 months when we see babies starting to gesture. Gesturing is easier for the body than the more coordinated motor plan of speech. If they’re representational gestures, we tend to see speech coming about 3 months later for that gesture. 

These gestures also bring in the ‘R’ (Relationship), too, because gestures develop with a caregiver. When a baby wants to be picked up, they reach both arms up and have a lovely back-and-forth with an attuned caregiver who picks up the baby. So the baby starts to learn that they have agency in this world. And so the more we as caregivers are responding to this development of gestures, the more we get the gestures back, Brookes explains. This is in the third Functional Emotional Developmental Capacity (FEDC) in the Developmental, Individual differences, Relationship-based (DIR) model. We always talk about how important this preverbal communication is before speech and language develop, and, of course, some children do not develop speech and language, but communicate in so many different ways.

Individual differences impacting Gestural Development

I shared that when I was getting questionnaires about my autistic son who’s now 15 and they asked if he points to things and look at you to show you what he’s looking at, I said that he did not, and then it must have been 4 or so years later when he started pointing at things. So a lot of times with this developmental model we see development unfold in these ways, but it might take longer in some kids and in my son, it’s been a lot longer of a process. But it still follows this developmental trajectory, even though it might look different. Brookes responded that we want to look at how a person’s ‘I’ (Individual differences) impact the developmental capacities.

Brookes went back to the example of the baby lifting up their arms for their caregiver to pick them up. Some kids might not have the postural control or the ability to sit up. Some may need both hands on the ground to be able to sit up, but you can’t have both hands on the ground and also bring them up. That doesn’t mean the child didn’t have the idea to reach for the parent, but at that time, this individual difference impacted the baby’s ability to do it.

This was a significant shift for Brookes in her thinking as an SLP, she shares. So if you answer on a questionnaire that your child is not pointing, then what do we do with that information? We want to wonder deeper about individual differences, Brookes states. It’s not that a child doesn’t want to communicate, Brookes says. It’s not that they don’t want to be part of a shared world with the rapid back-and-forth interactions. Something might be making that harder for them, so we want to know how to support it as caregivers. 

Relationship impacting Gestural Development

That’s where the ‘R’ comes in. When practitioners see some of these differences early on, then what can we do to support parents? Maybe we can see that the baby moved their eyes, but can’t yet move their whole hand. First, a baby moves their whole hand to point to something and then eventually you get that lovely distal point where it’s just the one finger, Brookes explains. If they can’t do that but they’re sharing some eye gaze, we as parents can then model it for them and interpret for them. So the more we can understand what gestures develop when and why, and for what purpose, then, the more we can help support parents and help support our own kind of therapeutic goals, Brookes states.

In his radio shows and writings, Dr. Greenspan talked a lot about how parents can think that their child isn’t interested because they’re not showing the development as expected, and so you kind of get this snowball effect where the parent stops engaging so much with the child, and then a child doesn’t get that interaction. And that can be like a self-fulfilling prophecy where the child doesn’t interact with you. What Brookes is saying is that we can educate parents and explore and be curious together about what the child is doing or not doing and notice those other cues like their eyes going up because they couldn’t move their arms up.

My little guy was a little butterball of rolls of chubbiness and cuteness. If I look back at old videos of him now maybe I see some signs of having a harder time doing certain things. The Occupational Therapists (OTs) always said he had a weak core because he was W-sitting instead of being able to have that strength to sit up. It’s different than strength because I could hold his feet and he could do a wheelbarrow walk, yet he slouches all the time. There are so many individual differences, Brookes says, that can impact gestural development. We want communication to be easy. Brookes is not looking for perfection.

My goal as a Speech-Language Pathologist is that every kid or team that I see feels like communication is easy and that they’re understood. Those are the primary things we should be working on.

Brookes is looking for meaning, and thinking about how to support children in their bodies and their ideation, and everything else. Individual differences like motor planning and praxis affect our ability to gesture along with postural control and visual-spatial skills because if we’re not watching others, it’s hard for us to take in that information because we can’t track. But relationship factors also impact gestural development. Think about parent attachment as well. If you have an insecure or avoidant kind of attachment, that child might be gesturing, but the parent might not respond, so the child stops gesturing. There are so many pieces that impact gestural development, and we can help parents understand what it is that the child is doing in a communicative way.

Holding Gestures Longer

Brookes says that if a child isn’t gesturing, we can hold our gestures longer. When playing with the child and you don’t know something, you can hold your hands up and shrug for a long time. Another piece about gestures that goes so well with Floortime is that you have to use affect. You can’t really gesture without using any kind of affect. It all goes together. Brookes says that sometimes people get confused with sign language and gestures and they’re very different, because sign and speech are stored and used in the same part of our brain, whereas gestures are in a different part.

Gestures allow us to fire up more of our brain, Brookes says. She took years of sign language as a student and worked in a deaf hard of hearing classroom. There was a teacher of the deaf who was deaf and one of the best paraprofessionals was a child of deaf adults. They were part of the deaf culture, and signers as their first language and Brookes could sign proficiently with them. When they told a story or read a book, they use more of a gestural type of communication and due to that affect, Brookes didn’t even need to know all the signs because the gestures helped her understand.

It’s not just the child gesturing for communicative intent, Brooke says. When we gesture, it helps the child process language better and process communication better, so we’re supporting their understanding, not just their expression, Brookes declares.

The Importance of Preverbal Affective Signalling with Gene Christian

Pre-linguistics are Pre-Social Abilities with SLP Mary Beth Stark

The Building Blocks of Motor Planning with OT Maude Le Roux

All About Praxis Part 1 and Part 2 with OT Joann Fleckenstein and LPC Mike Fields

Physical Therapy Part 1 and Part 2 with PT Mary Beth Crawford

And Interdisciplinary Approach

Brookes is so aware of so many factors as an SLP which speaks to the fact that this is an interdisciplinary approach that really helps parents. As a parent, I commented that not many parents have an education on child development. I have one child and I’ve only ever had one child, so I watched my child develop, and didn’t know if it was different than other kids or not. I could see that my child was fussier than the other kids in my mother’s group.  I knew he needed to move and later learned that his vestibular system really needs that input and his proprioceptive system needs input, so it’s so helpful to have this knowledge through a DIR approach.

DIR practitioners look at the why behind the behavior presuming competence, so wonder what’s preventing someone from doing something like communicating through gestures. Brookes says that often the Speech-Language Pathologist (SLP) is the first therapist who is contacted because parents want their children to speak. Often she will look at what needs to be done first developmentally, and sometimes her clinic takes a lot of Medicaid and insurance families, so they have to justify their therapy to those insurance companies. If families have to choose between therapies, sometimes Brooke will advise that they choose Occupational Therapy or Physical Therapy first.

The other therapist may need to look at what is happening with the motor planning system and the whole body picture. Thinking about what we do to help support parents, Brookes continues, oftentimes depends obviously on individual differences, but as a whole, she wants to look at the deeper why about why she thinks they’re not gesturing.

Supporting Parents

Brookes will educate the family on typical gesturing and have them do bigger, whole body gestures. She’ll get them to do many different kinds of gestures to begin with that grab attention, called deictic gestures. These are simple gestures such as when you look at the light, point to the light, and then label the light, or when you go outside and the dog walks by and we point to the dog and label it. The toddler may then start to point and say “dog” and eventually two-word phrases. 

Those kinds of gestures start first, Brookes explains, and then we go into more representational or symbolic gestures like putting your finger up to your lips and saying, “Shh” or when you change the baby’s diaper you wave your hand in front of your nose and say, “Whoo, it’s stinky!” Those are more symbolic, so we want them understanding how gestures develop what they look like as they develop. Next, Brookes continues, we want them understanding their child better to know what is happening. 

Brookes will also introduce a beat gesture where you’re talking and emphasizing language with your hands. The research on beat gestures says that when children use them, they show better narrative skills later. Watching the child gives Brookes information about where to support the parents whether it’s using more gestures or modelling gestures for them, or holding that gesture for longer. Parents tell her it’s working when they try, but they feel silly going around the room and/or outside pointing and holding a gesture using that affect while waiting. 

Brookes reminds us of the definition she shared earlier about a gesture being an image in material form, because once you speak, it’s gone and you have to mentally picture it. A gesture, on the other hand, can stay, so that’s one way we can support this is by telling families to use gestures more. Also, she helps them interpret what the child is doing with their body to communicate in order to interpret their gestures and make them meaningful to the parent.

Gesturing Supports Academics 

What Brookes finds so interesting about gestures is that they support us across a lifetime and we know this because they also there’s been lots of research that shows gestures can help support working memory and also can support long-term memory. We even know that if teachers are using more gestures when they’re teaching, it can support reading comprehension and even mathematics learning. This is so interesting because by holding the gestures and making the communication more meaningful with the affect, it helps the child make the connection and remember it better.

I’m willing to bet that a lot of kids like the teachers who use a lot of gesturing and affect, especially when they’re younger. Brookes shares that there is research using fMRI that demonstrated a change in the brain after implementing the Visualizing Verbalizing program. Parts of their brains were talking to each other that weren’t before. It’s a reading comprehension approach to help support concept imagery, Brookes explains because when reading, you should be making a movie in your head, which is the concept imagery.

It goes back to meaning making and how we have to have this imagery in our head, and then we get to play around with that imagery. It’s what locks us in and we can be in a different place, yet still remember. One way you can tell if a child is using concept imagery is that they start gesturing, Brookes shares. The research shows we are using a different part of our brain when we’re visualizing information and using a visual motor representation, which is a different part of our brain than speech. We need to activate working memory. A gesture allows us to hold on to the image and that’s what long term memory is, she says.

If we can use more gestures as parents or ask our kids to, we can see it having a role affecting working and long term memory. In fact, there’s research from SLP Sarah Ward in Boston who is an expert in executive functioning. You can tell a child to go upstairs and to put their pajamas on. If you instead ask them to ‘show and tell’ you their plan, they have to gesture it. They need to repeat back that first they are going to take their clothes and throw them in the hamper, then shower, then get their clothes out for the next day, put them on their bed, and get ready for tomorrow. This is different and they’ll probably remember it better because it’s firing up a different part of the brain.

Neurodivergent Parents

I asked Brookes about neurodivergent parents who may not gesture as much and so their children not only don’t have the same predisposition, but also aren’t getting that gesturing from the parent. Is it ableist of us to tell them they need to gesture more or are we just promoting gesturing to support their communication? We know that the neurodiversity movement is so relatively new and evolving since Neurotribes came out, and there’s so much information now on neurodiversity-affirming care, but there’s not a lot of research on autistic development, per se. We hear self-advocates saying that they develop differently. Is development just development for all humans?

In DIR we tend to believe that it can look very different for different individuals, and even so, that we all go through the same developmental process, although this is still to be determined in the research field. We believe it is neurodiversity-affirming in that we are respectful and do not force anybody to look neurotypical, respecting individual differences and wanting to empower everyone to communicate more readily. Brookes says that her goal is communication as an SLP. She will take any communicative effort she is given and say it’s intentional and meaningful.

If she has a child who is nonspeaking using a device, she won’t make them use her conventional gestures. They may struggle with praxis and use gestures of their own. She believes it is up to her to understand the client’s gestures and the meaning behind them through a strong Relationship. She honours that, and in that way she is being neurodiversity-affirming, she says. And when she talks about using gestures for working and long term memory, she can suggest to just try it. Even for caregivers, Brookes continues, she can suggest using more gesturing and just seeing how it feels.

Executive functioning is big now, Brookes continues, and we want to think about how to support that as well, she says. It’s just another modality and another piece of the gestures. The more we can give supports in visual form to everyone, the more we’re supporting their comprehension, which is support for regulation, she says.

Everyone wants to understand what’s going on in the world, and if we don’t, we tend to dysregulate.

DIR and Gestures

Brookes believes that the best part of DIRFloortime is that the evidence is not just rooted in blind studies, but it’s looking at all the other research that support it. When she looks at therapeutic goals and supporting parents, she examines what she is doing to support imagery throughout development, and supporting it through gestures is just one component. If she uses it in the earlier Functional Emotional Developmental Capacities (FEDCs), it will support her clients in their higher capacities. Holding the gesture longer, and using affect to hold that space is a part of that piece of emotion driving development, she says.

I shared that when I think about holding gestures for a longer time, I think of Dr. Gil Tippy putting his hands out to promote the child coming up with the next thing. Let’s all think developmentally about that deeper why, Brookes says. Thinking about that gestural development helps us chase the why and look at those individual differences and keeps us neurodiversity-affirming since all individuals are so unique and bring different things to us, Brookes says. I added that you you can’t teach developmental capacities as skills. I love how this model pulls so much from different disciplines into a theory that guides how we use all the information. And this podcast episode certainly gave me another way to think about it.

This week let’s practice gesturing with our children using a lot of appropriate affect. 

For example: Let’s try to point to things, gesture getting undressed and dressed, washing our body, and eating by bringing our hands to our mouth like we are putting a spoonful in our mouth. Let’s match our affect to co-regulate appropriately. That is, if our child is too upregulated, let’s exaggerate slow, quiet affect. If our child is not as responsive, let’s get bigger and a bit louder while still being slow and intentional with our gestures.

Thank you to Brookes for covering gestural development with us in such great detail and with such great tips for caregivers! I hope you found it as helpful as I did and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

Photo by Gustavo Fring

This Week’s Guest

Kerri Ciskowski is a DIR-Expert Occupational Therapist in central New Jersey who does in-home support through her service Therapy Keeper for families who are typically raising autistic kids. She is a happily married mother of 3 boys age 12, 10 and almost 8. Today we’re talking about in-home DIR/Floortime coaching which supports parents in unpacking ‘behaviours’ and finding connection and joy with their neurodivergent children. 

This Week’s Topic

Parents learning about Floortime often say that they understand the theory, but are still unsure about how to handle their children’s ‘behaviours’. There is no ‘prescription’ in Floortime, though, as each child and family are so unique. We discuss how you can figure out what to do in a great follow-up to the recent podcasts on Intentionality, FEDC 4, and FEDC 4 into 5.

by Affect Autism

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DIR Parent Network click HERE

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Setting the Stage

I set up a scenario that a family comes to Kerri’s service and she has to figure out how to support them. Kerri, I presume will be talking about that Floortime mindset where we look for the ‘why’ behind the behaviour, avoiding ‘teaching’ and ‘directing’, and looking at the sensory processing and individual profile of the child. Kerri says that what’s important when she meets a family is that she wants to set the stage before she even visits the home because it’s different than anything else they’ve experienced.

Kerri lets the family know that if the child is super interested in her when she arrives, and she establishes a great connection, she will run with it in the moment. She lets the parents know that they are a part of that process and if they have any questions, to write them all down because they’ll process it afterwards. The DIR model puts the child and family in the center. She’s never going to tell you what you need to do nor ask your child to perform. What she’s after–what families are always after–is the connection and the joy. This sets the stage for what the initial interactions are about, she assures us.

Appreciating Trauma

A lot of families are coming with so much trauma, including a lot of ‘icky’ experiences, Kerri says. She always wants it to look and feel like an environment where everyone is heard and loved. While this is typical for the Floortime community, Kerri continues, so few outside of it have experienced this. So when Kerri talks about the ‘I’, she wonders what that parent individually needs to have the capacity to even see the magic that’s unfolding in front of them.

The experience of trauma is as wide the individual differences can be, Kerri explains. I shared with Kerri how my son had a massive seizure and another 12 hours later, ending up in emergency, connected to so many contraptions that I didn’t know if he was going to die or if we’d be going home the next day. He was there for 3 weeks, then in a rehabilitation hospital for 3 more months. There, I saw children with very complex disabilities and felt guilty for feeling sad about what happened to my son.

It took me about four years to get over that post-traumatic stress without feeling guilty for feeling sad. I eventually realized that my son had many sensory differences from birth, and was born autistic. He is just like me. We have the same personality. Other parents face traumatic experiences with children who are banging their head or melting down a lot, and parents don’t know what to do to support them. Some children run off when in public, and sometimes you may lose your child, as discussed in this past podcast.

Meeting Families Where They’re At

Kerri concurs that when we realize that our child is not like other children we are overwhelmed. I shared that many find themselves in a behavioural setting like I did at the rehabilitation hospital where my 2-year-old was being strapped in a chair being asked to do menial tasks, and I hated it. It drove me to find Floortime.

Kerri says that Floortimers do an amazing job of holding space for this reality with parents. It’s such a big part of the story, she says. She loves working in homes to see the dynamics between the family members. It’s so organic in that way, she says. She prioritizes the individual profile, and often the conflicting profiles among family members, and she uses the word ‘trauma’ very carefully in a sensitive way, being sure not to project it on anyone.

Kerri and her team recently created two documents in Canva for families: Potential Triggers for a Parent of a Neurodivergent Child and Potential Triggers for a Neurodivergent Child which have both been very helpful for families to see because many people process things more visually. At Therapy Keeper, they are always meeting families where they’re at, but I asked what that looks like?

Wondering Together

If she has a mother who comes in with a fair amount of trauma and a child who is being triggered by something, Kerri looks at the ‘R’ (the Relationship) and the ‘I’ (Individual differences) of the Mom and why she’s feeling what she’s feeling, then separately looks at the child’s experience, the child’s individual differences and for patterns that often occur in autism, and then figures out in real time what’s happening.

If a Mom is saying, “Let’s go brush our teeth” and the child is in the middle of an activity, the child didn’t know they had to brush their teeth, they’re a Gestalt Language Processor (GLP), they don’t like brushing their teeth in the first place, or maybe their expressive language is very robust and they want to negotiate why they shouldn’t have to brush their teeth, this demand that the mother is putting on the child will not go well. It might be her childhood experience. She might be flooding the child with questions.

Kerri would say, “Here are the things that I’m wondering…” She says that her responsibility is to the family, wondering with them, about them, about the child, and getting the parents’ wheels turning as to why things might be falling apart. Kerri says that what might seem simple to a Floortime practitioner might be mind blowing to some parents, such as them asking a lot of questions when the child is dysregulated.

Kerri uses a lot of video footage in her practice without it feeling ‘icky’ or without parents feeling put on the spot. She also uses a lot of home cameras where behaviours might happen, such as during meal times, then they can go back and analyze it later. That shift–something that might feel so foreign to a family, yet is a standard tool for Floortimers who see it so clearly–might be something a parent has yet to see. When you make those simple shifts, Kerri emphasizes, it makes such a huge difference.

Without wanting to sound like a saleman, Kerri has literally seen this shift transform families. She tells people as one Mom to another Mom, whether you engage in her services or not, she needs you to know about Floortime!

Setting up for Success

I provided an example of what I do at home with my child who is verbal. We build structures into the day so every day is as predictable as possible. We get up, eat breakfast, go to school, come home, ‘relax’ on the iPad while I prepare dinner, eat dinner, play boardgame, have a bath, read a few books and then go to sleep. I shared that many families use visual schedules to show their child what’s happening which can help during transitions.

Kerri says that predictability affords a child the capacity for something else. They have a certain energy or battery capacity for the day. We’re making their day so predictable to reserve their capacity to problem solve things that come up that will challenge them, Kerri explains. Kerri aims to set a family up for success and finds that she can often see where minor shifts can help a family, such as the predictable routine. 

Schedules are critical components. But she’s also looking at how they handle transitions and she’s looking at the profiles of the parents. Many parents struggle with their child not wanting to leave their screen to come upstairs to brush their teeth, for example. Her team recently did a social media post on double standards that helps the parent take the child’s perspective.

Kerri asks parents if they’re watching TV would they want to stop watching mid-show? She also thinks about parents being on autopilot, always in a go-go-go mode. Often families have something planned out in their head, but haven’t conveyed that to their child, she explains. In the brushing teeth example, she says, the plan wasn’t shared with the child, and the mother had beautiful reflections about it afterwards. 

Parents’ plans aren’t transparent. She encourages them to share them in a clear and kind manner. Floortime is relationship-based. There’s nothing more than having solid relationships, including your relationship with yourself, Kerri says. She likes to help parents with having a schedule, visuals, and doing a lot of reflection about how transitions are being managed every day. Kerri created a document of 20 different transitions that parents may not even think of that she used with one client (some of which are documented here).

People moving into your space is a transition, for example. A child might find someone coming into their space to be very disruptive. Kerri continues that in standardized testing, the number one executive functioning challenge that comes up is shifting from one activity to another.

Kerri looks at all of the intricacies–which is what Floortime is, she adds–wondering about it together, and helping a family move away from the medical model, cookie cutter version of things. She instead gets them to think about where their child is getting caught up and struggling.

Kerri aims to figure out why parents are showing up the way they show up and what experiences brought them to where they are. She helps parents hold space for not judging that and empowering them. She says that we can all make a conscious decision to how we show up for ourselves and to others.

Tips for Parents

I asked Kerri that I can still hear parents asking, “What if I shared the plan with my child and they just won’t go along with it?” Kerri asks if it is a child who is aversive to demands (i.e., a PDA profile, aka Pathological Demand Avoidance, aka Pervasive Drive for Autonomy)? Kerri says that that can be an entire different case, but try to infuse a bit of humor, which can be hard at the end of the day as a parent.

She suggests giving autonomy to the child by asking things with tons of affect like, “Should we fly to the bathroom sink or march like soldiers?” Always gear this to the child’s interests so if they’re into sharks, ask, “Should be go like a hammerhead shark or fly like a great white?” Some kids might like a race to the bathroom, but it might trigger others. The child might prefer using one bathroom versus another. Think of what will peak their interest.

It might be sequencing that helps, Kerri continues. You might have to say that first we’ll brush teeth and then race cars to the bedroom. If kids are interested in books, she’ll suggest social stories. In a social story, she’ll start with a positive thing, then the experience of the child’s experience, such as “I might feel frustrated“. Next, you give them options like, “If I feel frustrated when mom asks me to brush my teeth, I can…” 

I shared that Dr. Karen Levine said that the part where the child is scared is always left out of typical social stories! Educator Jackie Bartell always says we have to set the expectation, for example, “We have to brush our teeth.” In social story, Kerri says that what it’s doing is giving meaning to the social experience. Having meaning behind why the expectation is important then they might be more willing to do it.

You could also watch YouTube videos of what you want your child to be able to do. Dr. Karen Levine suggested doing this with my son around clipping his toenails, and he absolutely loved the video and asked to watch it repeatedly. Kerri asks who is the favourite aunt or uncle? Get a picture of them brushing their teeth, she said. I said you could also brush teeth together with your siblings or parents. Kerri said they also use dolls and brush their teeth.

Regarding giving agency, Kerri says that if they like the cartoon Paw Patrol, get them a Paw Patrol toothbrush. Also, beware of the flavours in case they don’t like mint, Kerri adds. The message here is to stay hopeful, Kerri encourages parents. Stay curious and you will find something that works. Sit in the space of “I’m going to figure it out“, she urges.

What to do about Screentime

Parents continually share that they struggle to get their child off the screen. Kerri first tries to understand the family’s opinion around technology. Some say it’s ok and it’s regulating, so there’s no limit. Other families see that the more screentime the child has, they have less opportunities for play and their instinct as parents is to get the child off the device. Kerri wonders how polarized it is between the different caregivers and wonders about what that looks like.

Research supports the claim that screens are wildly addictive, Kerri adds, and quotes Dr. Stuart Shanker who says that you can’t have self-control if you don’t have self regulation. She says that also Dr. Stanley Greenspan talked about the developing mind pointing out the importance of whether or not the child has the capacity to easily move away from a screen. Kerri reframes what that could feel like for a child.

For some kids, she explains, it’s a certain amount of time they’re allowed to use their screen. For some, the limit is one show. For others, it’s the type of show. A YouTube clip has a new screen cut every two to five seconds, but if you can find a show that stays with a plot, maybe that’s a better fit and can make for an easier transition away from it. Maybe you only make screentime available on the big television so the parent has control of the remote, she suggests.

Kerri has worked with bridging where she’ll have a picture to colour from the show they watch so when it ends she’ll stick with the content of what they watched by transitioning to colouring the picture. You can also use a step-away process where first a sound or a timer goes off, then you lose the picture. Next, you lose the sound. She says that you have to know your child and be willing to try things.

What is a brilliant game-changer strategy for one child can cause another child to melt down, Kerri emphasizes. Doubling down on outdoor time is an underutilized strategy, as well. Get out in nature with the sun on you, moving your body, away from constant stimulation inside walls with a lot of sounds and music. Sometimes our kids need to experience that. Kerri adds that if a child starts to understand what it feels like to be outside on a trampoline, on a scooter on a nature walk, or in the pool, and those neurochemicals start to feel really good, they might be more willing to put the screen down.

I also suggested making the screen a shared experience where you’re watching a show together and connecting around it, when you have time, but once you’re in the meltdown or struggle, it’s too hard to figure it out. Kerri likes the idea of stepping back and reflecting on it and how to make changes going forward. I’ve also heard that when a child has visual-spatial challenges, sometimes screentime can make it worse because we want them to see things in three dimensions, interactively in movement.

Being Prepared

Our brains are very nuanced, Kerri says, so let’s refer to the Floortime concept of attunement and look to our child’s cues to attune to them to figure out what feels like you’re moving in the right direction. And just like a child uses scripts, parents have to have their scripts, too, Kerri says, like a bank of things to say in that heated moment. 

Your child might have a hard time to do some things spontaneous. Kerri has a Commonly Used Phrases document that parents can put on their phone and inside their kitchen cabinet or where they keep their glasses, to have it handy when you need to use it. These are things parents can say instead of asking a lot of questions, Kerri shares.

Kerri likes to talk about a sensory lifestyle where families are prepared, knowing the things everyone’s body needs to stay regulated. Kerri has tools to up- or down-regulate. To down-regulated an overstimulated child, she suggests reducing your pacing, anchoring yourself in space, and lowering your volume.

I shared that for transitions my son’s preschool had a soothing song “Tidy up… tidy up… everybody tidy up, let’s go” clapping to the slow rhythm that helped keep the children regulated. Kerri says that we always want to start the transition saying something the child likes in a calming way in the regulation and pacing in a way that works for your child.

Non Speaking Children

I asked Kerri how she works with families who have non speaking children who may have apraxia of speech and motor challenges. Kerri will demonstrate herself how to be with the child to take the pressure off of the parents for a moment. She wants to show how you get that shared social engagement and connection in a way that you presume competence and build beautiful reciprocity–a fundamental thing in early communication.

Kerri says that some families said to her that she came in and didn’t bombard them with a million questions and just connected with their child so they got to see her do it in real time. This is one of the best ways she says that they can support a family. She also notices another theme that comes up when a child isn’t talking. The family stops talking back, especially if there’s a verbal sibling. There’s not an intentional ignoring happening, but it ends up being that the non speaking child is ignored.

Kerri says that you have to think about creating opportunities for communication. Build reciprocity even if there isn’t a verbal output. I shared that the podcast on Preverbal Affective Signalling I did and the podcast on nurturing intentionality might be helpful where we discussed how holding that space with your child to see what the child does is so important, versus feeling the pressure to do something. Kerri stresses that a child can get used to nobody responding them so give up trying. Keep persisting and trying.

Floortime is about Shared joy

Kerri says that you are the toy for your child, and there are some toys that change the chemistry between you, such as blowing up a balloon or spinning toys. Sometimes having a ‘thing’ helps when parents say the child isn’t responding or initiating and they are stuck. The toy isn’t the answer, but it might be the spark, Kerri explains. When the parent sees the interaction, it ignites a bit of hope and less defeat and you can build from there.

When parents aren’t using a Floortime lens, they’re looking at things differently. I talk about looking at the strengths in the We chose play documentary. We were in the Hanen program and I’m blowing up a balloon and letting it go. My son had these beautiful strengths in his early Functional Emotional Developmental Capacities (FEDCs), but I didn’t have the DIR lens yet and only saw what he wasn’t doing. Since discovering Floortime, I’ve watched these FEDCs bloom in my son.

Look at your child’s strengths. Kerri often tells families to measure backwards. For families who really need to see that evidence, you can then see that in November the child wasn’t doing x, y, and z, but in July they are. They wouldn’t have believed it back in November. It’s powerful in the reflective process to look at how far you’ve come. You always want your child to be seen, heard, and loved at their fullest potential. It’s ok to want more, but celebrate where you are at.

This week let’s think about the points Kerri shared with us and reflect on minor shifts we could make to help our connection with our child. 

For example: Are you sometimes in too much of a rush and directing your child when your child has ‘behaviour’? Let’s think about how we can slow down, share our plan, use a visual schedule, and/or incorporate something your child likes into the transition using fun affect.

Thank you to Kerri for sharing her resources and telling us how she works with families in such great detail. Please visit her blog, her fabulous Instagram page, and resources at her website. I hope you found it as helpful as I did and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

Photo by Tima Miroshnichenko

This Week’s Episode

ToniAnn Loftus is DIR Expert and Speech-Language Pathologist. She trained at the Rebecca School and now owns and operates Seaport Speech and Feeding, a clinic in Manhattan. Today we are discussing inclusion in schools with a specific focus on speech and language and how she can bring the Developmental, Individual differences, and Relationship (DIR) Model into the classroom to make it accommodating for all students. This is a nice follow-up to my podcast with Kim Kredich who, along with her family, was a keynote speaker at the March DIR conference in New York City.

by Affect Autism

Bonus Insights

DIR Parent Network click HERE

We will never share your e-mail.

Seaport Speech and Feeding

ToniAnn’s practice includes children from age 1 to 10. Depending on their needs, ToniAnn works with neurodivergent and neurotypical children at home and communicates with the school on their behalf. Sometimes does in-service work at the school where she’ll talk about what communication looks like, what development looks like, what sensory looks like, and how different communications come out, which can be through behaviour.

ToniAnn also sees children in her local community within the classroom. She’ll work with their Special Education Itinerant Teacher (SEIT 1:1 aids) and Occupational Therapists (OTs) to make sure their day is enriched with speech and language, such as joining their morning meeting or a cooking activity, and bring visuals for the classroom. She finds that the teachers will use the visuals for all of the kids in the classroom and continue to use them when her in-service is done.

Buy In from Classroom Teachers

I asked ToniAnn if she does a follow-up with the teachers. She finds that 99% of the teachers do follow-up and ask for more because maybe they have a child in their class who is on the quieter side and because of the changes they made after ToniAnn’s training, that child now feels like they have a voice using a visual aid in the classroom. She can also help the teacher take any book and help make it a Floortime experience for any class.

Many teachers and directors request learning more about sensory systems and Floortime after ToniAnn’s coaching and ask how to incorporate moving in their preschool. I commented that she must be thinking about movement so much due to her interdisciplinary work at the Rebecca School where she learned so much about the sensory system. Indeed, she says. She points out that you get a lot of buy-in from teachers when they recognize behaviours of children as sensory challenges or communication.

Movement and Meaning Making

After my DIR 202- The DIRFloortime Certificate of Proficiency Course, I had mentoring with an OT in Hawaii named Kiegan Blake who drilled that point into me about bringing what you’re playing into three dimensions. When my son was sliding down into the ‘water’, I used our blue lycra sheet as the water. It really helps with regulation at the first Functional Emotional Developmental Capacity (FEDC 1) and following the child’s interests if they like water.

Bringing the play into movement helps to solidify the concepts so the learning sinks in and motivates the child to communicate more since you’re using multiple parts of your brain, ToniAnn explains. Kids are more motivated to talk and communicate because they feel more successful, she says. They feel like they can point and gesture to communicate, even if their voice is failing them or they can’t get their words out due to apraxia of speech, for instance.

Toni Ann will ask children to show her what they want and if it’s a cup she’ll say the word ‘cup’, smiling. The child then gets to hold the cup to get the touch and feel of it and they’ll smile feeling understood. This motivates them to communicate more because they were understood.  That joy at the second  Functional Emotional Developmental Capacity (FEDC 2) makes them want to communicate more, ToniAnn explains, because you’re helping them form meaning.

Holding up a cue card of an apple doesn’t teach you about an apple as much as biting into an apple does, tasting it and feeling its weight, as Dr. Stanley Greenspan would describe. ToniAnn said that Dr. Gil Tippy explained to her when she first started working at the Rebecca School that if you haven’t heard the roar of the crowds, tasted the hotdog and felt the ketchup drip down on your chin, how can you be a Yankees fan?

When I joked that this is a very American example and that I didn’t like hotdogs nor ketchup, ToniAnn pointed out that even tasting the hotdog and not liking it is an emotional experience! ToniAnn added that many toddlers will eat something and make a yucky face while saying, “Yummy“. She will comment that it doesn’t look like it’s yummy. I shared that my son does the opposite. He says he doesn’t like it but then tastes it and wants more.

What about AAC?

Many parents in ICDL’s parent support group that I facilitate use Alternative and Augmentative Communication (AAC) devices with their non speaking children. ToniAnn said that she will introduce AAC to classrooms as many teachers are not trained to use AAC. She will often use visuals in classrooms for teachers first. It only helps communication. She will typically just observe the classroom for the first day to see how they’re phrasing what they’re saying. Are they making demands or just inviting comments?

ToniAnn tries to have them wonder how they can pay attention to everyone using AAC rather than centering out that one child who uses it. Everyone can use AAC in a functional way. I brought up how Andrew Klein brought up in our recent podcast on Reflective Practice about modelling and how this also came up in my Parent Perspectives podcast with Cass Griffin Bennett, who modelled both low and high tech AAC with her daughters.

I wondered how receptive teachers are to using AAC devices. ToniAnn explained that it’s tough on the teachers if they’re not supported. Most of the teachers have a general education background, but not working with special education needs. ToniAnn would rather they tell her that they have no knowledge about it upfront so she can support them. Getting the kids excited and involved in it helps them understand that it works for everyone, she shared. 

Many of the students feel excited that there’s opportunities to learn within the context of their classroom when they can use AAC. Teachers see ToniAnn use it during morning meeting then are excited to use it the next day themselves. It’s like learning a new motor plan, ToniAnn explains. Having someone model it for you makes it easier and as they do it more and more, it becomes a new part of their day and doesn’t feel like a daunting new task.

Speech is a Fine Motor Skill

Speech is the finest motor task there is, ToniAnn explains. When we think about learning something new for the first time, speech is like a motor plan. We have an idea in our head, we want to execute the idea, and move our mouth in a coordinated way to produce speech, she continues. If we learn the word ‘cup’, for instance, we want to be able to say ‘cup’ every time. Joleen and Lynn’s course on praxis and motor planning for speech is one ToniAnn recommends to practitioners.

ToniAnn talked about how when you start with gross motor movements so kids have to think less about their movements, their fine motor will eventually improve. Let’s teach kids how to use words while they run and jump first, ToniAnn suggests. We want to think about how you can break it down and make it easier. If you work more on gross motor, kids feel more successful, then eventually you move on to the fine motor skills, she says.

It’s not just about the sensory system and vestibular on the swing and then their sensory systems are awake you talk more, ToniAnn said. It’s about the mechanics of their mouth, how they move, and how your brain works, she explained. I shared how we had worked with Occupational Therapist Maude Le Roux going to her clinic’s intensives and my son had a phase where he started licking everything, starting with licking his dad’s face, then his friends at school.

Maude’s theory was that because he had gone through a round of Tomatis listening therapy to effect auditory processing, she believed his mouth was starting to awaken and feel new sensations to clarify how he spoke. Although I could mostly understand him, others couldn’t. Toni Ann said that it’s all interconnected. It’s all the brain processing information. His brain was trying to gain more information Licking felt good and gave him more information. Every child is different.

Development Doesn’t Skip Steps

When our kids are developing and not on a neurotypical pathway, they do things that neurotypical kids do years later, such as mouthing objects that babies do. My son did that when he was 3 or 4. Gene Christian talked about children grabbing parents’ glasses. Babies reach for their parents’ face and our kids are doing it later. My son started pointing at things about four or so years after they were asking me at appointments if he was pointing.

Development doesn’t skip steps, Toni Ann, says. Everything builds on everything else. That’s why she loves Floortime. Everyone follows a developmental plan and everyone will go at different rates. Toni Ann’s 4-year-old son burnt his tongue on hot soup and couldn’t tell her, so he looked at her and licked her hand. He was trying to get whatever was going on with his tongue off. It clued Toni Ann in to the reason and she realized he burnt his tongue and was able to tell him what happened to him.

A Focus on Communication

There are children on the autism spectrum who don’t start speaking at all sometimes until they are 6 or 7. ICDL’s board president Emile Gouws did not speak until he was 15. People didn’t think he would ever talk. There will be some autistic individuals who will never speak. They will use AAC devices to communicate. Dr. Joleen Fernald said that she’ll never make a prediction again about which children will or won’t speak after being wrong about it in the past.

I asked ToniAnn how we approach this with parents or teachers. She asks them how they feel when they are given a question in a crowd. Would it make them more or less likely to be able to respond? They maybe never thought of it as feeling like a quiz, she says. There’s talking versus communication. ToniAnn focuses on communication and how we can enhance it. After a few sessions with her, she can say, “Look how much better they are motor planning and letting us know what they want.“

We are always looking to improve a little bit more, ToniAnn says. We want to think about how we can support our child to feel heard. Let’s give the child space to show us how they feel most comfortable communicating. This will be a lifelong process, ToniAnn stresses, figuring out how they want to communicate. She has met kids who are poets, but don’t use verbal speech. Let’s celebrate each child as an individual, she emphasizes again.

Things are Slowly Changing

The world is slowly starting to understand that different children communicate differently, ToniAnn believes. Now people understand that each individual is different and the way we each learn is different, which makes it harder for teachers, but it’s starting to be recognized. Ideally we want teachers to notice “That’s different. Let’s celebrate it and support it” versus saying “I can’t do that!“

At the Rebecca School, ToniAnn shares, they would take the students out into the community and one time at Trader Joe’s a student started throwing apples. Her regulation plummeted along with the child’s. A worker there recognized them and introduced himself to the child and asked his name. He explained that we can’t throw the apples and asked him to help pick them up. It was so kind and supportive, letting the child have the time he needed to pick up the apples and put them back.

Process over product, ToniAnn says. That person could have been angry at Toni Ann or the child, but was instead supportive. Toni Ann taught a DIR 101 Introduction to DIR and DIRFloortime course in Heber Springs, AK where people from the entire town came to learn: the Walmart greeter, a police officer, teachers, parents, the librarian–they all came to learn how to interact with autistic kids in a way that’s productive for families versus being punitive and were there to learn how to support each other.

How do we have a sensory space in the library to support the children during storytime, for instance, was a wondering. A bunch of them then took the Basic Certificate Course, DIR 201 with ToniAnn and a few went on to the next course, DIR 202, as well, with another trainer. It was such a great experience for ToniAnn to see this community’s dedication.

Promoting Communication

Autistic self-advocates advise providing AAC as early as possible while children are learning, even if they do end up speaking. Even if they do end up speaking, some individuals will prefer texting over speaking verbally. ToniAnn says she, herself, prefers texting so she can think about her response. By asking adults how they communicate, it gives them insight into how their child might communicate.

Toni Ann shared her use of low tech AAC with her son on her Instagram account. She put pictures of the snacks that were in the cupboard. Her son would point to what he wanted, then open the cupboard and get it. It helped solidify the meaning of what each picture meant until he could speak, ToniAnn explained. If she had drilled him to say that he wanted a ‘bar’, it would have made him feel anxious. She is more interested in overall communication. The nonverbal comes before the verbal.

We talked about recognizing cues our children provide which is their way of communicating if they can’t make their body or mouth work how they want. ToniAnn shared that Dr. Gil Tippy presented a talk called, “What are you doing?” to the Rebecca School staff about how you walk into a room and read the cues of everyone to figure out how to enter the space just ‘being’ versus ‘doing’, gauging the environment before engaging in big affective communication.

ToniAnn will observe how a parent is interacting with their child and see if it’s a match. Video recording is so helpful so you can see how far a child has come, but also so you can see how you are at reading their cues. The way a child reacts might tell you that you’re giving them too much information with your face, affect, and volume, for instance, ToniAnn explains.

Too Much Communication

I asked ToniAnn about kids who talk a lot. Toni Ann says it’s serving a purpose. It could have to do with liking the auditory input. If you are in a home where the TV is always on in the background and people are talking, that input feels good to you. If the classroom is quiet, maybe they are talking to get that feeling. It ‘could’ be a reason why. How can we give that child more input to make them feel more comfortable?

Maybe you can start with every child having a chance to give a shout out to start the day, ToniAnn offers. Reframing is always helpful. You can reframe what a student is doing. They’re seeking auditory input or more movement, so think about how we can help them get that in different ways.

More Helpful Tips

Use visuals, ToniAnn stresses. Visuals are simple. You can use your mobile phone to take photos of places you go, your child’s school, and things they do around the house so they can visualize what’s happening. Having a red circle on the floor where they sit during morning meeting can support them going to morning meeting. Having a rolodex of things in their classroom that can help, ToniAnn suggests.

ToniAnn also suggests using picture boards on the back of their IDs for when they’re out in the community. It’s one thing to say we’re going to a new park today versus showing a photo of where you’re going and saying that it’s a new park. Take the time to explain and show the visuals because it is very helpful, she says.

Working with the deaf and blind community, ToniAnn has also learned about backgrounds. A black background with white print is easier to see than black type on a white background. You can label pictures with words. Think about things as a whole in the classroom that we can then use for everybody, ToniAnn suggests.

At Seaport Therapy, ToniAnn can help parents wherever they are, virtually. Sometimes it just takes a tiny little tweak to make a big difference. She learned so much at Rebecca School working with Dr. Gil Tippy, Toni Tortora, Andrew Klein and so many more. She is grateful for all of the training that lead her to where she is today.

Floortime is for Everyone

Floortime is for everyone, ToniAnn shares. It helps understand how we are learners. Getting DIR into more schools and to more teachers will open doors. Floortime is not just for kids with specific challenges and support needs. ToniAnn is excited to share that with others. They’ll start to think about things they can ask Occupational Therapists (OTs) and bring them into the classrooms. They’ll consider how to support kids on the patio and kids jumping all over each other. OTs should be in every school. If we start looking through this DIR lens, schools could be more inclusive, ToniAnn concludes.

This week let’s use visuals with our child, if we don’t already, to provide alternatives to communicating and be mindful of not being too demanding with questions. 

For example: Take photos of places you go to regularly and/or items around the home that you use, and show them to your child to inform them of where you’ll go frequently before you go, and/or giving them choices between items you have in the home–whether toys, food, clothes, or something else.

Thank you to Toni Ann Loftus for taking the time to record this episode with me about promoting communication for all in the classroom. I hope you found it helpful and insightful, and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

Photo by NEOSiAM 2024+

This Week’s Topic

The topic of this episode is trauma through a DIR/Floortime lens. Maude Le Roux recently did a course on this topic through the International Council on Development and Learning and here she covers how to work with trauma clients through the Functional Emotional Developmental Capacities (FEDCs). This complements the previous trauma-related podcasts I’ve done with Galina Itskovich and Erin Forward and Taylor Anderson and focuses on the DIR/Floortime aspect of the work.

This Week’s Guest

Our returning guest, DIR Expert and Training Leader and Occupational Therapist Maude Le Roux has a DIR/Floortime clinic, A Total Approach, just outside Philadelphia, and a satellite location just outside Allentown, PA. She is an international trainer in many other modalities as well.

by Affect Autism

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Trauma and Autism

Everybody’s talking about trauma and there are so many podcasts, blogs and articles about it. I haven’t felt worthy of covering this topic for a long time in a head-on way, but Maude is joining me this episode to take a DIR lens to the topic. My son’s medical trauma and the trauma I still face when I think about what happened to him, being in the hospital for four months following severe brain inflammation at the age of two, is one type of trauma. Autistic self-advocates talk about the trauma they face from attempts at being normalized by adults throughout their childhood.

Maude begins from the platform of an autistic individual having trauma. She points out that there are a lot of pieces to consider. Trauma is housed in the brain, even if we don’t recall it everyday. Trauma in an autistic’s life can be very different from other types of trauma, she says. They might be going through trauma, but because somebody says to them, “This is our secret“, they keep the secret. It will come out behaviourally, perhaps through stimming, and it’s just labelled as autistic behaviour. We may be missing the cues when autistic individuals are going through trauma, which is very tough.

In trauma you have the same structures that may be enhanced, like in the amygdala, that are enhanced in autism as well. Then, the biggest intervention in trauma is talk therapy. How can you do talk therapy with someone who doesn’t understand how to describe the emotions they are feeling? There are so many things to think about, Maude continues. The experience of trauma is very real. The numbers of trauma and anxiety are staggering, Maude says. Exponentially, autistic individuals are four times more likely than the neurotypical population to experience trauma when looking at the ACES data (Adverse Childhood Experiences).

At FEDC 1

Since the beginning of being asked to work with teams around trauma, Maude has used DIR/Floortime because it just fits her and the way she likes to work with anyone. It’s respectful and makes sure you are harnessing the individual differences. When considering the first Functional Emotional Developmental Capacity (FEDC 1), Self-Regulation and Interest in the World, we want to think about what self-regulation means and what having a regulated system means, Maude asserts. It’s a safety system.

FEDC 1: Self-Regulation and Interest in the World

FEDC 2: Engaging and Relating

FEDC 3: Intentionality and Two-Way Communication

FEDC 4: Complex Communication and Shared Problem Solving

FEDC 5: Using Symbols and Creating Emotional Ideas

FEDC 6: Logical Thinking and Building Bridges between Ideas

FEDC 7: Multiple Perspectives

FEDC 8: Gray Area Thinking

FEDC 9: Reflective Thinking and an Internal Standard of Self

When you’re looking at trauma and FEDC 1, regulation is about getting into that safe zone so you can comply to the rigor of everyday life and meet performance expectations, Maude explains. When you’re looking at regulation in trauma-informed care, you’re looking at how to create safety and providing that container within which the individual can find a ‘place of landing’, having an anchor to co-regulate and pivot around to create this order of safety.

When you’re working with trauma in autism, Maude continues, you have to know that the regulatory system will keep resurfacing even more when you’re doing the trauma work. If you’re talking not autism, every single FEDC capacity that you’re climbing is going to be a place where dysregulation can happen at a much more rapid rate. The trigger of the super vigilance of the sympathetic arousal is so high in individuals who are trauma survivors, Maude explains.

So when you’re looking at FEDC 1, you may see in a non-autistic population, that they’re highly verbal and in the emotional phases at FEDC 5, but needing the safety of FEDC 1 throughout the entire process. You’re not looking at them as ‘levels’ of a step ladder. Regulation is always a consideration. The concepts of Floortime (co-regulation, wait-watch-wonder, pacing at their pace, joining them where they are at)–all of these wonderful, golden techniques–are so instrumental for trauma survivors.

The Safety Principle

The first thing that came to my mind as Maude and I were talking was an autistic child whose parents put their child in an intervention that tries to normalize them and every time the child sees that person, they’re going to get dysregulated. It may take them hours to calm down and feel safe again after being with that person who is making them do things that are unnatural to who they are.

Maude says that’s why it is so critical with the lens we are operating from. Yes, there’s the trauma lens, but what are our own biases and frames of reference, Maude wonders. It doesn’t matter what population we are serving. Safety becomes the therapy she insists. We have to beware of violating that safety principle. 

If you look at the work of Dr. Stephen Porges on social engagement and the ladder that’s climbed from the ventral vagal, dorsal vagal to sympathetic arousal and the beautiful work of Deb Dana, Maude continues, we know about that co-regulation response from that neuroceptive “am I safe here or not” feeling. When you add in these components, Maude says, you can realize that you might be working at FEDC 5 to 9, but you still need to be working on safety with trauma clients.

If the safety is violated by a particular technique, Maude continues, that will add on to what has already happened to them, she asserts. In trauma-informed care, besides creating that safe ‘container’, thinking of the use of self in co-regulation, looking at not only the individual differences as the profile is now, you also have to remember that the trauma is never over when it’s over. The trauma trigger can be just as alive and real even if it’s years later, Maude states. The past becomes the present. You are re-triggering and re-traumatizing the individual. 

Talk therapists are shifting in their dialogue from wanting survivors to talk through their trauma, and focusing more on working on the body and how it’s holding and keeping the score, as Bessel Van Der Kolk says. As therapists, it’s a serious consideration: Am I adding to the trauma, or am I allowing the person to be who they need to be in this moment? So, in therapy, Maude says, it’s essential what kind of a framework you choose.

Lingering trauma

A few thoughts came to me. We can think about a child or pet who was abused by a man and they are then scared of all males. The trauma stays alive and comes back when they see men. When my son had brain inflammation, I was an emotional wreck and my husband said to me, “Do you like being depressed? Why are you watching all of these stories of people who went through what we did?” while I was wondering why I never saw him cry about what happened to our son. 

Then my mother-in-law had a conversation with me saying that everyone processes these experiences differently. When she is sad, she likes to watch a sad movie to cry to so it comes out. At some point days later, I came home to my husband telling me he watched a sad movie about a man who cared for an autistic son then found out he was dying and he said that he balled his eyes out. I realized that this was his way of letting out the grief of what happened to our son. 

Trauma doesn’t have to be physical or sexual abuse or something super horrific. There are so many types of trauma. When we moved out of downtown Toronto to be closer to our son’s school, I was out for a run and saw young boys playing baseball and was struck with sadness from out of the blue, realizing that my son would never play little league baseball like my brother and I did growing up. 

Trauma can hit us when we don’t expect it. Many parents of autistic kids have these experiences, and this gets into the concept of Ambiguous Loss that I discussed with Dr. Robert Naseef.

The Traffic Circle of Frustration 

Another thought I had about what Maude said was that Dr. Gordon Neufeld talks about emotional playgrounds. One thing he finds astounding is that people avoiding emotional healing, which is the way around everything: to soften the heart and feel these emotions, which means feeling that sadness about things you can’t control. That emotional release is what helps your brain adapt and move forward with resilience, he states.

His whole definition of resilience is to have the tears (physically crying, which contain cortisol the stress hormone), or sadness about realizing that there’s nothing more you can do versus being stuck in that traffic circle of frustration and anger where you circle around and around trying to change stuff that you have no control over. In his work he talks about that shift from being in that traffic circle to adaptation.

Think about how frustrating and traumatic it must be to be in a body that doesn’t do what you want it to do when you have severe co-occurrences with autism. We are hearing now from autistic adults who have learned to spell or communicate in other ways that they understood everything happening in their childhood but couldn’t communicate that.

Feeling ‘Felt’

As a therapist in the room, Maude says, we are resonators of feeling felt, heard, and seen because when you’re a trauma survivor you feel like you don’t have a rightful place and feel unworthy. Any trauma is not chosen. It happens to you and you have to wonder why it happened, Maude says, and everybody struggles with that. This changes the way you build your self-identity.

All of us wish to get around these struggles versus going through them. This is not the talk for today, though, Maude insists. The issue is that every experience that we have depends on our own temperament and resilience that we have, and as Neufeld says, we are too focused on the end product in which we lose the process of how we get there. 

The truth of all the empathy research is that we need to have empathy for ourself as a trauma survivor, Maude explains, and then empathy that we can then shape to feel for someone else, too, so the community at large can have compassion for each other. This is a very different animal. That comes only from that processed orientation to emotion. 

The DIR Way

Maude often says to families when someone important passes away that you should bring the child to the funeral. You need to find a way for the child to express the fear and anxiety, rather than avoiding it to ‘protect’ the child. A lot of the work in trauma, too, lies in FEDC 5 when we’re trying to get some symbolic understanding of what the trauma means to my life, how do I embody what has happened to me, how do I figure out where I stop and where someone else starts, and that I have an identity and it’s not broken.

Something happened, and it’s hard, but I’m not broken. I’m here. When we, as therapists, Maude continues, in DIR/Floortime show the client that I’m here for you and you matter, that my time with you is a worthy time spent, and that I find myself valuing our time together–when we give that message–the client gets it, Maude says. That’s the Floortime way. We’re going to be together. We have this time where we can value each other. At the end of the day, we know that being with each other matters, Maude stresses.

At FEDC 2

This is where the Floortime perspective and the use of self comes in so much, Maude insists. When we look at FEDC 2 (Engaging and Relating), it’s a crucial place for a trauma survivor because what they want to do is disengage or dissociate. They want to go through the motions, but don’t really want to be in the moment because ‘in the moment’ may bring them too close to feeling what they don’t want to be feeling–the triggering, the flashbacks, or that the therapist is going to expect more of me than I’m prepared to give.

Maude specifies that we’re not talking about the same engagement challenges from an autistic individual that is avoiding because of individual differences or not understanding the moment in a fragmented moment of time. It’s a different flavour when you’re working with trauma, Maude says, and the combination of trauma and autism can be really hard. When you’re working with a trauma survivor on engagement, you’re working on messaging. Whether the client shares the details or not, we’re stressing that you matter enough for me to engage with, Maude explains.

Maude says that we can say to parents, “This was hard.” There’s nothing we can do to change it. It is what it is, but we can say that we want to spend time with you and make it happen for you and take this journey with you, together. When you do this, in the DIR way, the family feels at home. It opens up and enlarges the picture. It’s not just a bubble around them that’s feeling so hard. As a therapist, you can expand the bubble to include one more in the family’s village to take this journey forward. It is powerful.

The Safety is the Therapy

If I think about my son’s experience, as I mentioned in the podcast about medically complex children, whenever my son sees someone with a band aid on, he gets triggered. He had numerous IV changes and blood tests in the hospital when he was 2 years old. He is so concerned when he sees a band aid or ‘boo boo’ on others. In a Floortime way, we can explore that. 

Maude says that there’s so many things about fear and in psychotherapy they can do exposure therapy. But what we often see, Maude explains, is that when you create the safe space, children know themselves what they need to work on. In trauma, she’s seen it over and over. When a band aid is an issue, it will come up. She doesn’t even have to initiate it. 

When the safety is there, they will face their fears, but without the safety, there’s no holding them because they can’t face it alone. This is why she says that safety is the therapy, and the playful approach is the approach that provides the safety. Maude gave an example of a child who played with having predators in a jungle, with all of them facing towards the middle of the scene. The child played, talking herself through it, making the animals come closer then go back. 

Then, the child took a little toy toilet and put it in the middle of the play. The child wants to do a sleepover so badly, but wets the bed. The toilet went in the middle of the scene and she didn’t touch it as she played with the predator animals around her, representing the threat of the bed-wetting issue. The therapist didn’t say anything about the toilet. The child needed to face the threat and be the animals and also be the victim. 

Two weeks later, the child stopped bed wetting. They didn’t even talk about it. It’s the beauty of the Floortime method, Maude says. The child knows where they need to go. Some of it is hard stuff, Maude says, but when you create this safe container, the healing starts from within. And it’s their process. I mentioned that in Maude’s trauma course, the example was a child who had experienced intense trauma and Maude showed how they went through the FEDCs in their play with the child.

The Brain Doesn’t Forget

It makes me think that that’s why my son is so interested in people getting hurt in shows he watches and playing with figures having broken limbs, putting a cast on them, and going to the hospital after all of his fears around having been in the hospital when he was two that are probably subconscious at this point. Even going to the dentist can be traumatic when strangers come at you wearing a mask and gloves, carrying tools, for a child who’s had medical trauma.

Maude brought up another complex case she worked on where a girl seemed completely fine except that she could not handle buttons of any kind. They had to do a lot of hard digging. They found that the child was in and out of the hospital as an infant and the nurses would lay her against their chest where there were buttons on their shirts. That feeling of buttons brought back the trauma and was part of the trauma trigger. It was such a learning curve to figure out what it was because there was no tactile defensiveness. The brain doesn’t forget, Maude says.

At FEDC 3

The way memories are laid down is through the sensations of the moment and the emotions associated to those sensations, Maude explains. Anyone working with sensory or emotional trauma clients could trigger them, Maude says. That’s why DIR is such a safe method, with regulation, engagement, then working on the two-way discourse providing a medium of safety. 

The activity doesn’t matter. There’s a rhythm of back-and-forth. Eventually up pops the thought from the client, Maude shares. In trauma, you have to be careful with that because in Floortime you’d usually say, “Hmm… I’m confused” whereas in trauma, you don’t, Maude asserts. Maude explains that if the client is already at FEDC 5 and 6, her and her team are just adding the foundation at FEDC 3 and 4 to give the client a better time at FEDC 5 and 6. 

In trauma, they’d just keep the back-and-forth going at FEDC 3 because you know the memories are coming up in fragments. When you dream at night, it’s not really sequential, Maude says. It’s fragmented. It’s also what happens when these fragments of memories come through in therapy, she explains. You just accept it. If you said, “Wait, I’m confused” they’d shut down. So you just go with it in trauma, which is different than working at FEDC 3 with autism, Maude explains.

At FEDC 4

Maude continues that at FEDC 4, having the structure is as important as with anyone. Depending on when the trauma occurred, the client may struggle with the stages of structure–building enough of the amygdala, the praxis, and motor planning in getting there. The client’s nervous system got stuck at the time that the trauma occurred. 

Then the development that had to come after that which is still part of myelinating the brain, Maude says, doesn’t happen at the stage or age that you want it to be, so you have to re-structure FEDC 4 and spend a lot of good time there to help them find a place where the emotion can land, Maude explains. They create many, many stories. 

Another thing that’s different from autism, Maude continues, is that when a client is building their structures of stories in FEDC 4 in Floortime, we tend to put playful obstruction in there to get the sequences out in that problem-solving, but in trauma you don’t. You will do the whole thing about role play and make sure they’re taking in your role, as well as their role, and you don’t challenge as you might in FEDC 4 in autism. 

Instead, you work on constructive problem-solving from their notion and their perceived reality, Maude stresses, because their perception of the reality is going to be very skewed, based on what they’ve experienced, and a lot of that reality distinction doesn’t happen until FEDC 6. But in FEDC 4, you’re putting down the structure on which that reality base can land later to improve their perception that this present moment is the present moment and the past is the past, Maude offers. 

At FEDC 5 and 6

You are creating experiences in FEDC 5 and 6 where the client is having many more positive experiences around the same emotions that, over time, can replace the bad memories associated with the same triggers, sensations, and emotions, Maude continues. The more you’re building those positive experiences with the same emotions and sensations, the further away you can move away from being triggered, even though you can’t forget. It’s about decreasing the impact of the trigger, Maude shares.

I shared that if anyone hasn’t yet listened to the previous three podcasts, and especially the last podcast where Maude talked about building the structure at FEDC 4 for FEDC 5, please go back and look at it so you can better grasp what Maude is talking about.

Parent Regret

What I heard Maude say answered the question I had in my mind. Parents often regret giving their child an intervention that may have caused their child trauma thinking that their child will never forget and be triggered by them. Maude just said that we can work through those experiences in play and work through the FEDCs to recreate a new, safe environment that can slowly overshadow the old experiences.

Maude says that you only know what to do at the time you know how to do it. What you did at the time is what you thought was best, so be kind to yourself. Our brain is plastic until the day we leave this earth, Maude states. You can change any brain, despite the child’s age. Can we say perfection? Nobody’s perfect. But we can make it functional and we can decrease the triggers over time when we apply safety and security, she says. 

This is where we need to know who is in the village around you. Are they speaking the same language? One thing that DIR/Floortime gives us is that the social worker can do it, the speech therapist can do it, the educator can do it, the occupational therapist can do it. They all talk the same language, which is so much less confusing for the child.

When we all do that, one is not doing exposure therapy while another is doing injection therapy and vagus nerve stimulation, another is doing DBT, and another CBT. Is the team all using the same sense of safety? Maude has had sessions where she simply sat on the couch watching YouTube videos with a client. She’s seeking a sense of connection because the child isn’t willing to give. She’s trying to enter the child’s world to be able to bring them into her world to show the child it can be safe.

Parents, let the bus of the past go by, Maude suggests. She knows it’s not easy. You did the best you could at the time. Every decision you made, you made because you thought it was good for your child, and that must be ok. Maude hopes that families choose DIR.

Magnitude of the Trauma

Trauma is such a loaded word. When you talk about the ACES (Adverse Childhood Experiences) such as poverty, war, divorce, abuse, etc., these can all be labelled as trauma and everyone experiences trauma differently. But, there is a feeling out there that some traumas are worse than others, so I asked Maude what the idea of little ‘t’ is where there’s a bunch of little traumas that add up over time (versus being raped or watching your parents getting murdered or some horrendous trauma).

Maude says that it’s only the perception of the child at the time. What might look to us as a little ‘t’ trauma, may have been big in the child’s perception and that memory stays big until they get through it which is until we can get through it in a way that can transpose of the magnitude of the event. The perception of the trauma survivor at the age and stage that it happened is what is the magnitude of the trauma, not how we as adults look at it, Maude says.

The parent or adult can think that the child is being overly sensitive. It may be a little ‘t’ for us, but in the child’s perception, if it was a huge piece for them, then we better take it seriously, Maude cautions. If the perception is the bigger piece of it, we need to really consider that even the small ‘t’ can linger for a very long time, and it does in Maude’s experience. It therefore behooves her to really look at it without regard to how big or small the event was in our, the adult, perception.

Stimming and Trauma

I asked Maude about what she meant when she said earlier that some autistics who have been through trauma might stim more. She said that you need to pay very close attention to stimming if there has been trauma. Most Floortime therapists don’t call on stimming. We know the client’s individual differences and that their vestibular system needs support, and perhaps they’re trying to access vestibular input through their visual system, for instance. There is a reason for it. Always give space for the stimming. 

Maude says that she is trying to figure out why the individual needs to stim right now. What happened just before this? Maybe this was a release after a hard activity. She will allow them to release the tension then redirect to a movement activity to allow them to release it through the movement. Maude starts to see that the client gets relief from the movement activity, such as going on a swing, for instance. Where there is stimming from trauma or a sensory need, it’s the same, Maude says, but she might give it a bit more time, depending on the individual’s profile.

DIR is a Valid Approach for Trauma

DIR is a valid method for trauma in many ways, Maude says. The DIR/Floortime approach is a respectful, warm, embracing way of helping somebody feel that they’re worthy and that “I want to be with you and I want you to be with me and I want you to feel felt and feel me. I want you to see my kind eyes and voice so you can reach within and bring yourself in the moment.” Maude hasn’t found another method that works as well. 

Plus DIR is developmental. Plus it’s respectful to the unique individual differences. Plus it enhances the family and brings the parent to a place where they can connect with the child. Floortime just gives you this fullness that can reach out at so many different levels and bring peace, Maude shares. If we do this, tomorrow will always be there. Maude always says that today is the scaffold for tomorrow.

If I harness this moment today, Maude continues, then tomorrow already looks brighter because I use what I have. This is what I have. I can’t control what happened in the past, but I can work on what I have now. Making today count is so helpful to decrease the anxiety about tomorrow. I added that all of this is through the power of relationships and through connection with each other.

This week let’s practice creating and/or maintaining that place of safety for our child.

For example: Are we putting extra demands on our child that we need not be doing? Let’s attune to our child’s emotional state to make sure they are not shutting down in response to us by ‘collecting before directing’, joining them in their interests and sharing joy together at their pace for as many moments of the day as we can–especially on the weekends.

Thank you to Maude for this informative podcast that really was helpful for me in understanding how to use the DIR lens in thinking about trauma. I hope that you found it as helpful as I did and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

Photo by cottonbro studio

This Week’s Topic

The topic of this episode is to give an overview and review of the fourth Functional Emotional Developmental Capacity (FEDC 4) of the Developmental, Individual differences, and Relationship (DIR) Model from last episode, an overview of the fifth FEDC, and to discuss how one moves through FEDC 4 into FEDC 5. 

This Week’s Guest

Our returning guest, DIR Expert and Training Leader and Occupational Therapist Maude Le Roux has a DIR/Floortime clinic, A Total Approach, in Glen Mills, PA, just outside Philadelphia and a satellite location just outside Allentown, PA. She is an international trainer in many other modalities as well.

by Affect Autism

Bonus Insights

DIR Parent Network click HERE

We will never share your e-mail.

The Fourth Functional Emotional Developmental Capacity (FEDC 4)

Two episodes ago, we talked about the third Functional Emotional Developmental Capacity (FEDC 3) and moving into FEDC 4. Last episode we dove into FEDC 4, and this week we are recapping FEDC 4 and bridging to FEDC 5 in the Developmental, Individual differences, Relationship-based (DIR) Model. Maude says that everyone always asks if their child is there yet, about FEDC 4, and the bridge between FEDC 3 and FEDC 4 is a huge bridge to climb.

FEDC 1: Self-Regulation and Interest in the World

FEDC 2: Engaging and Relating

FEDC 3: Intentionality and Two-Way Communication

FEDC 4: Complex Communication and Shared Problem Solving

FEDC 5: Using Symbols and Creating Emotional Ideas

FEDC 6: Logical Thinking and Building Bridges between Ideas

FEDC 7: Multiple Perspectives

FEDC 8: Gray Area Thinking

FEDC 9: Reflective Thinking and an Internal Standard of Self

FEDC 4 is the structure on which everything lands, Maude explains. It’s the whole social-emotional understanding of having a social discourse and problem solving around a social-emotional level of being. If I want you to understand my thoughts without me always explaining them, then we need to have FEDC 4 in place, Maude explains. Theory of Mind–understanding another’s perspective–is where we get that ‘shared’ part of problem solving. The important word there is ‘shared’, Maude continues. 

It’s not cognitive problem solving. How do we help each other to understand my thoughts versus your thoughts, and my opinion versus yours? How do we negotiate now that I will pretend to be Captain Hook and you’ll be the pirate, and then we’ll switch around? When we understand standing in another’s shoes, the beautiful work of empathy starts, which is the food of shared problem solving, Maude says. Maude says it’s emotional. It’s cognitive. It’s language. It’s practical on a praxis level. That’s where the depth of FEDC 4 really lies, she says.

We can construct what the jail will look like, how many bars it will have, that it will have a key, and we figure out how to build and structure it from our mind. We have to negotiate if we now have the praxis piece of the sequence of the structure, then how do we lay the sequence of pragmatic speech on top of that, then how do we take both of those constructs and put the story onto it that develops from the beginning, middle, and end, that contains visualization, ideation, imagination, and creativity.

When we then bridge into FEDC 5, Maude continues, the sympathetic arousal that comes with emotions has a place to land. If FEDC 4 is not in place, there’s no place for the emotions to land, and there’s no construct to hold them, and no container to understand them. There’s only a fear that the emotions will be overwhelming. When we have FEDC 4, then when we get into the true depth of the plot and understand what each emotion is, then we have to be sure that the child has the capacity to hold and contain it and not feel overwhelmed, Maude explains.

Bridging into FEDC 5

When I started learning about Floortime, Dr. Gil Tippy told me the biggest leap is that jump from the concrete world to the abstract world, which he felt happened at FEDC 5, whereas Dr. Greenspan thought that happened at FEDC 4. Once you can co-regulate off of another person, you no longer need to have catastrophic emotional reactions. I like the way Maude described that the emotions have nowhere to land without FEDC 4.

I couldn’t wait for imaginary play to start in my son and many starting out place imaginary play in FEDC 5, but it actually starts in FEDC 4. Maude says that at a rudimentary level, which is representational–the child represents what they see people in their life do and put that into some frame of understanding for themselves in their play, or imitate scenes they see in a movie–imaginary play starts in FEDC 4. A child will stay with what they’ve seen.

It’s only when you start expanding away from that, by adding more complexity with more emotionality that you bridge into FEDC 5, Maude says. There is an emotional component in FEDC 4, for sure. Dr. Stanley Greenspan used to say that the only way you get to FEDC 5 is if you have 60 or more ideas in one session, Maude recalls.

That ideation doesn’t mean it has to be full-blown emotional recognition. It means there’s a bridge that collapsed, and I can make a plan to fix it, Maude explains. I don’t have an airplane right now, but I can make this cell phone look like one in my mind.

A ‘Container’ to Fall Back Onto In FEDC 4, Maude continues, you start to visualize and put things to the concrete in front of you that don’t have to be completely concrete. Visualization is a structure from visual-spatial skills and FEDC 4 is where that happens, she says.

When you have an emotion, you get a sympathetic arousal. How do you discern the emotion so you don’t become overwhelmed if you don’t understand what’s happening when you get the physical response from it and don’t have anywhere to place it? Social becomes a scary world here, Maude cautions.

In FEDC 4, when things come a bit more contained for you, you can start to make sense of why Mommy is giving the soother to your sibling and you want her to spend more time with you. You can wonder what the limits in this preschool class are. If you don’t have a structure, it remains scary and something to be avoided, Maude explains.

If kids can’t bridge into FEDC 4, they want to skip FEDC 5, and use cognitive logic and cognitive ways of becoming more left-brain, systemizing problems into certain categories, and if it doesn’t fit, they’ll avoid it, because the emotional grayness that we need in FEDC 5 is not available. There’s not enough structure for it to land, so they pull away cognitive skill from their structured executive, praxis ability. 

As it pulls away more and more, the disconnect between mind and body grows, Maude explains. The big piece we need to take that executive function to a place where the emotion can feel safe enough to explore is FEDC 4, so it’s crucial. Don’t rush it. Stay with it. The sturdier it is, the more we can do in FEDC 5, Maude encourages.

Staying at FEDC 4

I remembered my son being at Maude’s clinic wanting to build a big wall out of the firm, colourful pillow gym blocks. Maude said he had the ideas, but didn’t have the motor planning to build it himself, so he’d tell others to do it. He would place a triangle piece down on the tip so it would fall over. Motor planning comes in FEDC 4.

Maude also talked about beginning, middle, and end, and having timing and sequencing in FEDC 4. There’s so many aspects in FEDC 4. My son’s been in FEDC 4 for the better part of 7 years. Maude says that for some kids it does take longer. This is often where they see a lot of compassion and empathy for their families at A Total Approach, Maude shares, because things aren’t happening in the time frame parents expect because of how society tells parents that their child is delayed. It’s so important to support parents through these phases where it looks like their child isn’t developing.

There are many nuances to FEDC 4, but in it, an individual is working on praxis, language, visualization, and ideation, so it’s very important for clinicians to let parents know and help them understand that ‘FEDC 4’ is only the category of a wide range of things to be explored. Autistic exploration often lands up in single files, Maude believes, so it can take awhile for the single files (of praxis, language, etc.) to come together, then be translated into play.

It’s not that the child is not moving forward, Maude reassures us. It’s simply that FEDC 4 is a complex capacity so they have to focus on the different components of the capacity. It can feel like the child is plateauing and it can feel like you need to change therapists, but Relationship is so important, and we don’t want to send the message that relationships are not permanent and not to be trusted.

If you feel like a child is staying at the same place for too long, remember that if the child has a good relationship with a therapist, this is such an important piece. Maude talked about how going slower is how we move faster in a previous podcast. Maude says that without FEDC 4, it’s impossible to get to FEDC 5.

What FEDC 4 Imaginary Play Looks Like

I explained how my son’s play went from enacting a PJ Masks scene with PJ Masks characters years ago to now watching Curious George and enacting the scenes from it with Super Mario characters, or using a LEGO cart to be an ambulance in representational play, which is more complex than before. We can’t force our kids’ development. It comes from them when it comes. We can just provide ideal conditions, Maude stresses.

Maude says that the complexity is increasing. If your child takes the characters they like–whatever has foundation for them and their curiosity and what is comfortable to them–and if these characters start completing different scenes from what he has seen before–creating a novel storyline or creating a calamity that they have to solve, which is completely unique to that story–this is when FEDC 5 is emerging.

Maude continues that this is why Floortimers say to expand the play, along with promoting circles of communication. When you start seeing scenes like my son is doing–crossing over from one character series to another–then you can say, “I’m so scared…what am I going to do?” Once he starts putting his own story line with those characters with a production of a beginning, middle, and end, he’s emerging into FEDC 5. 

When he is facing me with an emotion, he has structure–visualization and imagination in order to say, “It’s going to be ok!” Then you can reply, “I don’t know… I’m really scared“. Then he can say, “Come under this pillow!“, figuring out that when I’m scared, I can feel safe under the pillow and that safety will feel better. I get safety and now I get my play partner’s part, and now we’re negotiating both.

See ICDL’s Newsflash entitled 6 Ways to Help Untangle FEDCs 4 and 5

Bringing Reality into the Play

I found rainbow colours of painter’s tape and made a spider web across the banister at home for my son. My son grabbed his plastic Super Mario figures and stuck them to the tape. Then, I put a piece of tape joining two of the pieces of tape, from the higher one to the lower one, and my son made one of the characters slide down it yelling, “Whoo hoo!” I thought this was a bit more novel than other things he’s done in play.

I shared with Maude, though, that I haven’t seen him enact scenes from his typical day with parents, with friends, or at school. There could be a variety of reasons for that, Maude responded. She’d encourage him to take his characters to school and also add a piece of reality into his current play. If you went to the museum, for example, enact going to the museum with his characters. Bring in those pieces of reality so it becomes part of the fantasy play, she urged.

Maude wouldn’t push the fantasy in the play, she said, because that comes later. It’s not really FEDC 4. Instead, bring reality into the fantasy play so there’s more material of things your child has to make sense of, that they have to generalize from one thing to another. This brings the visualization to life, which is really important, she asserts. This ‘practice’ is essential for solidifying the foundation for the next capacity.

There’s still work in FEDC 4 with my son, Maude explained, because in FEDC 5 we have to start making emotional sense of things, which is the integration that FEDC 4 creates for us to build the material where we can land emotions and thoughts on later in FEDC 5.

What is FEDC 5?

The fifth Functional Emotional Developmental Capacity (FEDC 5) is called Using Symbols and Creating Emotional Ideas (earliest emergence 18 to 48 months). We’ve already said that the emotional piece must land on the structure of FEDC 4. This emotional piece is a crucial place where the sense of self comes into a place where one can understand interoceptively, cognitively, and emotionally what their emotions feel like, what they’re going to label them, and how they’re going to be dealing with them, Maude explains.

You can label emotions cognitively in FEDC 4, Maude says, but if my Mom is playing sad in FEDC 4, I want to go make my Mom smile by putting my fingers on her mouth to make her smile. At the end of FEDC 4 where they have cognitive empathy, they can start to handle you being sad, Maude continues. You can say, “I’m so sad. My doggy is sick.” They might kiss you to start, but when they are doing that real empathy, they can suggest putting a blanket over the doggy so he’ll feel all better. Then you can problem solve how to put the blanket on the dog because you’re out on the street, for instance. 

The more you’re sad, the child tries to figure out how they can help your sadness and solve it in FEDC 5. Deeper in FEDC 5, they’ll come sit beside you and just hold your hand saying something like, “I know you’re sad” like when Sadness from the movie Inside Out put her hand on BingBong‘s knee when he lost his van. Empathy shines thorugh. Empathy feeds that sense of self in who we are, and our productivity and capability of actually dealing with someone’s emotion and leaving it separate from our own emotion is the depth and breadth of FEDC 5, Maude explains.

What about Empathy?

A lot of autistics say they have more empathy than others because they feel so much. Some autistic kids seem to be more overwhelmed by emotion than neurotypical kids. If you see sad things on TV, neurotypical people tend to think it’s cognitively sad, but it’s not the same as their own family. However, many autistics feel as affected as if it were their own family. What I hear Maude saying is that it’s not that the empathy isn’t there. It’s that there’s so much feeling that they don’t know what to do with it until they get to FEDC 5, whether you’re neurotypical or autistic.

Maude points out that in FEDC 1 we feel emotion, but you’re not able to label it, understand it, or be anywhere close to dealing with it. You’re just feeling dysregulated by it. You’re a victim of the environment. So it’s not that emotions aren’t there from the get-go. Empathy is built from the minute you are born when your mother ‘coos’ with you, Maude asserts. It used to be said that there were no mirror neurons in autism, but this is not true, however, they might be underdeveloped or underutilized, Maude says.

This is why we love to sit across from the child in Floortime, which makes the mirror neurons four times more active, Maude says. Iacoboni’s research on empathy says imitation is the place where empathy starts in our brain. Maude continues that you build the type of parent you’re going to be from the way that you were parented. It’s not what you say with kids, it’s what you do. As they pick up your response and empathy, that’s where empathy will land. 

It is not true that autistics don’t have empathy, Maude stresses. Empathy, as it lands on interoception in the body, she says, can overwhelm the interoceptive system, and can lead us to shut down the interoceptive system if we don’t know what to do with it. This can then also lead to other problems, Maude explains. There’s a lot of adults who still struggle in FEDC 4 when you’re under stress, I pointed out, but we’re talking about the development of these capacities.

The Development of Self

Maude says that there’s a line that walks through the Functional Emotional Developmental Capacities (FEDCs) and that’s the personality. We’re born with different temperaments. Maude gravitates toward the nature-nurture theories that nurture shapes the personality. As we go through these capacities, a little ego is developing and becoming autonomous. Feeling that sense of “I can” is developing through these capacities. 

All of us need to know that the moment you’re an entity as a baby, you have the full capacity in your nervous system to have the things in place you need to have, Maude asserts. Your nervous system is hard-wired to develop. You don’t tell a baby when to crawl. They naturally do that because we are pushed towards development. But when one part of development isn’t happening the way it needs to, then we turn into avoidance, she explains. We avoid the things that make me feel out of control, which is what causes the delay.

The experiences you need to become praxis-oriented, to build vocabulary for language, to put your language to what you’re doing, and applying yourself to it in play gets missing, so you don’t build the constructs that you need to. A model like the DIR model is one model of explaining how these things have to follow on each other, but it doesn’t mean the availability isn’t there from the beginning, Maude insists. 

From the moment you see your mother’s eyes or hear her voice, you are feeling something, but being able to capitalize, understand, and organize those feelings comes with time, support, and containment, Maude continues. Any developmental model provides the timeline, but it’s not about one step at a time. In the podcast conversation, Maude says, her and I are doing the first six FEDCs at once, thinking of what we’ll say next to help others understand.

In DIR the ‘I’ is for Individual differences, and we like to focus on the individual profile over a diagnosis because everyone is unique in their development based on their unique profile. The whole emotional piece that is such a big piece in this developmental model is what we focus on, Maude says.

Final Thoughts

The fifth Functional Emotional Developmental Capacity is where we can work against polarized thinking, Maude says. If an individual can understand the range of emotion in themself and where it lands, and understand that another goes through something too–that is, if I can get you and you can get me–then we actually have a place where we can have a debate. 

It’s an organizational structure on which I can trust you and where you’re coming from, and you can respect me and where I’m coming from, and the fact that we may differ in opinion doesn’t make it wrong or right. That ultimate respect lies in this model. It brings about so much healing that our world needs right now, Maude reflects. FEDC 5 provides the room in which me and you can be in a space that corresponds and keeps us co-regulating each other so we can both grow, Maude concludes.

This week let’s practice meeting our child where they’re at, and fully working on making that capacity robust.

For example: Are they having robust circles of communication? If not, go back to watch this podcast from last month. If they are, let’s start enacting their favourite scenes with their favourite characters or stuffed animals. If they are fully doing representational play, start playing the role of one of the characters and have those emotions like Maude talked about. Let’s be a part of the drama they create.

I thank Maude for taking the time to record this podcast and I hope that you found it as helpful as I did in really getting a deeper understanding of FEDCs 4 and 5! Please consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

Photo by Mikhail Nilov

This Week’s Topic

The topic of this episode is the fourth Functional Emotional Developmental Capacity (FEDC 4) of the Developmental, Individual differences, and Relationship (DIR) Model based on the presentation our guests in March at the New York City DIR/Floortime conference called, The Spectrum of FEDC 4.

This Week’s Guests

Katie Shepherd is a DIR Expert and Training Leader with the International Council on Development and Learning (ICDL) and a Speech-Language Pathologist in Chapel Hill, North Carolina. Sanette Louwrens is also a DIR Expert and Training Leader with ICDL and owner of Sensorium Therapy Inc., a DIR Occupational Therapy practice in Redding, California. Sanette completed the Napa/UC Davis Infant Parent Mental Health fellowship in 2022. Reflective practice development in DIR is one of her passions.

by Affect Autism

Bonus Insights

DIR Parent Network click HERE

We will never share your e-mail.

The Spectrum of FEDC 4

I asked what made Sanette and Katie choose this topic to present at the DIR conference in March. Sanette says that Katie and her taught DIR 201- The DIRFloortime Basic Certificate Course together, and had such a wonderful synchrony, that they wanted to present together. They chose FEDC 4 because it is so complex. It’s called Complex Communication and Shared Problem Solving. It is such a shift in the child’s affective development and the development of ‘self’, Sanette says. It’s an incredibly foundational shift.

They called their presentation The Spectrum of FEDC 4 because you have an imagery of a white light lighting a prism and then radiating the colours of the rainbow. That is how FEDC 4 is. Everything is stepping up. The regulation is stepping up, the communication is getting more complex, and there’s more nuances. They were trying to capture this complexity in the title. They want this to be a resource for people so they can dig in and have more wonderings about FEDC 4.

You have an imagery of a white light lighting a prism and then radiating the colours of the rainbow. That is how FEDC 4 is.

When Katie and Sanette teach DIR 201, it covers the first four Functional Emotional Developmental Capacities (FEDC 1 through 4), and then in the Certificate of Proficiency course, DIR 202, they cover FEDC 4 through 6, so FEDC 4 is visited twice. Then, as they did their literature research and also looked at what Drs. Greenspan and Wieder have written about FEDC 4, Sanette says that her and Katie both expressed awe and humility in the breadth and depth of this fourth capacity and how beautiful this DIR model is at meeting every child and family.

Diving in to the Fourth Capacity

I referred listeners to our last podcast on the third FEDC with Naomi Wong and Andrea Snyder and Katie said that she attended their presentation at the DIR conference right before presenting hers and Sanette’s, which really helped because you can’t really think about one capacity without considering the earlier ones. Katie added that in the DIR model, she doesn’t think Dr. Greenspan intended on any of us to only work on only one capacity at a time. We’re always thinking about all of them.

Complex Communication As an individual is moving from the third to the fourth capacity, their back-and-forth interactions are becoming longer and more complex. These long chains–affectively charged and continuous–of circles of communication create a flow of communication. As the interaction progresses, these circles of communication become more complex. It also involves the use of many communicative signals such as facial expressions, gestures, all forms of body language, vocalizations, and/or words to communicate increasingly more complex ideas.

An Interactive Experience As a DIR 201 instructor, Katie values and celebrates the preverbal experience. The non speaking communication is so important to promote and encourage communication, she emphasizes. Individuals express more complex ideas gesturally with vocalizations or sound effects as well. We also want to highlight how this is interactive, Katie says. You’re interactively solving problems with a sense of ‘we’ in the fourth capacity. We think of the development of these interactions in this capacity.

Maintaining Regulation Another component is that we need to maintain regulation while maintaining a broader range of emotions, which is something we really want to focus on, for longer periods of time, Katie continues. Through all of these rich interactions, we establish a sense of self and this understanding of a ‘you’ and a ‘me’. An individual can begin to advocate for themselves and say ‘no’ when you have a sense of self, Katie shares.

Motor Planning We want to support an individual’s pursuit to lead reciprocal interactions and sequence and execute action plans, Katie adds. This is where the recognition of patterns comes in. All of this is interactive with a communication partner, even under healthy levels of stress, Katie adds. I shared that in ICDL’s parent support meetings, parents are learning the FEDCs and it took me years to even remember what they are, even having read about them numerous times.

Continuous Flow I pointed out that the developmental capacities are like a spiral. They are not stages or steps where you master one and move on to the next one. We’re working on this all the time. I highlighted Katie’s point about the flow of communication being continuous. This is different than start-stop interactions where you may ask a question that your child answers, then ask another question, etc. Or your child asks you a question or sends communication to you, and you answer, then you change the topic.

Broader Range of Emotions I also wanted to highlight Katie’s mention of maintaining regulation through a broad range of emotions. In my Floortime series, ‘We chose play‘, you can see my son starting to demonstrate this when his father presents a symbolic idea of the train putting out the fire which my son protests, but he stays in the interaction and his distress lessens because he is so motivated to continue playing trains with Dad. 

Co-Regulation I didn’t realize at the time all the developmental capacities he was showing, even though he still had constrictions in his capacities. When he was younger than that, he would have got up and walked away, but he stayed in the interaction. I pointed out what Dr. Stanley Greenspan would say about reaching the point where one can co-regulate with another person using those affective signals versus having ‘catastrophic emotional reactions’. Getting to the point where your child feels safe enough so they can co-regulate with you through those dysregulating moments is a part of this fourth capacity.

The Genuine Relationship

Katie pointed out that the Relationship is so important in my example, and my son was motivated to continue being in that relationship with his Dad. She also wondered about the affective signalling Dad was providing in that interaction. I replied that Dad’s affect was pretty neutral and he was more focused on his agenda, as he was newer to Floortime then, but acknowledged Katie’s point that the child is affected by the parent’s affect and how I would have been much more reactive to my son being upset than his father was; he was always much more calm and chill.

I shared how important it is for parents to be able to find their genuine affect with their child because you have to be comfortable interacting with your child versus following how someone else is doing Floortime. Katie also highlighted that I said my son isn’t having catastrophic reactions much as he did when he was much younger. It’s because of the rich emotional interactions and emotional signalling, which helps a child learn to tame their own emotions.

Shared Problem Solving

Sanette added that in the train example, my son could stay in the interaction through distress. The individual’s regulation has more stability in the fourth capacity, whereas in the earlier capacities (FEDC 1 to 3) you have to work a lot harder at co-regulation, she explains. There was a ‘problem’ or ‘challenge’ created that had meaning to the child, so that was affect-mediated problem solving. Problem solving in FEDC 4 isn’t just having a problem in the play, Sanette continues. It’s about having meaning to the child, and in that meaning the child will negotiate and navigate through affect.

It’s interesting to reflect on how the circles of communication in the third capacity help the child realize they have an impact and influence through their initiation and gestures. It helps them figure out cause-and-effect, whereas in the fourth capacity, they realize the world is their oyster. This concept of signalling, negotiating, and navigating makes them realize they can resource the other in the problem, and the problem has meaning to the individual.

When you have the flow with interaction, you don’t have to do too much to regulate and bring a small challenge, Sanette continues. In order for this to be in the fourth capacity, we want to see that it’s affect-mediated and meaningful to the child, and the child resources you to solve the problem with them through their communication system, Sanette stresses again. 

Many times when we do playful obstruction, Sanette says that we’ll use ‘magical’ problem solving: “Whoops! The fire is out!” or when playing with cars, you’ll say, “Oops! My car stopped!” The child might come and pretend to put gas in the car and ‘magically’ solve the problem instead of seeing the sequence of needing to call a tow truck so you can figure out what happened to the car. When you do playful obstruction, make sure the challenge has meaning for the child, Sanette stresses.

I shared that Dr. Gil Tippy really stressed with me in the past that any so-called ‘intervention’ can bring a child to FEDC 3 but DIR/Floortime stands out because getting a child to those higher capacities is where we see thinking emerge. I added that this is where the praxis piece comes in, too, because if you aren’t yet capable of planning, initiating, and executing your ideas, it’s a struggle in this fourth capacity to problem solve with someone.

Katie points out that’s it’s so important to realize that problem solving is so much more than verbal negotiation. There are so many ways to communicate with your body language what to do with your car during playful obstruction, for instance. You are seeing if the child can make sense of the vocal and social action patterns of the play partner’s movements of looking, showing curiosity, and wondering together, without words, really leaning your body in there and make meaning of whatever the solution is going to be.

See ICDL’s Newsflash on this capacity HERE.