The following initial draft is based upon my ten years experience as a special educator working in early intervention and in private practice with toddlers, preschool and school age children with core challenges in areas of receptive and expressive language communication and affect-sensory motor processing domains, including autism spectrum disorders. It is in part influenced by the work of Dr. Stanley Greenspan, Lev Vygotsky and Mikhail Bakhtin. Over the coming months there will be video clips included of children both typical and atypical and their families.
How To Deepen Reciprocal Emotional Attachment and its Connections For Healthy Social-Emotional Development in Children with Autism Spectrum and Related Developmental Challenges.
All receptive, expressive communicative, cognitive and sensory motor planning differences must be recognized as possessing meaning by the family of the child who has been diagnosed with autism spectrum and related developmental challenges. Even if the child has been diagnosed with moderate to severe deficits with respect to reciprocal emotional attachment or joint attention, ideation and communication, the child's world is always unique, complex and meaningful and, therefore, must be respected and appreciated from the child's perspective. One of the core primary challenges in autism spectrum disorders is the child's ability to connect his/her natural affect or intent to meaningful praxis. Praxis is basically composed of the following three elements:
1) Ideation (e.g., "I see the ball on the shelf, I desire it, I want it."). 2) Motor planning (e.g., "Okay, the ball is up there on the shelf; what fine and gross motor skills, or affect sensory-motor coordination planning, do I need to use in order to get it down?" "Do I need to walk over and reach up?" "Uh oh! What if it is out of reach? Um!?"). 3) Execution of ideation, fine and gross motor planning seamlessly integrated with complex facial and bodily gestures-and-verbalization, for example: "How do I socially co-regulate my natural desire or intent with others? Do I easily use my facial affect, which indicates excitement, disappointment and frustration in conjunction with my use of natural body gestures?" In other words, "Do I turn, look up, point, reach and grasp at the ball I desire, then, slightly frustrated, turn back to mommy, point back to myself, and then point back up to the ball with communicative context-bound or referential utterances?"). In typical development these above steps occur, more or less, in a consistent back and forth manner in accordance to the child's natural intent.
Basically, the child's natural intent must be strongly connected to his affect reciprocal motor-planning with others for any meaningful praxis to occur. Often when there are disruptions, due to underlying biological conditions or family relationship patterns, to a child's emotional-cognitive, language and social development, we see differences not only with respect to specific emotional-developmental milestones but in terms of specific affect sensory-motor processing differences. For example, one child's natural intent or affect sensory motor planning can be hypoactive or under-responsive and may require a great deal of high-affect input to get him drawn into meaningful back and forth joint attention and reciprocal interactions. Another child can be hyperactive or over-responsive and may require greater soothing in order to get her drawn into meaningful back and forth joint attention and reciprocal interactions. Still, many other children, which is frequently the case, might have mixed hyper and hypo reactivities depending upon what sensory-motor processing areas are challenged. (1)
We often find a consensus among clinicians and caregivers with respect to what at first glance might be understandably misinterpreted as the child's aberrant or "non-compliant behaviors" but are, in fact, "behaviors" that are systemically connected to the child's natural affect and sensory processing based challenges. For example, Auditory input: sounds or certain frequencies can be felt as extremely discomforting and can appear to others at times, as a child's inattentiveness; Tactile input: a slight touch at particular moments or to certain surfaces can be felt as painful and result in a child withdrawing, but may very well appear to others on the surface as a child's lack of affection; Visual-spatial input: too many scattered objects or movement by others in a room can be experienced as extremely disorientating and result in severe meltdown tantrums, etc. (2)
Therefore, any comprehensive Developmental approach for the integration of the child's emotional-cognitive, sensory-motor processing and language based differences, contrasted with cognitive-behavioral approaches (e.g., Applied Behavioral Analysis, ABA), where the primary focus for each child is the successful completion of a series of adult directed cognitive-behavioral discrete tasks, must be strongly grounded in a developmentally based approach that takes into account a basic psychological understanding of caregiver/child attachment guided by the child's natural affect sensory-motor processing challenges and any other neurophysiological based differences. The latter in conjunction with the clinicians' and primary caregivers' affective relationship styles (e.g., emotively underbearing or overbearing to the child's natural affect sensory-motor processing differences) begins to set up the framework for two-way reciprocal emotional-problem solving circles of communication [praxis] and reconnect the foundations necessary for building healthy autonomy.
When we use a functional-emotional developmental approach we are essentially encouraging the spontaneous integration of the child's affect sensory-motor and receptive-and-expressive language communication together with guiding primary caregivers to slow down and adjust their affect relationship styles (emotional interactions) to become more sensitive to the child's variable affect sensory-motor processing strengths and challenges. The focus on the "less redirecting" and the "more affective" (or emotional) attunement to the child's affect sensory motor processing differences begins to engender a process of deepening attachment and functional emotional reciprocal circles of communication. The attunement to and engagement with the child's natural affect or intent begins to meaningfully build the necessary developmental milestones for all receptive and expressive language and emotional-cognitive skills in a meaningfully integrated manner, rather than an on cue and robotic manner as is commonly found in behavioral based approaches.
This Developmental focus on the deepening of emotionally guided circles of engagement between child and primary caregivers necessitates primary caregivers and clinicians co-creating emotional-developmental bridges of pleasurably based interactions around what represent the current interests of the child.
In contrast to the above, the widely acclaimed success but clearly non-developmental behavioral task based methodologies of redirecting
the child (i.e., Applied behavioral analysis, ABA) utilizes the principles of what is widely known as operant conditioning with schedules of re-enforced social-environmental contingencies. This initially involves clinicians performing a functional behavioral assessment (FBA) on the entirety of a child's current behaviors. Essentially, "behaviors" are artificially extracted and primitively broken down into three primary components: the antecedent (what specifically leads to the behaviors), the behaviors (what is currently happening) and the consequences (what does the child receive as a result of his/her behaviors and how are they being re-enforced). Once clinicians gain an understanding of the child's "behaviors" they attempt to modify the child's aberrant or unacceptable behaviors to socially acceptable behaviors.
Typically, beginning with discrete trial training (DTT), clinicians consistently have children comply on cue in an automaton-like fashion to a selective series of social, cognitive-behavioral and language rote based tasks. Upon successful completion of the executed functional task typically given in a 1:1 by the adult to the child (i.e., touch nose, touch circle, give cookie) the toddler receives an externally desired object or verbal praise (i.e., a "positive material re-enforcer" such as a desired candy or toy combined with a verbal re-enforced and drone-like response from the adult clinician/presenter such as "good job.").
It is thus the child it is typically believed learns according to applied behavioral clinicians and cognitive behavioral psychologists (i.e., in more or less rote compliance to 1950's B.F Skinner's conditional response stimulus pigeon training/learning theory that guides operant conditioning), how to modify her/his current inappropriate behaviors with "learned" or conditional responses to better or more appropriately complied with antecedents. When a functional analysis of the child's current behaviors (i.e., What causes a particular behavior, or the antecedent; the behavior itself; and the consequence of the behavior) are properly assessed and subsequent re-enforced schedules towards more desirable behaviors are properly implemented this is said to result in scientifically proven and measurable reductions of inappropriate behaviors and positive increases in on-schedule and on-task performances. For toddlers who have been diagnosed or suspected of having an autism spectrum disorder, early intervention typically begins with the data protocol and operant conditioning methodology known as discrete trial training (DTT).
*Applied behavioral analysis focuses on the primitive and reductionistic analysis of the mechanical function of tasks where the neuroanatomical foundation of affect-regulation or the child's individuated emotional differences that constitutes healthy biological-psychological and social Development are confined or artificially separated from tasks and plays no role except as a utilitarian monkey-see monkey-do function for purposes. For example, in order to have the child complete successive rows of scheduled affectless tasks on command. Since for assessment purposes the latter (i.e., focusing on the child's behaviors either in individual task isolation or task aggregates) is more easily empirically measured, impressive claims of great scientific success then not unexpectedly follow, often accompanied with the vapid and misleading claims of "The only scientifically proven methodology." The focus is predominantly on the child completing adult-managed and affect or emotionally detached object-oriented tasks rather than caregiver/child dyadic affect reflective thinking. The latter would imply the presence and integration of "a self-with-other" or the child's natural emotional intelligence (honored, respected and followed) in conjunction with his/her affect sensory motor processing strengths and challenges in affect-guided social relationship based caregiver interactions, as opposed to a focus on, shall we say, the (suppressed mirror-neuron) more "predictable" and less messy selective rote outcomes (i.e.,"touch nose", "Give me ball", "Say, ball", etc.).
Generally speaking, since the messiness of working with "feelings",
which in empirical truth constitutes the basis of all reciprocal child/caregiver interactions and meaningful pragmatic language emergence, cannot be neatly accounted for at the extreme discomfort of providing organic and non-mechanical protocols, they are either put entirely to the curb or given secondary stature at best by behaviorists. This neurodevelopmentally corresponds (or using the widely acclaimed "only proven scientific methodology" translates) into the child acquiring a foundation of re-directed surface memorized responses but that is alarmingly held hostage from the full functional emotional developmental foundations of meaningful social engagement, that is affect which constitutes and guides the integration or true acquisition of any
functional task as an integrated part of overall praxis.
www.pasadenachilddevelopment.org/articles/Prizant-IsABAtheOnlyWaySpring09.pdf
What all educators and therapists need to developmentally explore as the basic foundation of every child's healthy growth and development are not a series of a successfully institutionally marketed but entirely misleading picture of cognitive-behavioral performance based tasks that the child must accomplish on cue in order to "secure the basic foundations or precursors to greater behavioral compliance and/or academic achievement." Or, to be a bit brutally honest, and at the risk of facing much ire from some colleagues, the child acquiring a uniform set of emotionless tasks by way of the teachers' and therapists' admonition and thus the exploitation of the parents' underlying fears, i.e., "Dear parents, better educate yourselves now on the prerequisites for your child's preschool readiness skills."
Instead, what we are focused on from an historical Developmental systems theory perspective, which is fully supported in numerous areas of neuroscientific research,during the last few decades, is a deepening of attachment, understanding and ideation from the child's perspective. Hopefully in the not too distant future, daycare facilities to public schools will be increasingly based upon the principles of a Comprehensive Developmental approach rather than prescriptive splintered and uniform behavioral and pre-academic agenda of modifying "aberrant behaviors", re-enforcing surface memorized tasks and teaching to the test protocol. The latter almost always leaves unaddressed the deeper foundations of emotional-intelligence across the spectrum in both typical-and-atypical (neurodiversified) populations.
Primary caregivers with the guidance of special educators and other therapists (all interdisciplinary team members) will begin to co-create incidental (small) back and forth meaningful emotional connections (i.e., shared attention) around what the child finds naturally interesting as well as emotionally reassuring (for example, primary caregivers and clinicians spinning self or the wheels of a car; thrashing or knocking down blocks; flicking on/off light switches; jumping; pushing or throwing non-injurious objects with the child). The participation in these and similar activities are not performed, shall we say, as "novel" or pivotal means-to-end strategies" in order to attain a greater degree of success in "behavioral targeted outcomes." For example:
A) Indulge the child by following/doing what s/he enjoys. B) Once joint attention is pleasurably achieved begin to re-direct child's attention to focus on compliance to positive task completion and the elimination or reduction of "negative behaviors."
Rather, as developmental special educators and therapists who have a considerable knowledge of the healthy foundations of deepening attachment and dyadic engagement, where each child's natural intent or affect in spontaneous pleasurably based and two-way emotional problem solving interactions with others must guide Development, we are not focused on the remediation of so-called, "aberrant or non-compliant" to traditional school ratified "acceptably compliant" look good/feel good (politically correct) behaviors. An all too common and shocking illustration of this we find in the following article. The director of a US based and internationally recognized applied behavioral analysis (ABA) learning center, the so-called only scientifically proven (behavioral) evidence based approach, avers the general reprimand of undesirable behaviors during a TIME interview, as one of her staff in an adjacent room is observed commanding her student, "Hands down!" while the student is flapping. "We're not a culture that accepts that," says Taylor. "Fifty percent of the battle is addressing behavior to look good." (May 2006 TIME Magazine: A Tale of Two Schools.http://www.time.com/time/magazine/article/0,9171,1191852-1,00.html#ixzz1AOdShBDo)
From a clinical interdisciplinary and comprehensive Developmental understanding that is consistent with extensive research over the last twenty five years in the neurosciences, specifically the relationship between co-affective regulatory signaling and neuroplasticity (i.e., synapse strengthening of compromised pathways), we are engaged in a dyadic process of deepening attachment by empathically co-creating affective bridges between our world and the child's world.
For example, primary caregivers guided by clinicians will begin to meaningfully gain an increased knowledge of their child's functional emotional-developmental and underlying affect sensory motor processing based strengths and challenges (often interpreted and manifested on the surface as the "child's unfocused, non-compliant and perservative behaviors"). This will enable primary caregivers to co-create with their child an exchange of simple emotional communication/ language and shared experiences and as a result the beginning of a true caregiver/child co-created/co-communicative meaning-making process. Essentially, a focus on primary caregiver/child affect-reciprocal signaling leads to non-scripted and genuine two-way communicative engagement and thus represents the core basis of any true Developmental approach. It is precisely a focus on the child's functional emotional developmental milestones, affect sensory processing differences and caregiver affective interactive patterns that contributes significantly to the underlying core strengthening of the child's healthy emergence of self-with-other and the general neuroanatomical and biologically supportive foundations.
In contrast to the above, the utilization of the basic principles of five decades of applied behavioral thought (i.e., operant conditioning), essentially to observe, data collect and in the name of "objectivity" detach from the co-affective (or co-narrative) zone of meaningful dyadic interactions (founded on the extraordinary polarized and mechanistic language of antecedents and consequences), and thus implement an infant/toddler (IFSP or IEP) educational plan to address stereotypical or aberrant behaviors "in the child" without adjoining it to a comprehensive Developmental framework to address the bio-psycho-social dynamics of affective processing (i.e., which includes many differentiated affect-sensory motor components) commonly misinterpreted as the child's core (in reality symbolic and surface) behaviors is from an attachment theory and functional-emotional developmental perspective unacceptable.*
*Or worse, reductionistically interpret the "child's behaviors" (with the patronizing intent under the benevolence, shall we say, for parent palatablity and/or the dumbing-down of future educators and therapists) in the simplistic, adolescent and polarized terms of positive versus negative behaviors.
From a developmental perspective of joint attention (i.e., child-led pleasurably based interactions), we begin to suggest (to the child) with the increased use of two-way affective expansion (or dramatization) a slightly added affect-sensory-motor variation in keeping with the child's perspective. This includes engaging in so-called undesirable or stim behaviors with the child. For example, spinning ourselves with the child, or the wheels of his toy car with him in a slightly different direction (and accompanied by varying affect verbal intonation, affective sensory-matching rhythmic sounds, pregnant pauses, etc., adjoined to emotive words, e.g., vroom, uh oh! go! go!, stop! a-choo! etc.).
Now, as a simple functional developmental rule, all meaningful primary caregiver/child social reciprocity only begins to transpire within a zone of comfortability (e.g., the "emotional interests") of the child. These interactions, slowly over time, become a spontaneous or integrated part of the child's new repertoire with others. For example, as multiple affective interactions (i.e., meaningful emotional opportunities for engagement between child and primary caregivers) deepen, the child's internalization of experiences begin to attach to and/or form "new memories" and thus begin to integrate or envelop various novel affective modalities of thinking, relating-and-communicating. Thus the Developmental emphases placed on the diversification of meaningful social interactions (i.e., reciprocal signaling through two-way emotional problem solving) from the child's perspective (i.e., following the child's lead, engaging in two-way emotional problem solving and consequently deepening affect) manifest in terms of specific and measurable neurophysiological changes and begin to coalesce a much greater integrated neurodevelopmental foundation.
For example: An increased strengthening in the qualitative integrity of praxis or the motor planning, sequencing and execution of numerous [social] interactions of the prefrontal cortex, which is instrumental in calming, co-regulating and integrating the impulsivity or fight or flight reactions of the amygdala; the cerebellum with respect to the increased integrity in the overall smoother coordination of sensory-motor movements, or rhythmicity and timing, between actions, and increased typical functionality of the fusiform face area of the of the fusiform gyrus, which is instrumental in facilitating the interpretation of facial and somatic gesturing schema of others, etc. (http://psych.wisc.edu/lang/pdf/dalton_nature_neuroscience.pdf)
The above areas subsequently help build a stronger and more integrated underlying emotional-developmental foundation for the child's emerging autonomy with respect to successfully encouraging not only longer but more seamless and nuanced dyadic affective exchanges during primary caregiver, clinician and peer exchanges: The core neurophysiological processes constituting the child's general praxis and, subsequently, supporting a measurable set of greater nuanced circles of communication, continue to strengthen by the deepening of caregiver/child and clinician attachment.
Now, contrary to widespread administrative educationally approved "best-of-breed of behavioral practices" (and many board certified behavioral analysts' misunderstanding) these developmental milestones are easily empirically measurable throughout the toddler's/child's daily activities as the toddler/child with caregivers begins to become more confident in emotionally self-managing wider resources of newly available interactions. However, it is in the subtle nuances - or patterns of emotional changes (for example, the qualitative nature of the small affective interactive circles of reciprocity, such as a minutest subtle change of facial gesture, a slight lingering look or slightly more nuanced pointing..) that we have to begin to more seriously take into account and understand the role of affect and its enormous developmental impact in setting the foundation, tone and general conditions for the continued underlying neurodevelopmental integration and the larger and more typically measured macro developmental changes.
The continued hazards of not doing so is that we continue (for example, non-developmentally) to take "objective measurements" of the child's concrete operational performance of "compliance versus non-compliance to cognitive-behavioral command tasks" with our increasingly peer reviewed, self-congratulatory, elaborate and minute generic lists of checks and minuses and good-do notes and in the process continue lose invaluable opportunities as we remain affectively blind or emotionally obtuse.
Several completed research studies, including a concurrent standard fully randomized clinical trial, that neuroscientifically supports evidence-based functional emotional developmental intervention approaches that directly addresses the core challenges in ASD and related complex neurodevelopmental challenges can be reviewed in the following: http://www.icdl.com/dirFloortime/research/documents/DIRFloortimeOverviewandSummaryofSupport-NOV2010.pdf
The developmental evaluation for the assessment of "meaningful skills" includes such areas as the infant, toddler, child (or older) increasingly experiencing sensory survivable interactions. This empirically translates [milestone by milestone] into an emotional functional and psychologically healthier dynamic. For example: The child's frequent catastrophic meltdowns, or all or nothing reactions, branching out to increased sensory self-regulated interactions in the caregiver/child proximal zone of pleasurably based co-regulated interactions and, consequently, engendering greater self-with-other receptivity. This includes the child's ideational variability or the child's ability for placing together measurably complex back and forth symbolic play sequences (e.g., Elmo running from the tiger chasing him, getting a boo-boo, "Uh oh! No tiger, sit, down!).
The latter is an integral part of the child's expanding circles of affect-gestural and verbal reciprocity with others which allows for, due to emphasis placed on a slow and attuned deepening rich and pleasurably based two-way engagement, the child's emergence of meaningful expressive use of word/signifier to phrase constructions with others.
During these back and forth deepening affect-exchanges, and at each opportunity along the way, these functional emotional developmental processes necessitate a highly attuned and co-regulated emotional signaling between primary caregivers and the child. This includes an increase in affective suggestiveness or dramatization provided by primary caregivers and clinicians of a newly expanded (slightly more complex) ideation (i.e., new ways to play, relate and communicate).
For example, primary caregivers and clinicians will begin to frame the child's simple actions, from looking/staring at the object that the child is fascinatingly looking/staring at, to activities such as lining up or repetitively pushing objects in back and forth in place with the child. This is the opposite of the rote modeling of simple task compliance (e.g., touch nose, good job!) or mechanically repeating, in flat affect, boring and monotonous tone the sound shape of signifiers, nouns, prepositions, verbs, such as, "ball ","up", mama, or command model phrases given to the child, such as,"Say, mama" or"Say up" or "push car."
The latter does not generally involve the typical prescripted behavioral (or non-developmental) thinking of having the child comply to simple to more complex adult directed one step to multi-step compliance. The latter does occur but, and this is quite important to note, as a "natural downstream effect" and integration of the child's natural emerging desires to engage with others. As a result of the child desire to engage with others in numerous scenarios, the child's receptivity/turn-taking and expressive linguistic skills subsequently increases, that is to say, provided that the child does not have specific oral-motor dyspraxia that present additional challenges in helping him/her to produce the proper phonemic sound-pattern combinations. Receptive and expressive language skill increases to age or near age appropriate levels (in a consistently non-cued/non-prompted fashion, across a wide diversity of simple to complex social/communicative exchanges) is a Developmental fact that I have seen with children I have worked with across the spectrum, including children who were essentially nonverbal at the start of therapy, as well as little and in some cases any functional facial or somatic gestural reciprocity approaching twenty-four months. *
*Some of these children (18 months - 30 months) were originally diagnosed with ASD on the mild to moderate end of the spectrum, others had strong classical characteristics in common with ASD on the high moderate end (i.e., loss of early emerging word use by 12 months; no functional use of gestures to communicate simple requests; no seeking of simple social reciprocity or desire to engage with others, including caregivers; perseverative spinning wheels of cars or rolling same car in place for hours in isolation; sensory seeking, in terms of proprioceptive input; tactile avoidant or sensory over-responsive to touch by others, often including primary caregivers; normal healthy birth, no underlying medical conditions; audiological examination showing typical, etc.).
However, an appointment with a developmental pediatrician for potential diagnosis in several instances were elected not to be made, as it did not impact the family receiving services. Most significantly, however, over the course of one-year (but in the above overview described of the toddler who began services at 22 months dramatically progressed over an 8 month period) using a non-behavioral emotional developmental approach in common with the foundations of DIR, these children improved dramatically, in some cases, to near indistinguishable levels from peers across social adaptive, cognitive and receptive and expressive language domains from the time of original evaluation where there was a 33% or more delay in one or more areas to approximately one-year later, where using standard evaluative protocols there were 10-18% delays.
Now, none of the above is to dissuade families from having their child evaluated, especially when core characteristics are clearly present or strongly suspected. Quite to the contrary, in at least a couple of cases (e.g., the above characteristics of the toddler described above), if the child's regular pediatrician had been better informed that the toddler's early use of words without accompanying functional gestural reciprocity or in this case any gestures; lack of functional gestural reciprocity accompanying meaningful utterance, no simple back and forth circles of communication or simple play and hyper or hypo sensory reactivities, all of which are red flags, then this child in question would have not begun services at 22 months or at least directed to Early Intervention for an evaluation of services at 10-12 months, perhaps earlier. _____________________________________________________________
The purpose of heightened affect is simple suggestive narrative building or attribution of meaning to the child's actions. When the child's actions are connected with in a soothing, purposeful and meaningful way from the child's perspective, attachment begins to deepen. As attachment begins to deepen we see an increase in overall receptivity (i.e., the child's increased willingness/ curiosity and desire to accept slightly added nuanced variations from primary caregivers and clinicians to his/her current interactions). Again, to critically reiterate a very important point, we are not addressing surface behavioral compliance; nor are we focused on functional behavioral assessments and schedules of re-enforced social and environmental contingencies in order to have the child/subject produce proper functional task responses; in fact we are neither focused on "responses" nor treating the child in the fashion of reductio ad absurdum. We are addressing the child's emerging sense of healthy autonomy, which can only proceed upon a nurturance based foundation and practice, which developmentally and clinically recognizes the important role of affect and engages a child where s/he is.
It is so crucial to note that when we exchange simple affect emotive facial gestures with vocal utterances we are "narrative building" (or rather, "co-narrative building"). Increased affect-emotiveness (or dramatizing) by primary caregivers and clinicians as a fundamental core necessity includes, but not limited to, long periods of experimentation with emotive variants of human voice-and-facial affect combined: For example: primary caregiver and clinicians varying intonation, rhythmic spacing, pause and inflexion, from soothing to excitable; from loud to soft; from looks of playful shock and fright to surprise with wide happy, wry or grimacing smiles and, importantly, simple, small variable exclamatory linking emotive phrases "Oh wow!" "Uh oh! oh no!" The above will vary according to the level of the child's comfortability, affect processing thresholds and current developmental levels.
Basically, what we are doing is framing the child's actions in a way that is meaningful to him/her. That is to say, in a manner that is connected to his natural affect and respectful and comfortable within his zone of functional emotional development in conjunction with his sensory processing styles, strengths and challenges. [It is this which we can affectively define as the zone of proximal development]
None of the foregoing generally involves the primitive behavioral and traditional closed-ended system of attempts to assume the role of an objective (intersubjectively divorced) adult data collector technician and child subject with the mission to identify, frame and predict a schematized or a priori set of precipitating factors (i.e., the antecedents of the child's behaviors) and the manipulation toward more desired (selective) rote outcomes (i.e, the child performing a set of tasks on command or cue typical of his peers). Interestingly, the child learning to perform or carry out a set of tasks on cue is a contradiction in terms. In other words, it is, a violation of how principles of Development naturally occur (e.g., typical peers do not have to be constantly directed or manded to stay on task, as the desire to engage stems from the child's natural affect or intent and increasing curiosity to form relationships with others) or in neurodevelopmental challenges such as ASD can be repaired (different areas of brain-nervous system especially in early stages of development reorganized or strengthened) through deepening reciprocal attachment and affect guided pleasurable based emotional problem solving dyadic exchanges.
In any case, the principles of healthy reciprocal emotional attachment and deepening two-way engagement is found equally across one end of the spectrum to the other (typical to atypical) and as such needs to be firmly implemented (i.e., needs to be attuned to and focused on by primary caregivers, therapists, et al). But since behaviorists are so preoccupied with the manipulation of antecedents to achieve desired consequences, they tend to forget in the process one of the most crucial human elements and the most driving, if you will, developmental factors, which is following the child's lead, emotional reciprocal interaction, attunement and engagement, which often, amusingly, speaks to their own (not the child's) theory of mind and corresponding, in this case, adult mirror neurons that are either capable and willing or disinterested and therefore unwilling to existentially give themselves license, let alone entertain (intersubjectively and empathically), not standing apart and manipulating surface cognitive-behavioral responses but forming deeper bonds of understanding by taking a step closer (going more directly) to the child's world.
What has generally failed to be recognized in a field that has been dominated by a focus on Behavior and compliance to task is that the task of engagement is the primary Developmental foundation. Any splintered or surface functional tasks (e.g., child following one or two step commands or pointing/labeling shapes on cue, etc.) are in a sense optional downstream effects that simultaneously develop alongside or in conjunction with a deepening primary attachment based foundation. This varies from child to child depending upon what affect-sensory based challenges are present and the necessary redirected recognition from primary caregivers and clinicians with respect to synchronicity with the child's differences, which then in turn form the deeper foundations of two-way reciprocal affective engagement.
Nonetheless, the child who is moderately on the spectrum is stereotypically viewed with respect to systemic deficits of basic engagement (i.e., interpreted by complying or failure to comply with primitive yes/no commands) that can only or best be addressed by beginning with highly systematic deprogramming (i.e., stim behaviors) and reprogramming or compliance to more desirable or appropriate behaviors (i.e., touch nose, show me ball, give me ball on cue, etc.). This is typically neurolinguistically conceptualized by the practices of applied behavioral analysis (ABA) with regards to the "re-direction of the toddler/child to comply with or perform desired tasks on command and/or to decrease undesirable behaviors."
(However, from an affect-developmental and dialogical perspective, let us both seriously and amusingly entertain the following: Firstly, at what point are we entering the dyadic conversational or affective flow with the toddler/child and taking highly selective snap-shots, as it were, of the "antecedents" that consequently "cause" or lead toward a chain of events, that is, the so-called, "aberrant behaviors?" Secondly, at what point are we emotionally detaching ourselves (unknowingly but quite literally "objectively" removing ourselves) from the otherwise larger potential natural conversational or preverbal affective flow with the child (which is much more than a series of extractable "aberrant behaviors") with the toddler/child? Moreover, are we, as an unintentional consequence, decidedly schematizing the child essentially under the guise of "carefully controlled proven scientific studies", i.e., ABA, that essentially reduces the "child's social interactions with adults and peers", reductio ad absurdum, to a series of compliant or non-compliant behaviors?
To digress for a moment, knowing the original location of the natural occurrence and combination of the pigments that comprises a work of Rembrandt or complex music theory and the composition of Beethoven does not necessarily either make one a better artist or a better musician, let alone one at all! However, it is instructive to note that it is precisely this "sense of control" over the elements of a child's data collected, extracted, analyzable, isolated and atomized behaviors (i.e., re-enforce social and environmental contingencies expressed in terms of changing antecedents and manipulating outcomes/consequences) that falsely and gravely conveys a deeper, let alone any, understanding of the deepening of attachment and the healthy functional-emotional dynamics of two-way engagement which is dependent not upon the efficiency of theoretical design but the efficiency of intuitive and empathic engagement and the developmental understanding of healthy core underlying integrated neurodevelopmental functioning.
These questions are more than merely "philosophical or academic." However, due to a prevalent, obsessive compulsive focus on the "child's pathology", re-enforced or given wider substantiation by "educational performance efficiency based models" pandemic throughout the culture, we are often, unwittingly, circumventing a much more vital and significant examination of the underlying system dynamics of caregiver/child healthy attachment and thus the deepening of two-way affect-guided reciprocal social interactions. Generally speaking, we are tragically overlooking a much "larger developmental picture" which includes strengthening the underlying preverbal foundations that do not precede but guides-and-integrates, at each step along the way, meaningful affect-verbal child/caregiver and child/peer, interlocutor exchanges.)
One of the many points that I attempt to consistently emphasize here after years of having worked with many therapists, educators and families is that the shortcomings might not only be the toddler/child's current deficits or ability to establish joint-attention and reciprocity and other functional forms of engagement but our own, particularly at the at the time of crisis or intervention, yet to discover abilities to slow down and find the means of deepening attachment and engagement by understanding, honoring, respecting sensory-motor differences and learning how to follow the child's lead. Rather, we opt for five decades of acclimated impulses that consequently results (partially because of anxiety, panic, time constraints and successful biopsychiatric advertising) in the demand for the long time fetishes of applied or cognitive-behavioral remediation as a means of last and, tragically for many families who remain in the dark as to what comprehensive Developmental approach is actually comprised of, the only viable known option made available for their child who has been recently diagnosed with spectrum challenges.
Now, it is understandable that we often find the apparent reluctance (as well as considerable unconscious resistance -or, if you prefer, schedules of generational re-enforced contingencies that are beneath the threshold of the visible) on the part of many clinicians to significantly deconstruct this pandemic social-historical bifurcated pedagogy (for example, the child and the "external manifestation of his aberrant behaviors"). Along with the latter, we have a completely natural desire to maintain "some control"rather than "no control" over an apparent, that is prior to intervention, uncontrollable situation (i.e., the child's general lack of attention, compliance and out of control perseverative or impulsive behaviors). Given the tremendous challenges that families face hour by hour and that educators and administrators from a school-management perspective anticipate as the child prepares to enter the educational system, it seems perfectly "reasonable", therefore, to many that a carefully selected and the only proven "behavioral approach" (i.e., ABA) is the best and most productive educational intervention treatment accompanied with the added benefit (despite extraordinary misleading to all): "The only evidence-based methodology in the treatment of autism spectrum disorders."*
(*Gernsbacher, M. A. (2003) Is one style of autism early intervention "scientifically proven?" http://psych.wisc.edu/lang/pdf/gernsbacher_scientifically%20proven-.pdf)
Thus, as a critical outcome of every child's growth and development, many therapists fail to sufficiently, shockingly some at all, to convey to primary caregivers the importance of a comprehensive Developmental framework, which systematically works on 1) Deepening attachment that naturally leads towards variations in pleasurable and emotional problem-solving circles of meaningful communication; 2) Core sensory-motor processing differences and reactivities within those differences and 3) Matching primary caregiver affect styles to the child's natural affective differences. True social receptive and expressive language/communication and meaningful engagement does not improve because "undesirable behaviors have been initially reduced and positive compliance based skills have been initially increased."
When the child is begun to be viewed by professionals predominantly in terms of pathological dysfunction, that is, synaptic and genomic sequences that have gone awry and pathology has taken over (overtaken) the child in the sense of "aberrant behaviors that need to be re-trained", we have in effect attempted to assume a role of "objective and detached observer" and subsequently erect a deus ex machina (i.e., the child and his/her pathology) that needs "modification." By doing the latter, we have hitherto, occluded or razed any sense of attributable purposeful meaning to the child's current interactions (i.e., from the perspective of the child's eyes). In other words, the child's "[aberrant] behaviors now to be micro-managed, defined and redefined, selectively tagged, isolated - and to be worked on " under an incontrovertible banner of the "only scientifically proven early intervention method."
The mapping of behaviors now for all intents and purposes functionally distilled [anesthetized] and linguistically re-constructed, or "empirically re-conceptualized", strictly as a rule, in terms of antecedents and consequences. Consequently, in a very real sense, we unwittingly become aberrant in our detachment and our inability to connect (e.g., learn how to follow the child's lead and understand from his perspective - or theory of mind), under the safe guise (objective observer) of now "scientific observer and technician." There is no deus ex machina.
One of the major challenges that we face here is the widespread prevalence of a pervasive "task-based mentality" and the simplistic and polarized belief systems attached to it which are systemic throughout every aspect of attempting to micro-manage the "tasks of our and our children's daily lives and routines" (e.g., all remedial based applied behavioral or cognitive behavioral approaches and their larger supportive institutions that focus on changing the external component of surface behaviors and not the critical underlying associative links or organic connections/emotional-social interactions that, in fact, constitute any external performance or surface). It is imperative that we learn how to look and emphasize to other generations how to look at the "deeper narratives" behind the surface interpretation of an event - or our child's typical or atypical behaviors.
As a part of evolutionary caregiver nurturance based practices, an applied emotional-developmental approach is strongly and consistently placed on the deepening of attachment. Attachment here deepens as a part of an orchestrated symbiotic co-created meaning making process, attuned to (and thus in keeping with the cultivation of) the child's affect-sensory motor processing differences, including caregiver to child affect relationship patterns. This Developmental focus results in heterogeneous - as we all have areas of strengths and challenges - but overall as we progress up the developmental ladder, more integrated levels of typical functional emotional development.
With the exception of the child demonstrating predominantly gross or fine motor based challenges, the surface functional abilities of the child to demonstrate what are commonly presented to primary caregivers as routine cognitive tasks (e.g., matching shapes; pointing and labeling pictures on command; completing block towers, pairing like objects, etc.) are not one iota as important as the ability for the child to meaningfully connect, in other words, for both clinicians and primary caregivers to respect and follow the child's lead and once connection is established to add more varied suggestive affective nuances, which then in turn, provides a basis for stretching out and deepening meaningful two-way interactions. The latter can, but by no means must, include the aforementioned or other randomly selective cognitive task based skills. Interestingly, when caregivers and clinicians use an attachment oriented-and-affect developmentally based approach they unwittingly incorporate the vast majority of "must focus-on isolated/selective task based skills" in an integrated and meaningful manner.
Nonetheless, the understandable rush and anxiety for the toddler/child to follow adult-directed tasks on command often stands as a testimony to a profound ignorance among many educators and therapists in the field with respect to the underlying emotional developmental and processing dynamics that not only, in fact, naturally guides what are considered many typical "cognitive skills" but more significantly provides a sure (present) foundation for their spontaneous initiation by the child, again, as s/he becomes more confident [emotionally reassured] in his/her emerging dyadic affective communication and emerging sense of autonomy or self-with-others.
As the latter occurs, naturally, in the context of emotional interactions (through following and building upon the child's lead, deepening attachment and deepening/stretching out affect guided interactions, co-regulated interactions) the antecedents and consequences of the "child's behaviors" do not need to be artificially extracted (as for example, in ABA), as they naturally and organically transform in the context of pleasurable two-way emotional-problem solving interactions. Hence, the zone of proximal development of nurturance based affective interactions are fundamentally different than a non-integrated, polarized and applied behavioral oriented mechanical focus on task completion and reduction of behaviors.
In contrast to attachment oriented and developmentally based approaches, traditional cognitive behavioral or applied behavioral approaches (e.g., ABA), of "breaking down tasks" for the toddler/child to their smallest possible units to make them more graspable under the presumption of the toddler's/child's greater ease of acquisition and comprehensibility and then, rebuilding towards general task development (i.e., once reflexive surface command compliance/proficiency is achieved through repetitive practice/positive behavioral support) is understandable but, nonetheless, misguided and tends to insult the toddler's/child's emotional intelligence, as well as our own.
The act of breaking down or the conceptualization of deconstructing tasks into discrete units in order to make them more palatable or graspable for the toddler/child whose primitive impulses or aberrant behaviors appear extreme, naturally has almost for always and always seemed perfectly straightforward, since we quite reasonably have always asked ourselves, for example, "How, can my toddler/child be in a position of understanding, learning and communicating if his/her behaviors are erratic and/or has neurological impairments."
However, this seemingly commonsensical just-so reductionistic narrative in lock-step with the prevailing dominant ideological cognitive/behavioristic practices, in fact, has far less to do with the actual nature or underlying neurodevelopmental maturational and constitutional processes on how infants/toddlers/children begin to integrate the preverbal and verbal dynamics of learning (either neurotypically or neuro-diversified) and much more to do with our initial recoiling or immediate reactive [misguided conditioned/ learned] adult impulsive responses to our child's emotional-developmental challenges. In that respect, as a general rule, and without any implicated primary caregiver blame, primary caregivers, educators and therapists always quite reasonably feel compelled to have a stringent measure of controls over their child's aberrant or primitive impulsive behaviors (e.g., heretofore perceived as interferences that must be extinguished for child learning how to "self-control" aberrant impulses), that is to say, in order for the child to be in a position to "properly attend", according to both the pedagogies of traditional child rearing practices and general learning theory.
However, what many primary caregivers and clinicians are beginning to realize is that historically there has been a widespread failure to understand that it is specifically primary caregiver and clinician affective attribution of emotional meaning and affective-rhythmic attunement to the child's present actions (e.g., following the child's lead) that creates a [pleasurable] foundation for two-way meaningful communication skills in the context of social interactions and not the artifice (and, indeed, part of the centuries' legacy of old child-rearing beliefs) of first identifying, delimiting and controlling many undesirable environmental variables (i.e. "distractions") and thus have the toddler/child begin to self-control surface responses by beginning a process of "learning" by focusing on a series of selective or isolated tasks (e.g., rote memorized actions by external prompt and cuing, ad nauseam). Historically, this can also, as well, be conceptualized in the sense of entification (i.e., nouns separated from actions or, in practice with toddlers and children with developmental challenges, labeling or isolating actions separated from meaningful interactions).
It is the deepening of attachment (i.e., following the child's lead and, as a consequence, the deepening of nuanced social interactions) and not the former which engenders a true basis for meaningful emotional-cognitive, receptive and expressive language development (the former is a highly parsed or sanitized intrapsychic controlled environment that understandably can, at first blush, appear enormously seductive to primary caregivers as the child becomes proficient in a school-readiness look good/feel good series of highly selective or isolated task completions, which in fact, stands in direct contrast to addressing integrated emotional-developmental functioning and true foundations of language-and-social communication).
In fact, the cognitive-behavioral activity of labeling the child, for example, the "child's primitive impulse responses" or in the more popularly termed, "the child and his/her aberrant behaviors", strongly tends to dissuade primary caregivers, educators and therapists from actually engaging in a much more empathic approach, that is, in understanding the child's behaviors in a Developmental context (for example, appreciating/understanding their impact or psychology of meaning for the child in relationship to others - and, we can say, beneath the institutional adolescence of positive or negative labeling or surface compliant/non-compliant behaviors, the core presenting affect-sensory processing challenges which would provide a more accurate and, indeed, deeper clinical understanding behind the symptomatology).
When cognitive or applied behavioral or task-based approaches are used (e.g., A.B.A) and the child is "trained" by primary caregivers, educators and therapists by discrete trial training or other methods to immediately begin to learn how to redirect aberrant behaviors and "follow commands" (i.e., "look at me") and upon the "success for a job well done" promptly rewarded (i.e., robotic verbal praise and/or material reinforcers) for complying with adult directions to "selective tasks"* the early critical functional emotional-developmental milestones (i.e., shared attention by pleasurably based interactions that naturally leads towards the emerging complex milestones of deepening circles of affect facial/bodily gestural and verbal reciprocity) do not begin to happen. Why do they not begin to happen? They do not begin to happen as a dominant focus on the redirection of the child's surface behaviors does not begin to substantively engender a [Developmental] context for encouraging of deepening [emotional] connections of attachment and spontaneous affective initiation or meaningful turn-taking (e.g., on the simplest level conceived as a smile, a smile back; a frown, a frown back).
The emotional-developmental emphasis in caregiver/child from simple to complex symbolic interactions begins to form a genuine basis of neurophysiological (affect sensory-mind-body) integration and inter-individual meaning [true social interactive viability versus a repertoire of mimetic or prompted responses]. As the emotional-developmental milestones begin to emerge from the foundation of deepening child/caregiver affect circles of communication (e.g., shared attention with an increased focus on affect reciprocally connected circles of communication establishing more dense reciprocally nuanced emotive signals that encourages a process of symbolization - or the gradual separation of ideas from catastrophic, all or nothing, fixed modalities of perception leading towards the emergence of language), we see a strengthening of neuronal pathways between the subcortical and cortical regions (e.g., the more primitive limbic system and the regulatory functions of the prefrontal cortex). Consequently, from these complex affectively guided interactions we have a continual increase of spontaneous co-regulation or co-coordination of social interactions without prompting.
*"Selective tasks", such as, naming/pairing common objects; stacking blocks, completing shape sorters and/or following one or two step commands: "touch nose"; "show me circle", "take ball out of bag, give to mommy", etc.
The general reason for a lack of emotional-developmental integration or true praxis (for example, the child's prompted or rote responses in contrast to spontaneous affect guided circles of communication) when, instead, the child is cognitively trained by adults to redirect aberrant behaviors and "correctly respond" by carrying out selective tasks on command is that the overwhelming emphasis (or applied behavioral "learning theory") is on the management of the child's surface memorized cognitive-behavioral responsiveness system (at the risk of stirring much ire, dare we say, often largely motivated for proficient test score purposes, that is, irrespective of whether they are truly Developmental and addressing the child's processing differences, manifested in terms of safely, easily and surface-selectively demonstratable "cognitive-behavioral tasks").
Tragically, in the course of typical educational settings (i.e., classroom-management educational settings), the clinical, educational and caregiver emphases are generally not being guided by the child's natural intent (e.g., regarding the child's in-present emotions as purposeful and meaningful and joining-in her/his non-injurious behaviors) but, instead, the dynamics of learning are consistently geared toward a hierarchical series of emotionally detached scripted or memorized responses. To use a rather worn but apropos phrase, "What is learned by rote is not the same thing that is learned by the heart."
Surface memorized responses are the quintessential opposite of an affect based approach. An affect-based approach respects the child's current emotions and empathically attempts to understand the child from his/her perspective. Moreover, we attempt to understand how caregivers' as well as clinicians' affect or natural emotive styles may be overbearing or underbearing for each child at any particular moment. Traditional applied behavioral analysis (ABA) or task-based approaches are essentially without any substantive affect emotional-cognitive interactive meaning that involves two-way emotional signaling other than surface mimetic or reflexive responses (there is developmental oversight in many cases to even take into consideration the toddler's affect sensory processing differences and caregiver affect relationship patterns).
Misguided and well on the road to becoming arcane from contemporary neuroscience perspectives on the whole co-signaling brain or interconnectivity of emotional-cognitive learning, growth and development, the "scientifically proven theories" on learning and motivation under the tutelage of the Skinnerian to Lovaasian pedagogy of "operant conditioning" (i.e, the child as tabula rasa or a bundle of neurologically mis-wired aberrant impulses and that through a systematic focus of utilizing numerous modalities of positive behavioral single to general task re-enforcement can be "re-trained" to respond appropriately) are admittedly but limitedly successful, that is, in what they set out to measure: The control and manageability of the child's surface learned (reflexive) responses on cue.
However, what they do not address, what indeed they inexcusably fail to address/recognize, are the fact that the child's so-called, surface "aberrant behaviors" as a part of wider systemic core of underlying and differentiated neurophysiological processing challenges: The processing challenges that include affect-sensory under-reactive, over-reactive and mixed reactivities in auditory, visual-spatial, tactile, vestibular and proprioceptive domains. These affect-sensory motor processing differences strongly varies from child to child and urgently need to be addressed not by a surface remediation but in an affect-developmental [emotional] interactive and clinically integrated manner. Moreover, they need to be seen as unmistakably possessing both purpose and meaning for the child (i.e., emotionally-developmentally/ psychologically).*
*By naturally and gently nurturing a child's affect or intent through two-way pleasurably based, emotional problem solving interactions that nurtures, honors and respects the child's affect sensory-motor processing differences we are, indeed, fostering the core factors of spontaneous thinking, relating and language development rather than robotic or scripted responses given by the child on solicited command or query by the adult.
Instead of continuing what for many decades has been mistakenly or prematurely conceived as a "developmental intervention approach" by a pedagogy of [unconsciously] deconstructing and mico-managing the toddler's/child's surface cognitive behavioral responses, we are addressing a much larger organic and systems oriented approach. We are looking at the qualitative nature of affect at each point of functional emotional-engagement. We are looking at our own (primary caregivers and clinicians) affective or emotional engagement fine-tuned to the child's individual processing differences and affect relationship patterns (e.g., dialectical and dialogical inter-actions in contrast to a traditional and pervasive pathological obsession (diathesis) on the the child's object-performance completion of object-oriented tasks). Irrespective of where a child is developmentally (neurotypical or neurodiversified) this is the primary guiding principle and, in fact, the primary unifying factor that begins to coordinate, bridge and strengthen brain functions and differences.
Essentially, what is overlooked by traditional re-enforced task-based compliance approaches is the individual or "whole child" and what is (subsequently) rendered is a false and deleterious (Cartesian) distinction between the child and his behaviors. A selective identification of the antecedents and the manipulation consequences can result in external changes in the child's reflexive responses but not the child's underlying (more expansive) emotional-developmental processing functioning and increased connectivity. Thus, the Developmental counterpoint to an antiquated uniformed cognitive-behavioral mentality with respect to looking at the individuated communicative challenges of the child-with-primary caregivers would be, for example:
The child performing (Oops! let us hereby correct, "performing" to "emotionally-developmentally relating and interacting") not in terms of "task compliance on cue" but by developmentally addressing the architectonics or preverbal dynamics behind any "task demand completion", specifically the child's sensory-emotional signaling processing-and-primary caregiver affective patterns as an integrated part of not a static but a dynamic (dialectical/dialogical) social communicating. In other words, where the neurophysiological processes of "affect-regulation" [simple to complex emotional signaling, for example, between the prefrontal cortex and the limbic system] is literally transformed by a deepening of meaningful joining/attachment between primary caregivers with the child's current affective processes or natural intent. These affect nurturance based connections between primary caregivers and child, et al., begin to re-connect nonverbal-and-verbal modalities [i.e., sensory-mind-body learning] by virtue of the amazingly resilient affective plasticity that are an inherent part of all neuronal connections (e.g., caregiver/child co-affective regulated signaling becoming pleasurably-integrated as a part of the child's emerging autonomy manifested in a strengthening of previously compromised neuronal connections).
The correlations between affect regulation (or affectively attuned and co-regulated pleasurable based caregiver/child interactions) and concurrent positive or negative changes in the strengthening of neuronal pathways and hormonal production (e.g., increase/decrease of stress hormones, cortisol) are not speculative. Five decades of research in the neurosciences (and more recently, neuroplasticity) have clearly demonstrated significantly improved affect sensory-motor functioning and overall general praxis (for example, from deprivation studies conducted on primates in the 1960's; to dysfunctional family dynamics, where there is evident a pattern of child neglect/abuse; to healthy family dynamics, but where there are present underlying biological processing challenges, such as complex neurological disorders that includes autism spectrum disorders).
This affect based theory and practice has been shown to become practically translated into "evidence-based teaching"when "functioning" is viewed not in terms of simple labeling of positive and negative functional behaviors, but when connections are consistently made clear and put into practice by primary caregivers, educators and therapists between healthy integrative neurophysiological functioning and emotional engagement. In complex neurodevelopmental disorders, such as autism spectrum disorders, this entails a detailed re-examining of the child's individual sensory-motor processing and child/caregiver affective attunement at each level of functional emotional development. This [interdisciplinary] process enables a continual strengthening neurophysiological foundation for the healthy emergence of the developmental milestones (this includes, beyond the child's mimetic responses, the emergence of spontaneous language/ communication and higher order critical thinking skills, symbolic play to reasoning between symbols or ideas). This has been clearly and consistently demonstrated in primary caregiver nurturance based practices (e.g., DIR/ Floortime) during the last two decades where the role of affect or emotional signaling is given primary emphasis.
In traditional task/behavioral based approaches the emotional-developmental critical process of meeting the child where s/he is at (i.e., what is of affective interest or fascination to her/him) hardly ever once enters the picture, except as a means to an end (e.g., when using techniques of "natural environment" and the toddler's interest to quickly facilitate the garnering of the toddler's attention but then quickly "behaviorally re-directing" the toddler). Essentially, skills/tasks are generally approached across many educational and therapeutic settings as classroom performance management routines - which frequently are not just partially but entirely disconnected from toddler/therapist affect-guided emotional interactions and thus (from the methodological start) emotionally developmentally and cognitively disassociated from the toddler's natural interests - or his unique affective sense with others, as a part of his natural functional emotional-developmental emerging sense of self/environment.
Despite an overarching and never-ending grand cognitive-behavioral management model, the pedagogy of operant conditioning, which serves as the primary underpinning principle of applied behavioral analysis (and, dare we say, often unconsciously adjoined to a diatheses of child-rearing beliefs, i.e., "children should be properly taught/conditioned to be seen and not heard" , "Give a child an inch and s/he will take a mile" - or transferred to an "educational context" on that which constitutes the prerequisites for toddlers able to presently and later "attend and "learn", i.e., "children should initially comply to adult directives" as a non-controversial first step, especially so for children who present "cognitive and behavioral disorders") has a useful but limited place (e.g., the toddler possessing little or no awareness of self-body boundaries resulting in significantly moderate self and/or other injury). However, its "usefulness" must be severely tempered by a socially healthy and neurodevelopmental note of extreme caution: To be used only as a limited specific duration or temporal measure in a comprehensive Developmental framework.
Essentially, all the emerging emotional-cognitive milestones are fundamentally a part of the spontaneous unfolding of simple empathic natural back-and-forth circles of [social] communication (irrespective whether the child is assessed as neurotypical or diagnosed with neurological complex disorders, such as ASD). Functional emotional-cognitive skills only begin to meaningfully emerge (i.e., begin to become neurophysiologically integrated) when clinicians and primary caregivers begin to observe and gently emotionally engage each child where s/he actually is with respect to her natural world (i.e., the child's natural emotive or affective state, interest and comfortability zone).
What I have been outlining here is a fundamental Developmental psychological based approach in accordance with the six basic infant/toddler functional emotional-developmental milestones formalized twenty five years ago by the most respected child psychiatrist Dr. Stanley Greenspan and Dr. Serena Weider. This includes clinicians and primary caregivers slowly observing, mirroring and joining in with the child's atypical but non-injurious perseverating behaviors for the purposes of
1) Clinicians and primary caregivers learning to respect the child's present reality rather than too quickly attempting to re-direct or shift the child's focus without understanding what it existentially (personally) means to the child (i.e., how the child navigates reality from his/her immediate affect-based connections with the environment, including his atypical sensory processing behaviors)
And as a result of not attempting to "redirect" the child's natural affect (e.g., repetitive non-injurious behaviors) but rather critically taking the time to understand, listen, feel and observe the meaning of the child's processing intentions into intuitive consideration - as possessing existential validity (viable and substantive social and linguistic competence and meaning and measurable neurophysiological changes)
2) Clinicians and primary caregivers begin to develop a solid basis for a more empathic or theory of mind understanding - from the child's perspective.
The reason why the above begins to constitute an integral part of an emotional-developmental psychological based approach (i.e., grounded in attachment theory and aids clinicians and caregivers to gain a much needed empathic or emotionally based understanding of the child) is that we are adopting a systems theory approach - and thus looking at the child from a position of integrative consciousness: We are looking at the child's whole developmental functional emotional reciprocity-with-others and no longer adopting the systemic and unconscionable position that the child (a bete machine) is in a state of confusion due to neurological insults resulting in primitive impulsive or aberrant behaviors that need to be immediately redirected (re-trained) from the outside-in, so s/he will "learn" to self-constrain (e.g., vis a-vis repetitive drilling or positive behavioral re-enforcement) those aberrant impulses and productively advance [surface prompted] learning. As mentioned, neuroplasticity, the ability for the brain throughout the life cycle but especially during the first several years of life to make new connections or strengthen existing connections is much more affectively responsive than conceived decades ago.
Clinicians and caregivers learning the natural process of how to tune-in and connect with a child's emotions is precisely the key that begins to make available the probabilities of strengthening those connections and rebuilding the milestones that constitute healthy development. This necessarily entails looking at the child's unique sensory-emotional processing differences and child/caregiver relationship patterns and not the frequented well intentional and superbly implemented but often shockingly non-developmental diatheses that many therapists and special educators in early intervention and preschool to school-based settings often reflexively implement:
A uniformity of one-size fits all developmental procurement of each child's surface cognitive-behavioral management skills with the goals of preparing the child for preschool to school surface readiness skills and concomitantly general teacher and administrative control (e.g., the child's, non-developmentally conceived, "out of control or unrestrained self" to "better behaved or under-control self").
Instead, we urgently need to look at each child's emerging sense of self-in-relationship-to other and not simply functional behavioral assessments that exclusively examines compliance or non-compliance with respect to the accomplishment of adult directed performance-based tasks (e.g., receptive/expressive language, cognitive, social adaptive) that are executed by the child on command by the adult.
Indeed, what we find is that when we begin to gradually slow down, feel, observe and guide primary caregivers to join-in with the child's natural emotive or affective state is that we begin to directly convey (at a preverbal level) to both the child and caregivers an often clinically neglected but developmentally necessary validation that the language of the child's "atypical cognitive and perseverative behaviors" are not only "acceptable and engagable" in their present functional affect-based expression (e.g., self-spinning; repetitively lining up toys; echolalia, etc.) but are emotionally-cognitively and socially meaningful.*
A proper understanding-and-joining in the child's affect emotional-developmental processes is extremely crucial for the integration and growth of a child's development (and concurrently, primary caregivers' understanding-and-interaction). Yet, when this is initially brought up to clinicians in the field who are unacquainted with a Developmental approach, which necessarily includes an understanding of attachment and affect and involves going directly to the child's world, it is met with incredulous stares, as often the entire emphasis, mind you, not just with children with developmental challenges but increasingly and tragically throughout the majority of present day cultures in general (neurotypical or neurodiversified), is not about looking beyond the surface and forming deep and abiding connections (e.g., neurophysiologically and inter-individually) but essentially about the management and control of surface behaviors.
As a society we focus on defining and fixing the problem; we talk about the problem child, on defining, working and isolating specific challenges in the child; in other words the dominant focus is intra-psychically and intra-personally; not inter-personally and interactively where functional emotional milestones are transformed through affective reciprocity in dyadic pairs (preverbal-and-verbal co-narrative transformation) and have corresponding, system dynamic, neurological correlates.
*The context of the words used above, acceptable and engagable applied to a child's non-injurious "perseverative or stereotypical behaviors" is enough to make many primary caregivers, special educators. therapists and administrators initially cringe. However, when clinicians guide primary caregivers to refrain from what appears to be a common but severely misguided practice of redirecting "inappropriate behaviors" and, instead, begin to guide primary caregivers to empathically understand and slowly join-in with the language/movement of the child's natural intent or emotive expression (e.g., repetitively lining up or knocking down blocks or spinning self or objects, rocking with the child, etc.), the child's attention, in turn, begins to become meaningfully engaged (i.e., a deepening of attachment). It is precisely here we begin to see non-prompted or spontaneous co-regulated emotionally-connected circles of caregiver/child communication significantly increase.
Again, the reason we can define the foregoing as "Developmental" (for example, in contrast to cognitive-behavioral methodologies) is that we are addressing the core issue of the child's internalization or emergence of meaning (i.e., emotional-cognitive integrated functioning) during a process of adult with child gently facilitated "co-created affect gestural/verbal circles of communication with others" rather than, for example, child mechanical compliance to adult directed [surface] behaviors (i.e.,"accomplished/proficient adult performers" directing "toddler/child incompetence", either synaptically compromised or tabula rasa). The latter, however, "productive" in its cognitive functional task expediency-and-"school-behavioral management function" (i.e., maintaining orderly classroom management, efficient input/output productive flow of assessment-scores and thus the assurance of continued federal/state to school district funding) does not, as a rule, involve clinicians and educators consciously attempting to slow down, connect and regard the child's internal sense of meaning (i.e., the child's current sense of "self-with-other") as valid: The primary working framework for both a Developmental and an empathic clinical based understanding and practice.
It is specifically child/primary caregiver affect guided co-regulated meaning-making (i.e., continual co-created interactions built upon following the toddler's lead resulting in deepening attachment, meaning and spontaneous integration of skills) which begins to set-up the Developmental framework for the integration of functional-emotional development and sensory calm and regulation (i.e., the integration of cognitive skills from an internalized standard of emerging self of the child-with-others). This strongly needs to be represented as the primary Developmental foundation of all clinical and educationally based interventions. _____________________________2_____________________________
In my practice with children on and off the spectrum, which is largely based upon a DIR/floortime developmental based methodology, where harnessing a child's natural emotions are central, I do not place any emphasis on training caregivers and their child to complete a prescriptive series of cognitive based skills, but "cognitive skills" are placed into context and explained to caregivers and clinicians as having to unfold from a more fundamental basis of attachment and emotionally guided social interactions based on following the child's natural lead for skill acquisition to become meaningful.
Over the course of working with hundreds of families, I have consistently found that the non-developmental curriculum of pre-school readiness skills found in many special educational programs, as toddlers transition from early intervention to pre school - and early intervention is largely geared toward (e.g., "pre-school readiness skills" that often amount to a laundry list of surface tasks irrespective of the toddler's interests and processing differences) are nowhere near as imperative as the underlying emotional-developmental foundations, or an emphasis on the deepening of attachment that enables the acquisition of any skill to occur in the first place. In other words, for the basic emotional-social intelligence behind all "performance based tasks" to take on meaning and thus become an integrated [rather than surface] part of the child-with-caregivers' natural joint affect-dynamic. Without the latter, we tend to see an expeditious mechanical assembly line of "functionally compliant" (look good/feel good) but non-developmental skills passed down from parent to child, resulting in a tremendous disservice to the children under our care, their families and future generations of clinicians and educators.
Despite seventy years of useful behavioral observations and widely acclaimed success (from B.F. Skinner to O.I. Lovaas), with respect to marginally improved and select I.Q. scores and reduction or transformation of certain aggressive behaviors to functionally compliant behaviors, no degree of behaviorally oriented data collection and task-analysis have ever enabled clinicians and families to significantly address the deeper emotive processes or underlying core developmental capacities and unique constitutional processing based differences of thinking, relating and communicating that are present in autism spectrum and related developmental disorders. What may come as a shock to some, but indeed what is a Developmental fact, is that the targeting and redirecting of "inappropriate behaviors" is not necessarily, one iota, to address the core issues of praxis. True praxis in contrast to the child's acquired surface gains to selective cognitive tasks and redirecting aberrant behaviors (external rule following), or the child's scripted responses on cue can be conceived of by the following:
Each child's ability to spontaneously and pleasurably co-regulate his natural intent in synchronization with caregivers and others to communicate emotionally meaningful ideas, and not simply adapt to adult-directed test performance success (i.e., newly acquired surface memorized responses) resulting in the successful mimicry, or rote imitation of task, or once imitation of task is learned the surface memorization or scripting of simple actions to obtain immediate object desires. The Developmental focus, from day one, with each and every child needs to fundamentally address a social-emotional foundation with respect of the meaningful communication of simple to complex ideas (i.e., the child's ability to read nuanced facial/bodily expression, inflexion of verbal tone, pause and rhythm) with caregivers, peers, et al. during increased (daily assessed and recorded) lengthening/deepening circles of back and forth joint-emotional problem solving.
Essentially, an integral part of a Developmental approach that takes into account the child's functional-emotional developmental and unique sensory-motor-processing differences (i.e., under-reactivity, over-reactivity, mixed reactivities across differing sensory-motor processing domains) requires a basic emotional-intuitive understanding (prior to and hopefully in the future consistently addressed as an integral part of all academic educational and clinical training). Understandably, at first, this might seem a bit peculiar as the main historical emphases, e.g., since the inception of special education, for professionals, as well as primary caregivers, has been on a toddler/child mechanical compliance performance model defined in terms of object-task completion (at surface social adaptive and cognitive levels) rather than (more deeply) comprehending the affective-subtleties of [emotional] processes in direct relationship to improved sensory-motor functioning or praxis and [true] social connection.
This emotional-intuitive understanding is required from both primary caregivers and clinicians. This often requires (with the guidance of trained clinicians) an education on the practice of what is defined as affect, and what I have come to refer to as a simple but "developmentally applied theatrics": The ability for clinicians and primary caregivers to affectively frame the child's inter-actions (moment-to-moment) by learning the Art and the psychology of accessing and substantiating the nonverbal zone of proximal cues with respect to how to slow down and affectively frame, dramatize and increasingly convey subtlety or nuanced (layered) emotional meaning to the child's (inter) actions. For example: A subtle passing look by the child developmentally adjoined, if you will, to the embodiment of a conveyed feeling by the adult, that is in direct empathic keeping with the child's natural intent or affective state, thereby, suggesting/conveying to the toddler/child a greater psychic weight or substantiation to the her/his [inter]actions, and thus the beginning of a true deepening of a two-way co-created meaning-making process or natural emergent flow of child/caregiver affective communication.
Now, it is precisely here [child/caregiver nonverbal affective nuanced framing/conveying/relating] that the infant/toddler's (or older child's) spontaneously reading-and-reciprocation of affect facial and bodily cues during simple two way back and forth emotional problem solving in contrast to the well meaning but plainly misguided six decades of research of "scientific data" on the successful transformation of the child's maladaptive [surface] behaviors or "task non-compliance to task compliance that substantially begins to form substantive cortical and subcortical or cross synaptic integration and the basis of true [meaningful] emotional signaling [social relating, thinking and communicating].*
*These early affect facial and body movements (i.e.,widening of eyes, cooing, frowning, etc.) in synchronicity to primary caregivers guided by affect [the emotions] are continuously and abundantly present beginning in the early months of neurotypical development but are either derailed or later become derailed in ASD.
Now, again, this is not to blanketly suggest that applied behavioral analysis (ABA) or task based approaches with some children at certain times is without necessity or positive outcomes (e.g., establishing, where there is initially present little or no environmental awareness, a simple sense of causal connection in order to help reduce self and other serious injurious behaviors), but, as a rule, they are clearly not "Developmental", as they fail to address the core (and extraordinarily critical) developmental maturational and constitutional challenges that children (or older) with ASD have to not the same but variable degrees (hence, the word, "spectrum") in connecting and coordinating their natural affect or intent with their unique sensory and motor planning challenges in a spontaneous flow of back and forth emotional problem solving communication with others!
For example: The child connecting with regulation, warmth and intimacy throughout the opening and closing of many affect guided emotional-problem solving circles of communication (i.e., shared attention leading to deepening reciprocal exchanges with representational or symbolic ideas) from single to two-part and more novel sequences; and the increasing emergence of spontaneous (non-prompted) language usage/ dialogue with caregivers, clinicians, peers, et al. to transform not single bound "object tasks" but (open-ended) social actions into meaningful two-way emotional problem solving exchanges. In contrast, cognitive-behavioral discrete task oriented approaches typically produce context-dependent or scripted responses produced on cue to picture symbol, gestural or verbal prompts, and thus often limiting higher possibilities of developmental intelligence growth and integration. (3)
Addressing these basic underlying core emotional-developmental challenges (i.e., connecting or relating with warmth and pleasure to others, representational thinking and spontaneous communicating) in autism spectrum disorders must initially entail a deepening of child/caregiver attachment and preverbal or affect based relating. It is this which sets the foundations for the child's subsequent meaningful [expressive] language skills, symbolic play and a transformation from catastrophic or all of nothing thinking (e.g., perseveration on single objects/desires and frequent moderate to severe tantrums) to gradually more diversified thinking (i.e., nuanced circles of communication-and-increased calm and regulation). However, what needs to be moderately emphasized in practice is that it is not just the "developmentally challenged child" who needs to be able to learn how to climb up the emotional-developmental ladder and relate with others, but it is equally clinicians and primary caregivers who need to begin to learn how to meaningfully slow down and re-adjust or fine-tune their way of connecting to their child's world: Their child's unique combination of emotional-developmental and sensory based processing differences.*
*Which we must always remember are not only emotional developmental challenges that the child has - which needs to be exhaustively understood and addressed using an interdisciplinary model - but also existential validity from the child's perspective (by primary caregivers and clinicians) that needs to be emotionally registered (felt) with respect to how the child co-constructs meaning with others. This "felt validity" (i.e., empathically understood from the child's sense of emerging self-with-other) becomes, in turn, a critical navigating component of improved executive functioning [or praxis]. What we are focused upon here is the child's (or rather, child/caregiver's co-coordinated) re-strengthening and/or re-connectivity of compromised affect-neural sensory-motor connections. As we are re-strengthening these "underlying sensory-emotional-motor connections" - through deepening attachment and dyadic co-regulated interactions - (i.e., following the child's interests) we are building a Developmental foundation for the child's greater emotional-cognitive growth-and-intelligence (i.e., a confluency of higher complected symbolic exchanges of ideas along with the emergence of meaningful expressive language skills).
(for a wonderful article on deconstructing stereotyping to greater conscious meaning on what constitutes our widely habitual reflexive use of the term "reciprocity", see, Gernsbacher, M.A. (2006) "Toward a Behavior of Reciprocity" http://psych.wisc.edu/lang/pdf/gernsbacher_reciprocity.pdf
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Primary caregiver emotive or affective relationship styles in helping to significantly facilitate (or impede) the child's development irrespective of normal or atypical functioning has been far too long neglected by traditional cognitive-task and applied behavioral based approaches. This should not be taken in any sense as accusation or blame. The dedication of many families, time, sweat and tears speak untold volumes. Instead, what this involves is not clinicians and educators continuing to adhere many of the antiquated or surface developmental practices of thinking/assessment (e.g., cognitive-behavioral checklists for assessment of skills), whereby clinicians implement their daily practice with the goal of the child obtaining test proficiency in acquisition of performance based tasks, and thus consequently from goal formulation to assessed outcomes often erroneously equate "accomplishment" (e.g., accompanied with a mark of + or - with an occasional footnote) for the rote presentation of skills produced on command.
What this involves is a qualitatively different theoretic than the generally taught surface educational training on cognitive and behavioral skill development for clinicians who work with special needs infants, toddlers, adolescents (or older). This needs to include an educational and clinical affect-based practice that examines two-way nurturance based processing, including the subtle nonverbal affective system dynamics (e.g., the expanding subtle nuances of two-way facial affective responsiveness during child/caregiver communication; affect variations of inflection, pause, tone and rhythm and so forth) at each point of [emotional] dyadic connection.
The reasons for engaging this process would begin to become obvious as the child with caregivers slowly begin, milestone to milestone, to developmentally progress in a much more integrated fashion. This would greatly help clinicians and caregivers to more substantively understand and correctly help eliminate the highly seductive but misguided focus on selective or "discrete tasks." Thus, the potential paradigmatic shift (which we see in approaches such as DIR/floortime) would include less clinical, educational and parental hyper-focusing on noun driven or selective object-task completion but, instead, a welcoming and going off on multiple tangents with the toddler's emotional interests (i.e., following the child's lead) from moment to moment, and in the process (i.e., through this rapport) building a much more complete understanding of the true developmental dynamics of age appropriate social exchanges (as well as the specific needs and individual differences with respect to each neurodiversified child's strengths and challenges).
For example, as clinicians begin to more fully engage the latter (i.e., attachment based affect guided reciprocal child/caregiver exchanges), this process would naturally begin to engender (in practice) a fundamentally different dialectic (i.e., a wider developmental perspective in contrast to the typical school based perspective) where the assessment of compliant based tasks are not just present and accounted for (vis a vis cognitive/behavioral task inventory checklists) but begin to become emotionally integrated in the growth of the child's autonomy (i.e., based upon deepening circles of communication about his/her interests) and thus help form for the child-with-others a truly more social-communicative progressive and overall healthier Developmental foundation.
The latter naturally embraces higher and earlier feasibly acquired skills sets (e.g., two-part symbolic play sequences, which further sets the necessary stage for pragmatic social language/communication skills, instead of context-bound or referential rote labeling of simple requests or tasks on command, which often takes a less than accurate and respectful view of each child's greater existing intelligence and potential).
In that regard, I have consistently worked with children who only after a very short period of time (e.g., a few parent/child one-hour sessions) were able to engage in non-prompted pleasurable joint attention; strengthening circles of preverbal communication with simple referential language to more pragmatic (verbal) language based expression, etc., using an affect-guided developmental approach, rather than many months of a previously used applied behavioral approach or regular DI. This has included toddlers on the moderate end of the spectrum who were able to be engaged at much higher levels than previously thought possible, according to the families and the clinicians who had previously worked with these children using more rote traditional educational and behavioral approaches.
A Developmentally based nuanced understanding (rather than a "an educational fiscally prudent" on-task uniformed behavioral compliance approach) significantly demands not caregivers and clinicians garnering better "instructional control" by teaching the child isolated or selective skills and compliant behaviors with the goal towards the generalization of acquired tasks. Instead, this involves a slowing down and careful re-examination what Development actually means by beginning to comprehensively grasp a clinical and an emotionally based understanding of each child's unique biological maturational and constitutional processing combinations (i.e., different heterogeneous mind-body connected pathways) of "meaning-making" (i.e., the child's emotional-developmental and affect sensory motor processing differences) along with the crucial impact of primary caregiver relationship based strengths and challenges to expedite or exacerbate present functioning. We need to consistently look for and begin to understand (and thus honor and respect) how each child uses his/her multifarious strengths and challenges (e.g., from advanced visual-spatial thinking to tactile defensiveness; from superior fine-motor skills to poor body praxis) to co-regulate and co-create meaning in her/his world with others.
Now, the activity of caregivers and clinicians joining in with that meaning (i.e., the child's world) and the facilitation (with an emphasis on embracing and expanding) of those affect-based strengths and challenges begins to naturally allow for pleasurably based interactions and (subsequently) a deepening of caregiver/child attachment (internalization and true skill production) as part of the natural emergent and integrating autonomy of the whole child.
This outline of a developmental understanding and approach significantly differs from traditional task and applied behavioral oriented approaches (e.g., discrete trial to pivotal response training), where many proponents tend at times to view in a quite impressive but, nonetheless, in an astonishingly affectively detached and reductionistic manner, complex spectrum differences (i.e., the child's unique emotional-developmental, communicative and sensory-motor processing and primary caregiver relationship styles) to essentially a meticulously charted, de-constructed and modifiable series of non-compliant and compliant behaviors. As a result, the latter often brings to an unintended insulting and arresting halt each child's (and caregivers') present but unexploited greater emotional intelligence (4)
There does seem at times among some professionals irrespective of educational or clinical discipline a certain missing something, a je ne sais quoi, between a theoretically grasped and a comprehensively applied developmental understanding where, for example, many of those who strictly insist upon cognitive task-based or applied behavioral approaches find it extremely challenging to either theoretically or practically take into account each child's unique emotional-developmental and sensory processing based differences. At the risk of ducking invectives, dare I softly digress here for a moment and reverse apply the often overused popular phrase, "lack of theory of mind" to those clinicians and educators who would responsibly refrain from guiding caregivers to a more developmentally empathic approach than a task-based one and instead - rather than see how they can devise detailed programs replete with data collection and task analysis to redirect the child's surface behaviors - see how they can devise warm intuitively inspired and emotionally developmentally informed relationships to guide caregivers to join with and begin to see from the perspective of the child's world. (5)
This would naturally entail clinicians and educators (across all disciplines) guiding primary caregivers and others to consider the child in a more gentle and comprehensive emotional-developmental light. For example, a more clinically informed understanding of each child's perseverative behaviors with regard to specific underlying affect sensory-motor and other constitutional and maturational based processing differences in contrast to the "scientifically behaviorally applied" but, nevertheless, scientifically developmentally inaccurate or inchoate interpretation of "compliant and non-compliant behaviors."
This would be integrated into a developmental practice by observing the following, as discussed:
. Empathically embrace and engage each child where s/he is in terms of her/his natural affect, as opposed to traditional cognitive selective task or behavioral approaches (e.g., from discrete trial to incidental teaching to pivotal response training) where the shared assumption for children on (or off) the spectrum is to re-direct the child's "inappropriate behaviors" in order to orientate the child toward increasingly adaptive or typical peer learning.
. Understand from a comprehensive emotional-developmental perspective that the child's "inappropriate behaviors" do not simply infer a "disruption to the acquisition of learning" but instead present tremendous developmental opportunities to facilitate the deepening of caregiver/child and peer reciprocal attachment not by re-training the child's surface behavioral responses but by addressing the underlying core affect sensory-motor and relationship processing differences and, thus, most importantly, validating the child's non-injurious "inappropriate behaviors" as meaningful to his/her sense of self in relationship to others.
. Understand that a deepening of caregiver/child and peer attachment (by following the natural interests or inclinations of the child) leads toward a spontaneous integrated acquisition of language, thinking, relating-and-communicating, as this begins to set up the [emotional-developmental] conditions necessary for meaningful (not scripted) dyadic social interactions (e.g., reduction of catastrophic emotions and increased regulated sensory-motor-planning) which, in turn, begin to systemically integrate [strengthen] and advance the primary core milestones associated with ASD and other related complex neurodevelopmental disorders from within and not outside (or the intersubjective narrative) of each child's natural intent or affect with others.
The above once comprehensively understood, both theoretically and in practice, by caregivers, clinicians, educational and other community based institutions begins to strongly support the framework for each child's healthy emerging autonomy.
Instead, what continues to be prematurely concluded over many decades of early intervention, school-based and therapeutic non-developmental methodology (i.e., in accordance to a dysfunctional and systemic Institutional model, which attempts to uniformly deconstruct the enormity of socio-economic stressors with respect to handling the intake of large numbers of incoming special needs children by placing the highest priority on child compliance and expediency - or the otherwise silent pledge of allegiance that "one size must fit all") is that the child's "disruptive or maladaptive behaviors" (i.e., inappropriately learned responses) or predisposed lack of regulation or poor impulsivity "in the child" as result of underlying neurobiological disruption (e.g., compromised synaptic connections due to systemic environmental-genetic factors) is [naturally, therefore] in need of some form of Applied behavioral analysis (potentially accompanied by a regiment of prescribed antipsychotics) for better internal impulse control. Once the child's "aberrant behaviors" can be brought "under control" then s/he is in a better position to "learn."(6)
This understandably quite popular and seductive but egregiously exploited, or professionally and sincerely entertained but neurodevelopmentally misguided and over-arching, cognitive-behavioral/applied behavioral weltanschauung with regard to neurological based disorders including autism spectrum disorders (e.g., where the emphasis in the state of New Jersey, and other states, has been predominantly on instituting twenty plus hours of ABA) has contributed to the escalating costs of early intervention services to the tune of many millions of dollars over the last two decades. It has essentially bankrupted the funding of the early intervention (EI) system, as well as left many families in dire straits due to out of pocket costs.
Broadly speaking, cognitive behavioral approaches (e.g., ABA) while indeed useful (in some instances but for very limited periods of time) for the remediation of children (or older) with severe behaviors as mentioned inexcusably neglects - because of a systemically aversive position with respect to the validity of the child's sensory and relationship processing differences - one of the most important developmental facts:
Autism spectrum disorders and related complex neurodevelopmental disorders when conveyed as disruptions or compromises in neural pathways that lead to disorders the child (or older) has in complying with peer typical generic tasks is inaccurate. The latter is generally deconstructed, as discussed previously, into school orderly task defined routines, such as, following commands on cue; sitting quietly in circle time; knowledge of shapes, completing reverse sorters; labeling common objects, pairing like objects, etc. Unfortunately, the latter and many other related surface ("cognitive-behavioral") preschool readiness skill/activities have been the primary focus of educational and therapeutic intervention for decades. This is a 1950's model of what constitutes cognitive- emotional intelligence.
Instead, developmentally speaking, our attention must be an in-depth understanding of praxis, one of the most essential (primary) core challenges that children (and older) with complex neurodevelopmental disorders, such as autism spectrum disorders, have. Fundamentally, this involves learning how to gradually deepen attachment, co-regulate and maintain two-way affect emotional-problem solving circles of communication during simple gestural-and-verbal requests to more complex communication of ideas (e.g., placing together nuanced ideational sequences during symbolic play). These challenges vary from child to child and always involve compromises in, one or more, different sensory-motor processing domains (e.g., under-reactivity, over-reactivity or mixed-reactivities in visual-spatial processing, tactile, auditory, vestibular or proprioceptive domains).
Importantly, this is quite a different matter than the child's (or older) "ability to comply with adult directed cognitive-behavioral tasks" (examples cited previously), which unfortunately, as a general rule, often leads to a non-sequitur (or grossly false assumption) of greater significant cognitive impairment than actually is present. This is often not just plainly inaccurate but indeed preventable. We can often spare many families unnecessary additional devastation, if therapists, educators and caregivers in the spirit and discipline of a true affect Developmental and interdisciplinary manner look at the whole child: The child's-with caregivers' functional-emotional, sensory-motor processing and caregiver affect-relationship patterns.
As clinicians who are educated in the latest findings in cognitive neurosciences, as well as basic social-empathic beings, we must begin to maturely look beneath the surface of school-societal mandated generic compliant/performance behaviors and not so blindly revert to a false reductionistic thinking. For example, recklessly depict a uniformity of symptomology where there are true individual developmental emotional functional differences - and developmental emotional functional differences that equally cannot either be reduced (reductio ad absurdum) to a singular sum of selective pathological behaviors - but whose further developmental maturational and constitutional components (e.g., auditory, vestibular and tactile, sensory processing differences, etc.) must be seen in relationship to relating. Instead of an emphasis on compliance to task there needs to be an emphasis on dyadic emotional-social connecting.
Imperatively, what clinicians, educators and parents need to continually consider are the more subtle and complex challenges with regard to each child's ability to spontaneously maintain pleasurably based affect-reciprocal (emotional) interactions with others (i.e., the child's capacity to co-coordinate and sustain with others meaningful dyadic circles of spontaneous nuanced preverbal facial/bodily gestural and expressive verbal communication - true dialogue in contrast to scripted responses). Conversely, we can indeed say that each child's "behavioral non-compliance" is plainly obvious. In other words, as a legitimate observation but only at the most superficial level.
Essentially, cognitive behavioral and simple task based approaches in both theory as well as practice fail to adequately, if at all, take into account the most important underlying emotional-cognitive foundations, which is not the child's behavioral compliance to follow adult directed tasks on cue (i.e., non-developmental notions of "learning and motivation" based upon an antiquated six decade old model of operant conditioning). Rather, and in complete accord with the latest findings in the neurosciences, it is each child's ability to spontaneously navigate his natural praxis with others, that is, his/her individual affect emotional-developmental, preverbal (and verbal) communication and sensory-motor and other processing differences in synchronization to novel (not rote) child-with-caregiver emotional-problem solving situations. This is not to ignore, due to lack of discussion here, the enormity of aetiological factors, e.g., immunological compromises due to numerous neurotoxins, improper absorption of nutrients and production of enzymes, as well many other environmental-and-genetic components, which potentially and greatly contribute to the onset of autism and other complex neurodevelopmental disorders. ______________________________3______________________
One of the more significant questions that demands more discussion among clinicians and caregivers is not, "Whether the child is in a better position to prepare to learn by redirecting "inappropriate behaviors?" but simply, "How are we defining 'learning'?" And more specifically, "How are we defining 'Development'?" And in the context of how typical and non-typical children develop - on or off the spectrum - whether the focus on modifying or "redirecting behaviors"* are examined in a truly competent and systems theory integrated manner? What role does an understanding and facilitation of co-regulated affective signaling or the emotions play in the healthy emergence of autonomy, learning and development?
In other words, from a truly clinical developmental interdisciplinary perspective is each toddler's/child's individual affect-sensory-motor processing dynamics (e.g., proprioceptive, vestibular, visual-spatial, tactile, auditory challenges) that typically manifest in terms of perseverations or repetitive affect sensory-motor processing behaviors - and as a matter of daily and widespread practice and can appear on the surface and, in fact, routinely is misinterpreted as the child's "non-compliant behaviors" - exhaustively, let alone minimally to moderately considered in traditional educational settings in the treatment of those who are diagnosed with complex neurodevelopmental disorders?
Indeed, are these so-called aberrant or "non-compliant behaviors" - and the behavioral positive reenforcement strategies (e.g., ABA, beginning with simple discrete trial training ) considered in relationship to each child's underlying maturational and constitutional emotional-cognitive and sensory-motor processing differences, along with the instrumental (vital) role of the impact of caregivers' (and clinicians') affect regulatory dynamics to the child's natural intent?
Or, Is a pedagogical practice of some fifty years or more of blithely attempting to suppress, extinguish and redirect "inappropriate" obsessive behaviors (i.e., primitive impulse behaviors "in the child") to an educationally mandated compliance-performance task based model targeted reductio ad absurdum and, therefore, in the nurturance, growth and development of the individual child largely preclude or minimize these other very important clinical developmental factors - along with the critical developmental factor of family affect-dynamics?
Is the emphases on re-training the child's perseverations or non-compliant, aberrant or primitive impulse responses hastily developmentally [cognitively-behaviorally] assessed in a much too skewed or overarching manner from an otherwise much larger and interdynamic developmental picture (in part, to fill the coffers of pharmaceutical companies and educational systems - or the economic boon of the first two that fortuitously were brought before the same alter - with the transformation of bio-psychiatry in the 1950's, beginning with thorazine) and dominating well beyond its welcome, shall we say, over more clinically integrated functional emotional-developmental and less drug driven models/approaches?
Most importantly, does the latter, as a result of misguided historical practice-and-politics, in the process, dissuade those families who would otherwise most stand to benefit (both on or off the spectrum) from a more comprehensive and well-informed education on understanding the enormous value, let alone necessity, to uniquely address, facilitate and deepen the role of caregiver/child nuturance based relationships - and thus begin to effectuate meaningful systemic developmental change* rather than have present and future generations of caregivers and clinicians remain in the dark, invisible and antiquated chains of the 'Pedagogy of the Oppressed?"**
*Specifically, with regard to emotional-developmental challenges the central role of primary caregiver affect in rhythmic attunement to the child's natural affect for purposes of helping the child reconnect to meaningful praxis. A proper understanding and engagement of the role of the child's affect (at each emotional-developmental level) by clinicians and caregivers helps consistently guide, integrate and transform the core deficits associated with ASD (i.e., thinking, relating and communicating).
Indeed, an effective theoretical understanding and practice of the instrumental role of affect brings into focus and helps deepens the dyadic child/adult range of preverbal emotional signaling. It, in fact, reflects - with adjusted clinical modifications tailored to the child's unique emotional-developmental and sensory-motor and/or other processing challenges - the natural pathways of neurotypical development, see Greenspan 2001 The Affect Diathesis Hypothesis: The Role of Emotions in the Core Deficit of Autism and in the Development of Intelligence and Social Skills http://www.icdl.com/staging/dirFloortime/research/documents/Greenspan2001_AffectDiathesisHypothesis.pdf
**'Pedagogy of the Oppressed' is from the brilliant Brazilian born educator, Pablo Freire's, a still quite relevant and beautiful classic expose in part on the factory production-line mentality of "schooling", which ideologically, as a systemic part of unconscious pedagogy, uniformly and behavioristically, in contrast to heterogeneously and developmentally, continues to dominate after forty years, despite significant advances in both educational and developmental psychological theory and practice, including recent decades of research in the neurosciences on the role of affect-regulation through dyadic pleasurable based interactions and its correspondent transformation in the strengthening of underlying synaptic connections. ___________________________________________________________
The above commentary should not be seen merely as an off-the-cuff and venomous dismissal against on occasionally as needed supplemental pharmacological use, or psychiatry and cognitive-task oriented education in general, but the necessity to simply inform or strongly remind the general public of the reality of the politics of institutional lobbyists and other special interest groups that often play an enormous role in the popular appeal (extraordinary successful sales) of certain (often outmoded) forms of thinking/practice, which might not serve the best interest of primary caregivers and their children. These questions: "What is learning?", "What is development?" and "By whom are they interpreted?" are more than just of passing theoretical or philosophical import to be mused upon in hermetically sealed and elitist hallways, but have wide ranging implications (i.e., social, economic, psychological, etc.) not only for the developmentally challenged child under our care but for society as a whole
Essentially, general cognitive task based and applied behavioral approaches, or simply the "cognitive-behavioral approach" to psychology, began in the 1950's with the collusion of psychiatry and pharmacology (i.e., the increasing consensus on the deeper biological-and-genetic basis of all mental illness) and several decades later with its huge arsenal of antipsychotics and primary targeted emphases on the control or "management of symptoms" in the individual. For example, a child's prematurely conceived uniformed autistic behaviors (although clearly not a dissociative disorder, as originally conceived in the 1940's), when significantly reduced by re-training of the child's aberrant impulsive responses (i.e. ABA) , and as needed accompanied by the aid of antipsychotics, is regarded by some as partial recovery with respect to improved child impulsive behavioral compliance to adult commands - or the ability of the child to respond verbally with respect to labeling desires, objects or actions on cue (i.e., in the Pavlovian, Watson, Skinnerian/Lovaasian historical sense).
This is in direct contrast to an attachment based and a systems theory based approach, which also began to emerge in the 1950's and extensively addresses the biological-emotional-social-psychological aspects systemically impacting or connected with healthy nurturance of primary caregiver/child relationships. Research in recent decades has increasingly focused on the specific functioning of the role of affect regulation or emotional-signaling in child-caregiver practices to strongly impact sensory-motor and other regulatory brain-motor processsing areas (e.g., visual-spatial, auditory), and furthermore how the facilitation of healthy based dyadic pairing (i.e., child/caregiver nurturance) actually transforms (once properly engaged) into naturally progressive higher functioning social-adaptive, emotional-cognitive thinking and the emergence of expressively meaningful (pragmatic) language skills.
In recent decades, a nurturance based treatment approach (e.g., DIR/ floortime and other approaches to varying degrees, which are essentially rooted in attachment theory), have come to significantly advance the view that autism spectrum disorders should not primarily be targeted (in either theory or practice) as "behavioral disorders" that evince systemic progress by working on remedial task-based methodologies (i.e., guiding the child to peer functionality of adapative and cognitive performance by primarily working on school-performance competency models or "managed surface behaviors"). Rather, autism spectrum disorder is a complex variable and multipathway neurodevelopmental disorder that must, as a general rule, always be approached in a truly interdisciplinary/systems theory and heterogeneous fashion (e.g., clinicians not focusing on redirecting the child's surface habitual responses but addressing the deeper underlying or interconnected systems, i.e., sensory-motor, visual- spatial, etc., which helps create the foundation for a truly integrated and unified emotional-developmental and sensory motor functioning - or true autonomous functional emotional relationships.*
Again, the latter is tremendously facilitated by caregivers and clinicians beginning to learn how emotionally reconnect with a child's present affective state or natural intent or affect, and thereby beginning to setup the necessary developmental foundations for proper functional emotional (two-way affective) signaling which, in turn, leads to increasing deepening circles of communication, complex symbol formation and the emergence of meaningful language. Now, this does not in any sense revisit the once entertained but now properly defunct view that parents cause their child to develop autism; however, it does place enormous value on the ability of the role of healthy nurturance of family and clinician dynamics tailored to the child's affect individual sensory-motor processing differences to facilitate healthy integration of developmental milestones and the associated neurophysiological changes that subsequently transpire (both in healthy and biologically disordered functioning) as a result of strengthening healthy child/caregiver attachment practices, and the enormous role that dyadic affect-regulation has in maintaining and advancing those foundations.
*[Note: These differing sensory processing areas or systems (e.g., visual-spatial, tactile, olfactory, etc.) should not be conceived of in disparate or reductionistic terms, (alas there is a social-historical tendency to do so, in practice, regardless of behavioral - or even Developmental orientation). They are integrated, albeit uneven or competing (i.e., superior visual spatial thinking vs. poor discriminating auditory awareness) confluent aspects of the "whole child" and as we consistently see in practice differ not only from child to child (e.g., in terms of specific strengths and challenges in a particular domain, visual-spatial, auditory, etc.) but with respect to the nature of the specific child/caregiver affect-based interactions - and overall daily dialectical patternment of relationships.]
The process of building emotional-developmental relationships (child/caregiver, peer, et al) become increasingly more plastic/receptive-and-integrated over time with the guidance of deepening nurturance based connections. In other words, two-way relationships fine-tuned to what is attainable or feasible at any given moment with the child by presenting challenging emotional-problem solving scenarios (i.e. meaningful praxis) by keeping within (or respecting) the child's comfortability zone of emotional developmental and sensory processing differences.
The above contrasts with traditional selective cognitive task and applied behavioral approaches, which are part of an earlier primitive view whose historical cognitive-behavioral roots are grossly disproportionate or incongruous with recent decades of research in the cognitive neurosciences, which, for example, continues to demonstrate that it is not operant conditioning or the [external] re-shaping of surface learned or selective behavioral responses that systemically strengthens and integrates core functioning processing challenges (i.e., thinking, relating and communicating). Instead, it is the enormous role that spontaneous affect-regulation (i.e., two-way emotional signaling/engagement) has with the essential reconnecting and/or re-strengthening of synaptic connections between various compromised neural pathways (e.g., fight or flight responses associated with the amygdala - and which we often see in sudden uncontrollable moderate or severe tantrums) and the prefrontal cortex (the executive functions) which significantly includes the critical areas of praxis: ideation, motor-planning and execution of actions [social interactions].
What is important to understand from a Developmental perspective is that Neuroplasticity or the strengthening of neuronal connections (e.g., between the limbic system and prefrontal cortex) can be significantly strengthened through the enhanced or guided practices of expanded dyadic pleasurable affective emotional signaling between child-and-caregivers, as this sets both the range and the tone for greater co-regulated social interactions. For example: from simple child/caregiver shared attention (i.e., exaggerated back and forth facial gestures) to the exercising/strengthening of simple motor planning (inter) actions around a playful flow of back and forth emotional problem solving (e.g., trying to open top of a bottle and giving it back to child) to more complex dyadic emotional problem solving (i.e., early to advanced sequences of symbolic play that includes the precursors of verbal logical reasoning between actors/actions).
While the above is in complete accord with developmental principles on the emergence of healthy development (of well-regulated) emotional interactions (with affect guiding the flow of back and forth emotional problem solving) and, in the process, strengthening the child's (or older) neuronal connections, the former leaves much to be desired, despite its claim of best breed of practices and stamp of scientifically proven behind it. (7)
There is an urgent need to bring this Developmental understanding on what in practice constitutes the greater facilitation and integration of the healthy emotional-developmental milestones into light of public awareness, particularly to families who are about to begin or currently are receiving early intervention services for their child. This is not to dismiss the fact that in certain instances the necessity to intervene with very moderate behavioral remedial intervention methods to address some of the child's "immediate surface behaviors" does not have its place (e.g., severe cognitive compromises of the child processing a causal impact - or awareness of self, resulting in very moderate self-or-other injurious behaviors). But highly specific instances is where it must remain and never serve as the primary intervention*, as its overuse, which is more frequently the case than not, can actually suppress (and even begin to reverse) an otherwise potentially greater systemic integration and autonomous functioning of the child with others (i.e., each individual child's emerging foundation and fine-tuning of simple to complex capacities of spontaneous thinking, relating and communicating with others).**
*As a general rule, applied behavioral analysis (ABA), especially discrete trials, should never be used with children who are excessively withdrawn or strongly sensory under-responsive, as they, in general, require the complete opposite, i.e., high-affect input connected to two-way social motor-planning (specifically, the encouragement of their self-assertiveness and, dare we say, willful non-compliance for the purpose of strongly connecting their intent or ideation to meaningful emotional problem solving with others) and not behavioral remediation or compliance to commands, which, to be kind, is misguided at best.
**It is crucial for families and clinicians to begin to cogently review what constitutes in material dissemination to families about to receive intervention services the well solicited but highly misleading phrase, "only evidence based approach" (often used by many applied behaviorial analysts and advocacy groups in order to not so gently push aside from discussion with families other legitimate "evidence based approaches") and, moreover, what in reality constitutes decades of substantial evidence for a clinically in use comprehensive developmental based approaches. See the following:
http://www.pasadenachilddevelopment.org/articles/Evidence_Base_for_the_DIR111.pdf http://www.pasadenachilddevelopment.org/articles/CDC-ICDLCollaborationReport.pdf http://www.pasadenachilddevelopment.org/articles/DIR-Floortime_Overview-and-Summary.pdf http://www.icdl.com/bookstore/journal/documents/JournalVol82004.pdf ______________________________4_____________________________
What I originally found in my practice to be quite remarkable, and repeatedly continue to witness first hand, now for nearly a decade, with children at all points across the spectrum, is that once we begin to actually emotionally engage (not redirect) where the child is, e.g., respect and regard his/her language of surface behaviors as meaningful, this in turn is substantively felt-and-immediately conveyed (affect-wise) to the child, irrespective of his/her placement on the spectrum. Once that type of engagement or meaningful joint-attention happens then we have the foundations of deepening reciprocal emotional attachment. This often results not only in increased spontaneous reciprocal eye contact but the spontaneous increased desire to want to further connect over a wider range of reciprocal social exchanges. The latter, in turn, leads to more refined (nuanced) affect reciprocal emotional exchanges around more [naturally] self-regulated interactions with more spontaneous (not rote) language usage connected to a meaningful back and forth flow or exchange of ideas. (8)
For example: reciprocal ideation - or meaningful joint attention: I look at the ball on the shelf that I desire and then to mommy and then back to the ball with pointing; reciprocal exchange or expanding meaningful communication of ideas: I look at the ball that I desire and with greater intent point to the ball and then to mommy who is standing behind me and back to the ball and, along with more varied and increasingly determined facial affect, point back to mommy and to myself; reciprocal emotional problem solving-and-motor-planning around the deepening of the exchange of ideas: Mommy, in turn, signals back (embracing his "dilemma" and playing dumb) to Johnny, with an elongated, "Oh..no! What are we going to do?.. uh oh!!" and Johnny, in turn, co-regulates or looks back matching mommy's emotional expression with his emotional expression. Together mommy and Johnny engage (the slower the better) in a back and forth affect tailored dance of "trying" to reach for the ball and emotionally problem-solving both gesturally-and-verbally.
The above and millions of other daily examples rapidly occur in neurotypical development, beginning at infancy at an affect gestural or preverbal level (e.g., back and forth parent/child widening of eyes, smiling, frowning, cooing, etc.). However, what we adults tend often to forget in our daily web driven lives is that the affect gestural or pre-verbal - for example, from nuanced affect facial expressiveness to verbally inflected nuances, pregnant pauses, subtlety of tone and interpausal or interconnected rhythms, etc. - continually helps shape, organize and guide praxis or two-way emotional problem solving. As the nature of dyadic relationships (i.e., child with caregivers) deepens, the (specific) affective qualitative aspects (or nuance) of emotions not only adjoins but crucially ever conveys the intersubjective meanings that help build up or constantly inform the foundations of the spoken (i.e., referential-semantical utterances) from one magical moment to the next (even with us typical loquacious know-it-alls who give the finger and curse in traffic!).
From an emotional-developmental perspective that addresses the healthy emerging stages of autonomy with typical developing children - or with autism spectrum disorder and related developmental challenges but addressing and re-integrating specific underlying developmental processing differences with respect to the child's communicative and affect-sensory motor functions - what we in effect are changing are not "behavioral responses" per se but expanding purposeful social interactions by encouraging the deepening of affective reciprocal emotional attachment, by respecting, engaging and validating the child's current interactions (e.g., the ball dilemma cited above), including repetitive or stim behaviors (e.g., lining up toys, spinning objects, self, or hand flapping, etc.) as meaningful. This is done not by adult redirection but by immediate adult (and peer) empathic acknowledgment of the child's current internalized perspective (i.e., developing sense of "self-with-others") as meaningful.
In autism spectrum and other developmental and communication disorders there is often, as widely discussed, the tremendous challenge of having the child connect his/her natural intent or affect- gestures to back and forth reciprocal motor-planning with others in order to communicate, obtain and express his/her wants and desires. However, from an emotional-developmental perspective this is clearly not a matter of "training the child" to respond "correctly" through stringent behavioral protocols (e.g., discrete trial training, verbal behavior, incidental teaching etc.) but continually acknowledging, honoring and embracing where a child is and strengthening reciprocal emotional problem solving by doing what s/he is doing, and slowly - as we deepen the basis of attachment - adding new variations.
By going where the child is, by doing what the child is doing, we are emotionally-developmentally allowing for something else to meaningfully occur that otherwise typically cannot, as long as we are focused on changing a child's surface behaviors: Deepening child/caregiver, clinician/child and child to child attachment allows for greater co-receptivity, as there begins to form a mutual basis of understanding or trust (at a preverbal level) as the child begins to feel, i.e., "I understand that you understand because you're doing what I am doing." This begins to allow for greater spontaneous integration of the child's unique processing challenges and connected praxis (ideation, motor-planning and execution in spontaneous two-way emotional problem solving) in contrast to what behavioral outcomes typically produce, largely mechanical or rote responses.
Once we have reciprocal attachment, joint attention, based on pleasurable based interactions around the child's natural intent or affect then we begin to "add to the mix" slight affective variations (e.g., flapping or lining up toys with the child in a slightly different but emotionally challenging way) but always respecting and meeting the child in his "comfort zone." However, once that comfort zone is warmly, albeit fleetingly engaged (e.g., with increased co-regulated or back and forth curious, but furtive glances), we (the adult) take the lead and go beyond that comfort zone and add (more invitingly so, as the child is now more comfortably receptive), subtle affective variations, hence (potentially) deepening (expanding) the primary caregiver-and-child dynamic emotional engagement. For example:
Parent: "You want the ball?" "No mine!" (parent models "mine gesture").
Child: Has moderate tantrum.
Parent: "Uh oh! Oh no !" There! Oh, no!..oh ball!" (parent is articulating the latter as the ball "incidentally" falls from her hand and becomes stuck under couch.)
Child: Fleetingly looking at the ball not visible then indirectly to parent.
Parent (That fleeting moment of the child's gaze to location of ball then towards parent, the parent, in turn, knows it's her opportunity to deepen affect.) Parent puts her hand to her face with a slightly perturbed/quizzical look and a different affected inflected modulation of, "Uh! oh!..oh no! stuck!" (at same time parent pretends to reach for the ball under the couch) with "Uh oh! reach..!"
Throughout this above snippet parent-and-child are deepening the engagement which allows for greater attachment, receptivity and meaningful language exchange, as language exchange is emotionally-connected to the child's affect (built around what the child desires) but making it increasingly nuanced through two-way emotional problem solving.
It is precisely the latter (e.g., the space between a child's natural affect and environment acknowledged by others through emotional joining or mirroring and affective extension (9)) which begins to set the basis for a deeper systemic integration or internalization of the child's different processing modalities.* However, traditionally it has been (and tragically continues) far easier - in impressive detail but puerile fashion - to separate the child from the "behaviors" and treat the behavior(s) - as though they were occurring to or "inside the child", than to see that the "the behaviors" are part (and, in fact, have always been part) of a detailed nuanced affect based communication system that is (intersubjectively and dialogically) connected to the child-with-others!*
*Abracadabra, there is no deus ex machina! This is what the 19th Century essayist/poet G.K Chesterton, and so many others, call "thinking spherically."
______________________________5____________________________
Essentially, developmentally what we are strongly focused on throughout the systematic and progressive building blocks of caregiver/child relationships is the role of "affect", that is, the particular qualitative affective or nuanced emotional exchanges of (i.e., back and forth facial and bodily communicative - facial -bodily-vocal gesturing/signaling) that we see at each juncture and throughout the entire course (moment to moment) of typical primate and human development. Indeed, the latter (nurturance based/deepening affect regulation) not only accompanies but guides each stage and strengthens the underlying emotional-intelligence foundations and, in fact, sets up the conditions (i.e., greater receptive processing/plasticity) for the subsequent stages (the next milestones) of development (i.e., simple to complex circles of communicating; simple representational ideation formation to two and three part symbolic play and the beginning of the emotive-cognitive faculty of reasoning between ideas).
The role or affect or affective attunement has been both metaphorically as well accurately referred to by DIR/Floortime on at least several occasions as the "connected glue" that primarily orchestrates or synchronizes the dynamics of back and forth co-regulated emotional-developmental interactions (e.g., strengthening brain function/improved synaptic activity between the prefrontal cortex and the limbic system) in contrast to a highly selective focus of compliance to surface rote tasks and cognitive-behaviors along with a highly desired (arbitrary insistence) for a one-size test fits all, which is in fact only a tiny piece, of what, in fact, constitutes a much larger picture of a child's (or older) greater emotional-and-cognitive intelligence.
The desire for each child's behavioral compliance to peer performance goal-oriented cognitive behavioral tasks is entirely understandable as we indeed quite naturally, vehemently, desire for our child to be "preschool ready" and thus peer functionally competent ASAP. However, what is often overlooked in the frenzy is that this is often hastily accompanied by a rush (clarion call) to school readiness skills by administrators, educators and clinicians, et al, where shall we say there is an over-abundance of hypervigilance from day one, as we attempt to soothe numerous legitimate concerns (e.g., from parental anxiety, to state mandated requirements) that fail to adequately address each child's true developmental foundations. Tragically, what this often manifests in is a hallmark series of look good/feel good "check it-in a box skills" without comprehensively addressing the necessary underlying foundations of what, once again, constitutes each child's unique emotional-developmental, sensory-motor processing dynamics and family relationship based differences.
A careful consideration in terms of a clinically applied focus and general education on the latter (in contrast to the former) at each turn (i.e., at each point of attachment-and primary caregiver-child emotional attunement or deepening affective progressive level) supports and integrates higher functioning skills (e.g., two-part symbolic play to more nuanced reflective and critical thinking skills - along with expressive meaningful language development) and, in fact, qualitatively speaking, a broader and more functional and developmentally integrated peer competence! For a society which, if you will, has been "conditioned" over numerous generations to have more than its fair share of hypervigilance with respect to surface appearances (e.g., "What are others going to think of us and our child when we go out shopping" or "How is my is child going to fit in"), the emphasis on production of generic skills is quite understandable, due expectedly to normal pressures and anxieties in every conceivable corner. Also, not unexpectedly these pressures and anxieties become almost always invariably transferred to an immediate focus on our child's "external performance" - rather than what can and should be consistently emphasized by more professionals: the subtle or nuanced back and forth emotional signaling or qualitative foundations, which in a more comprehensive empathic and developmental practice continually informs-and-transforms internal growth-and-external performance.
It is precisely because of the internal-and-external pressures (e.g., mandates for "performance", "performance", "performance") that it is an entirely understandable, as well as a completely natural inclination for many primary caregivers and clinicians to immediately (indeed often without hesitation) focus on the number of compliant based skills (e.g., number of signifiers - nouns, verbs adjectives, etc.) the child can produce on command. Indeed, it can be quite alarming, or quite atypical (existentially threatening) not to do so, that is, based upon how in the past we (educators, clinicians, parents, et al) have come to define "learning."
However, from a well planned, clinically based and intuitively guided Emotional-Developmental perspective what is most necessary is a practice of guiding clinicians and caregivers to quite frankly learn how to be comfortable in their own skin in observing and taking the vital steps - (i.e.,taking the time and slowing down - which is mandatory here because of the child's unique affect-sensory-motor and other processing differences) and qualitatively wait, listen and feel as we begin to meaningfully deepen the emotional-developmental interplay of clinically progressive, intuitively informed and developmentally meaningful peer and child/caregiver relationships (i.e., from preverbal joint attention - with lots of rich nuanced affect/emotional gesturing) connected to affect-meaningfully guided dramatic verbalizing in simple to complex problem solving (e.g., playing dumb and reaching for the ball under the couch which has become "intentionally" and emotively stuck, to still higher complex emotional problem-solving with two or more symbolic sequences with rich communicative inflective language, etc.).*
*Note, this is not a rubber stamped or cookie-cutter formula, methodology, that can be applied identically in every instance, as it must be uniquely tailored to each child's affective style in relationship to specific caregiver dynamics, et al. ____________________________________________________________
To briefly summarize: True emotional-developmental based approaches (e.g., DIR/Floortime) that strongly focus on the natural intent or emotional affects of the child in the unique context of each child's emerging gestural and verbal communicative, motor and sensory processing patterns through affect-guided interactions with others (i.e. back and forth social-emotional problem solving) are neither conceptually nor in practice behavioural or cognitive task-oriented approaches. Instead, they address core processing challenges with respect to each child's emerging natural intent in relationship to sensory motor planning and emotional developmental differences, and thus continually builds upon the deeper core principles of emotional intelligence that guides not only our meaningful use of language but its accompanied prerequistes or antecedents, i.e., co-affective signaling and symbolic ideation, and through this meaning-making process the deepening sense of the child's sense of "self-in relationship to other" which, as a developmental rule, supports all higher critical thinking skills.
The latter is placed into practice by primary caregivers and practitioners deepening their understanding of the central role of reciprocal attachment in facilitating social emotional-cognitive connections and thus following and joining with a child's natural affect for the integrated and autonomous (not prompted) emergence of skills. Behaviors are not teased out and addressed as discrete isolated units, but addressed as a natural and seamless part of deepening emotional co-regulated interactions, and thus the very definition of "comprehensive" begins to take on, if you will, a deeper meaning, as it leaves little unaddressed (or in the antiquated and adolescent thinking of everything conceived as/relegated to "behavior on the brain").
In emotional-developmentally based approaches the underlying core foundations of healthy emotional functioning-and-autonomy are addressed in an integrated manner and within an overall developmental framework that respects each child's unique emotional developmental stages or milestones and affect-sensory-motor processing differences (e.g., under-reactivity, over-reactivity or mixed reactivities with regards to differing environmental social stimuli, and across vestibular, proprioceptive, auditory, tactile, olefactory and visual-spatial processing domains). Moreover, the latter is done in the context of primary caregivers' interactive styles and daily relationship patterns that can significantly either help regulate or exacerbate a child's affect-sensory-motor processing patterns, and that the developmental educator or therapist is there to guide.
Failure for clinicians and educators to sufficiently understand and guide the child's functional emotional developmental levels and affect sensory motor planning differences, and not just passing but strong consideration of primary caregiver dynamic styles-to-child processing sensory differences, all of which supports the essentials of what constitutes a child's healthy emerging autonomy, will always result in developmental growth that will be inadequate or a surface roadmap at best. Instead, what will tend to be both education-wise and therapeutic-wise "targeted in the child" rather than "joined with the child" (by a systematic focus given to the nurturance of deepening affect reciprocal emotional attachment between caregiver/child), will be only potentially improved changes to surface trained cognitive tasks and behaviors.
Undoubtedly, the latter can indeed result in positive re-directed surface based responsiveness (e.g., suppression of primitive impulsive behaviors resulting in compliance to commands and scripted verbal responses), but the question we need to ask ourselves is how far does that reach? In large part, the answer is without a deeper emotional-developmental understanding - or essential part of healthy emerging autonomy - one which addresses the unique heart and essence of novel or spontaneous communication and "meaning-making" from the child's eyes. It is from the child's unique eyes where we have to begin, and in a very real sense always return to, as it is this which constitutes the basis of all integrated and unified growth and development. ______________________________6____________________________
A child's surface re-trained positive behavioral responses (e.g., responding on gestural and/or verbal cue to commands and behavioral tasks) is clearly not the same [developmental] process with respect to either of the following:
A) Beginning at the same point of a theoretical and practical based emotional-developmental understanding that neurodevelopmentally and intuitively understands (based upon human caregiver/child nurturance practices - and over the interspecies course of millions of years), that guiding a child healthy emerging autonomy and spontaneous or (non-scripted) relating, thinking and communicating must address underlying core sensory processing issues in the context of deepening reciprocal emotional attachment.
B) Manifests with the same progressive and nuanced emotional-developmental outcomes. The latter from day one, and as an integral part of interdisciplinary practice, focuses on deepening affect reciprocal emotional attachment connected to meaningful praxis, which is one of the primary core deficits we see in autism spectrum and related developmental challenges.(10)
It is only upon the basis of primary caregiver/child affect reciprocal emotional problem solving (i.e., adult to child affect-attuned opening and closing of small to increasingly larger communicative circles based upon the child's natural affect) that the emergence of the child's healthy autonomy, or the internalization her/his emotional-cognitive-and communication skills can truly take place. Although, the understanding that the meaningful use of "skill sets" can only take place through dyadic (two-way) meaningful affect reciprocal emotional-social exchanges might seem, as it were on the surface, intuitively obvious at first blush to many administrators, educators and clinicians and not need much elaboration, the fact of the matter is that in actual practice, i.e., from zero to three early intervention in our homes, in our daycare facilities and in our preschools and secondary schools it is rarely if at all taking place.
Too often the child's written IFSP or IEP goals (but more often in reality many schools' agenda of non-differentiated child's one-size fits all or uniform goals 11), is on adult directed child performance to comply with surface cognitive-linguistic and behavioral skills or tasks that are commonly evaluated in a somewhat, shall we say, emotionally detached or sterile manner. Instead, at each step along the way - from initial assessment, written goals, revised and/or achieved outcomes - there must be a core practice and theoretical understanding of the imperative need of meeting the child where s/he is and striving not to attain isolated or general skill sets but engaging her/his natural affective emotional thinking (e.g., the primary core deficits or how a child on the spectrum coordinates his natural intent or praxis with others or the foundations of true thinking, relating and communicating, which includes two ands three part symbolic sequences, higher critical thinking and back and forth natural communicative exchanges as opposed to well behaved - and too often unecessarily dumb down rote responses!).
This must be an indispensable part of any comprehensive evaluation, where the primary focus is not on the achieved performance of isolated skill sets per standardised developmental checklist (i.e., in order to uniformly and efficiently bring each infant, toddler and child up to the same chapter, verse and line as quickly as possible) but on meaning-making that is derived out of clinician and caregiver to child affect-attuned reciprocal based interactions, that is based upon what is of interest to the child and not what is in the interest of the simple efficiency and expediency of those performing the evaluation.*
* Which, although it may not seem so at first blush, the latter, again, leads to the emergence of those "skills" in a much more natural integrated emotional-cognitive manner and thus raises the bar to even a higher level in terms of peer to peer interaction and greater critical thinking, communication and other relationship skills. It is not in adult-directing but in the actual allowing the child the space to express his/her natural intent or affect and by our genuine understanding of mirroring and engaging whereby a meaningful-affective developmental zone begins to be not only established but deepened. For example, a "welcoming pleasurable-based understanding" begins to be formed and (preverbally) communicated to the child; this forms the natural basis for a greater-joining and "overall greater skill emergence" (e.g., verbally, emotionally-cognitively and sensory-motor regulation wise).
Interestingly, and to certain extent humourously, no amount of applied behavioral task-analysis or objectively detached data collection will ever allow the educator, therapist or caregiver to enter into this reciprocal emotional conversational (preverbal-verbal dialectical) flow, as it is precisely by the doing and if I dare say so clinician and caregiver existential risk of allowing for innumerable variables, which naturally arise from the doing-and-allowing in any given exchange. However, it is the insightful and intuitive adult guiding of those variables in the context of each child's affect emotional, sensory-motor planning and adult-to-child relationship differences where it becomes an Art. In other words, the focus is not in redirecting "aberrant impulses" but "meaning-making" with existing impulses (without the pejorative label of "aberrant" or otherwise), which are integrally attached to the whole child, or "self-in relationship to other", which is part of the quite natural (and for the developmentally challenged child, re-constructive) narrative dance and flow. ______________________________7_____________________________
The developmental pediatrician, therapist or educator many of whom (but certainly not most) often demonstrate little understanding of the child before them with regards to the child's "actual abilities", as they try to "fit the child to the test", rather than demonstrate a much greater needed flexibility. For example: developmental pediatrician, therapist and special educator actually getting down on the ground with a toddler or child, who presents potential communication and/or sensory based challenges and follow him/her around and see what is of interest to him and thereto engage accordingly, instead for the most part conducting an assessment sitting at a table, which is entirely unnatural (if not entirely unreasonable, esp. given the nature and degree of a child's sensory based challenges), and, furthermore, seeking through adult directed commands, compliance to rote tasks. Compliance or non-compliance does not necessarily equate into actual ability or inability but instead, to the contrary, often ends up presenting a very skewed picture of a child's actual strengths and challenges.
What is crucial but often missing during many evaluations by many developmental pediatricians and pediatric neurologists is an understanding - and allowing the necessary time that is required in order understand - emotional attachment/engagement and theory of mind or empathy with respect to a child's emotional developmental and sensory processing differences. The latter once sufficiently engaged (which can involve a short span of time based upon soothing pleasurable based interactions from the child's perspective, and needs to be done over several sessions not one followed by a three or six month interval for greater accuracy), often begins to produce many of the desired performance standards and goals, or at least to a much more nuanced [meaningful] degree than the standardised or uniformed one-size fits all tunnel-testing-vision currently permit.
A uniform laundry checklist of cognitive-behavior skills conceived of in the rote-child production assembly-line of one-size fits all or hurried along time test driven units (rather than primary caregiver and child inter-dynamic or inter-subjective bio-psycho-social processes), regrettably ignores the true internalization of those skills or tasks (i.e., the child's naturally connected affect - or needed to be re-connected affect to meaningful emotional motor-planning). We can put this in another way and say, where those "performed skills and tasks"(12) take on true spontaneous and deepened viable [social] meaning, which, in turn, enable a more meaningful inter-individual emotional-cognitive foundation for the child's continual progressive movement toward a healthier and integrated autonomy - with more parent with child and peer complex forms of spontaneous relating, higher symbolic play, critical thinking and expressive language. (13) ____________________________________________________________
1 The following (bottom) is an outline of twelve of the sixteen functional emotional developmental milestones or stages that are necessary for the emergence of social thinking, relating and communicating from human infancy through adolescence. The first four stages have to be mastered for the full and proper emergence of language. Interestingly, what is evolutionary-wise significant here is that this can be accurately developmentally looked at as common characteristics, or direct parallel links, of reciprocal emotional attachment which was founded over millions of years of practicing primary caregiver nurturance based patterns of relationships. This is easily traceable to our earliest primate ancestors, which through the "commonhood " of interspecies - nuturance based primary caregiver/offspring practices, rather than through purely anatomical and/or genetic changes alone, allowed for affect based co-regulated patterns of simple to increasingly complex relating, thinking and communicating, or the emotional foundations of cognition that constitutes (significantly help construct) the [neurobiological] foundations of healthy human autonomy. The emergence of "Language" proper is not simply the result of anatomical changes and/or sudden genetic mutations but is based upon millions of years nurturance based practices that we share in common with our primate ancestors and to some extent all species. What is seen in the evolving of nurturance based practices over time, and across all species, is an increase in affect based reciprocal signaling. Thus, it is the affect based foundations or increasingly nuanced back and forth emotional signaling (between adult and offspring) that eventually led to (or enabled) the symbolization of thought (e.g., from more fixed modalities of perception to more nuanced or "free standing ideas" - that is an idea or symbol apart from more or less fixed notions) and led to (or significant potentiation for) the emergence of language. What is fascinating is that this is more than purely theoretical, as we see this naturally and rapidly progressing in neurotypically developing infants and toddlers in the first four emotional developmental milestones or stages [below]. In autism spectrum challenges, the child's perseverative behaviors, in at least one sense, can be compared (at one stage) to more or less fixed modalities of perception, but as caregiver-and-child deepen reciprocal (affect) emotional signaling around challenging but pleasurable based emotional problem solving interactions, this gives rise to natural (or co-regulated) exchanges and "free-standing ideas" (e.g., symbolic play) and (through this complexity of increasingly nuanced child and caregiver co-affect idea exchanges) significant spontaneous (expressive) language usage. The DIR/Floortime framework that addreses autism spectrum disorder and related communication challenges is actually based upon an understanding that directly addreses these stages of child/caregiver affect or preverbal based relating which is necessary for the proper and full emergence of language, cognition and communication.* I. Attention and self-regulating and with elements of engaging and signaling. II. Engaging and relating and early signaling. III. Two-way purposeful affective interaction and communication IV. Co-regulated affective signaling and shared social problem solving. V. Creating ideas or internal representations; symbolic and linguistic abilities. VI. Connecting ideas together; Logical Thinking. VII-VIII . Multi-causal and gray-area differentiated thinking IX-X . Thinking according to an internal standard and growing sense of self XI-XII. Reflective thinking on the future and expanded concept of the self. *Greenspan, S.I./S. G. Shanker. 2004 The First Idea: How Symbols, Language and Intelligence Evolved from Our Primate Ancestors to Modern Humans: De Capo Press. Also, for a brief sketch/overview of the DIR/framework in terms of dynamic systems theory model see http://www.mehri.ca/images/TheFirstIdeaSummary.ppt#3 . A two-year clinical research study has been underway since October 2006 with fifty children, approx. age 2 - 5 yrs old, previously diagnosed with ASD, using a fully standardized clinical trial with participants randomly assigned to either an immediate or delayed treatment group. What is singularly unique about this trial is that it will not only scientifically validate the effectiveness of DIR/Floortime treatment with respect to the deep or primary core deficits of thinking, relating and communicating, but it will begin present comprehensive data with respect to actual neurophysiological changes that occur as a direct outcome of using this treatment model, see http://www.mehri.ca/research/clin.html Below is a link to a recent article, 11/30/09, where clinical research has convincingly shown that if a child is diagnosed with autism as early as 18 months of age, that age-appropriate, effective therapy can lead to both higher cognitive functioning, language skills and behavior. The model used was Dr. Sally Rogers, Denver based model, which is child-led and play-based as opposed to applied behavioral analysis which is adult directed. http://www.cnn.com/2009/HEALTH/conditions/11/30/autism.study/index.html/HEALTH/conditions/11/30/autism.study/index.html ______________________________________________________________ 2 Greenspan, S.I. 2000 ICDL Clinical Practice Guidelines: Redefining the Standards of Care for Infants, Children and Families with Special Needs, Part Three: Motor And Sensory functioning, Chapter 8: Assessment of Sensory processing, Praxis and Motor Performance, G. Gorden Williamson, Phd., O.T.R., Maria Anzalone, Sc.D., O.T.R., and Barbara Haft, M.A., O.T.R. For recent case reports/ discussion on the diagnostic validity of Sensory Over-Reactivitiy see http://www.spdfoundation.net/pdf/reynolds_lane.pdf The latter is part of an comprehensive and invaluable library of current research on sensory modulation disorders that can be found at http://www.spdfoundation.net/index.html 3 What is so often initially confounding to many families, and I dare say many clinicians and educators, is that the suggestion of following a child's lead, for example, in "floortime play", rather than the initial mastering of structured task(s) should be emphazised from day one. On the surface it might seem counter-intuitive, for example, "How can my child focus in a meaningful way when s/he can't complete basic tasks?" The understanding is that once the child has mastery over "basic tasks" then s/he can form the foundation where it become easier to proceed to the generalization of those [structured] tasks. However, what is generally not understood, or rather tends to be inadequately explained from a Developmental perspective, is that the "task of engagement" is the first impulse of the child with caregivers whereby "structured tasks" - when connected in accordance to the child's natural affect or intent- then become "meaningful." If tasks don't become meaningful (e.g., by caregivers and clinicians incorrectly focused on "tasks" as an isolated set of structured or discrete items rather than developmentally co-guiding activity by following the child's natural lead, that is his natural affect or intent), then what (defacto) becomes mastered are (more) scripted responses (e.g., cognitive and language task/performance geared towards school assessment in terms of the child's accumulated hierarchical lunch task box or "string of signifiers" rather than interpersonal or dialogic relations where those signifers, nouns, labels or objects become co-narratively transacted, transformed and meaningful - hence, the indivisible stepping stones that build a child-with-others healthy autonomy). This of course does not mean that when there are specific task motor-planning issues that the occupational and/or physical therapist does not work on them intensely (e.g., grasping patterns, limb extension, trunk rotation and stability, bi-lateral coordination etc.), all of which of course does significantly interfere with the child's ability to complete simple two-way engagement-and/or tasks. On the other hand, what it does mean is that if those specific motor-planning challenges are not understood and addressed in the larger integrated context of the child's natural intent or affect-and- caregiver dynamics then "tasks" become artificially (unconsciously) teased or separated (i.e. erroneously self-contained or conceptualized apart) from integrated two-way child affect guided problem solving. In other words, functionality may improve but overall Developmental effectiveness becomes much more less than otherwise it potentially can, as the therapeutic focus becomes, more or less, strictly performance-functional based corrective tasks (e.g., satisfying immediate parent expectation-and-school agenda) rather than, concurrently, affectively emotionally integrated as part of a child's overall autonomy and social interaction with others. Affect-connecting or "dyadic meaning-making" always goes beyond specificity of (isolated) task performance: The reification of objects-or-the proper manipulation/transformation of "objects" only obtains existential meaning in their usage between dyadic pairs, and esp. with children with ASD, by being closely attuned and attentive to their natural intent or affect (which in fact, and I have seen repeatedly in practice, increases the child's general praxis or motor-planning abilities). To conceptualize the child's motor-planning apart from his/her unique sensory threshold differences (e.g., tactile, olfactory, auditory, visual-spatial) which largely comprises the child's affect regulation in conjunction with his/her emotional developmental levels and primary caregiver relationship dynamics is to selectively conceptually isolate or hyperfocus on "functionality" apart from the larger system view (a true Developmental dialectic) and thus perform a disservice. 4 Contrasted with a developmental perspective on integrated emotional-developmental and sensory motor processing functioning we can say, yes, non-compliant or "repetitive behaviors" but only on the surface, that is to say, beneath the surface implicitly understood and addressed, educationally and therapeutically, in terms of the child's underlying sensory processing differences. Also, very importantly (at the risk of perseverating) what is necessary to keep in mind is that from an attachment or emotional-developmental perspective, sensory-processing differences should not be addressed in and of themselves but always as a part of two-way affect reciprocal meaningful interactions. In other words, not to do this would be to make the same fundamental developmental error as addressing compliant/non-compliant behaviors "in and of themselves" (i.e., artificially or prematurely conceptualized in practice as leading to a boundary-specific selective outcome), in other words, in theory connected but in practice - as more or less, compartmentalized or isolated occurances (i.e. 30 minutes of OT pull out time, 60 minutes of ST pull out time, etc.). We need to meet a child where s/he is and thus honor, respect and validate present surface behaviors as meaningful. Once the child's "behaviors" are conveyed to the child as meaningful - by sincere adult participation in them - then this begins to set the basis for deeper emotional bonding, which then, in turn, leads to [or sets up the emotional-developmental conditions for] further meaningful primary caregiver/child affect-reciprocal interactions. By doing this - and clinically informed (and intuitively guided) by an understanding of the emotional-developmental interactive stages of the child - we are emotionally-developmentally on page, that is meeting the child where s/he is and participating in his or her world. There is also another factor here that frequently presents a huge roadblock for both clinicians and caregivers in putting into action the above, which is a great existential fear that is partially but, alas, strongly and often quite unconsciously, rooted in misguided child-rearing beliefs, i.e., "encouraging bad or inappropriate behaviors will just encourage more of the same" or "Give a child an inch s/he'll take a mile." This is further compounded by a general lack of education with respect to attachment or a developmentally based understanding of typical toddler behavior. Thus, the former can seem like a truism (e.g., "it's obvious it's my child's behaviors") when further exacerbated by complex affect emotional-developmental and sensory processing based challenges (i.e., ASD), which again has nothing to do with "inappropriate behaviors" (or the replacing of the latter with "appropriate behaviors") but rather reconnecting primary caregiver/child attachment and affect-emotional based circles of communication in accordance to the child's natural affect or intent, which not only changes the nature of the "external behaviors" but significantly helps construct the underlying foundations of healthy autonomy in contrast to (its complete opposite) behavioral surface re-conditioned or learned verbal rote responses. [Families I have worked with over the years often comment that once they are able to slow down, over the course of many sessions, and look at and engage/connect with their child's emotional-developmental, sensory-motor and other regulatory processing differences can, interestingly in turn, more safely and confidently begin to reflect upon and question, previously unquestioned, child rearing beliefs and thus entertain these "other possibilities", which, in fact, points to some of these historical underlying or systemic pedagogical resistances.] 5 "Lack of theory of mind", a term frequently used with respect to the inability to read another's intention or emotions. It is often believed to be common with children with autism spectrum disorders and recent research would suggest a possible deficit in the mirror neuron system of the brain, which essentially enables one person to "mirror" or visually internalize the actions performed by another without having to perform those actions herself/himself. However, we need to be rather careful here, as it is often not an "inability of the child to understand another's intention or emotions and thus conceptualize and demonstrate a basic empathic awareness of other" but rather the child's unique combination of sensory processing challenges which make it appear as though there is a fundamental lack of empathic understanding of other and sustained or even basic warmth (i.e., avoiding eye contact, turning away, blank facial affect and withdrawing from affection or touch) because of tactile and other potential sensory compromises. Even though there appears to be some preliminary findings which would suggest a potential deficit in the mirror neuron system of some children with ASD, a follow-up question that seriously needs to be asked, "Are we, in fact, looking at other mitigating factors, i.e. sensory compromises, that would make it appear as originating deficit in the mirror neuron system itself?" (I have consistently found that a child even with what appears to be very moderate compromises, e.g., joint attention, has a much greater intuitive-cognitive awareness and emotional attunement than we typically, and understandably, assign.) 6 That is to say, educationally stigmatized into a "social narrative" of impulsive or aberrant behaviors as a series of events (or rather " things") that are "happening to" or "in the child" and once those neurobiological behaviorally based insults (i.e., "atypical or inappropriate and maladaptive responses") that are occurring in the child are at least - on a surface basis- functionally changed (i.e., into improved impulsive responsiveness), then the child is in a better "receptive" position to learn. In essence what we have here is a very Cartesian or antiquated view. One that - by virtue of habitual or unconscious historical necessity - artificially separates the child from affective based interactions and views the child as a victim of an affliction that is occurring, as it were, "inside him" (i.e., as a result of his environmental-genetic or hard wired make-up but s/he can at least be brought up to a level of peer functionality by the science of "behavior modification" by founding father of operant conditioning or advanced response learning theory - B.F. Skinner or later incarnation, Ivar Lovaas' ABA). The more viable [developmental] alternative in accordance with recent decades discoveries in the neurosciences (i.e., neuroplasticity or re-connecting of interactive - cortical and subcortical - synaptic pathways through deepening of co-affect reciprocal emotional interactions), is not to reductionistically (and distortively) view behaviors in the common PR marketing parlance as hard-wired or neuro-bio-behavioral "things or occurrences" that are happening "in or to the child" but acquired dynamic patterns of bio-psycho-social patterns of interactions - albeit affectively limited patterns of interactions - that can be functionally and meaningfully joined with the child. In other words, from an emotional- developmental perspective we are not separating child from anything (i.e., chronically reverting , if you will, to a deus ex machina or "child + behaviors"). Rather, once the child's interactive patterns are emotionally-inter- dynamically- joined with (affectively emotionally bonded or deepened) from the child's perspective, then, through this back and forth joining or reciprocal patterns of [registered/felt] "meaning-making", they not only can but consistently are naturally widened and diversified into more [complex] affective meaningful reciprocal patterns of social interactions. The latter [preverbal process] subsequently results in, or perhaps more accurately said goes along with, the emergence of spontaneous expressive language skills and simple to higher symbolic to logical thinking patterns (that is, indicative of healthy integrated autonomy of the child's emotional developmental stages - in contrast to - and by the "one and only" highly acclaimed "scientific basis" of behaviorism - rote response). We can perhaps muse for a moment and say in a certain sense that the Cartesian myth/construct of "deus ex machina" has yet to awaken from its Seventeenth century non-developmental slumbers, but thankfully there is some light over the lemming reflex-response horizon, as this more sound [developmentally sane] ecological and dialogical view is beginning to find a more solid home among educators and therapists. 7 http://home.cc.gatech.edu/ubicomp/uploads/12/Gernsbacher,%202003.pdf It is frequently believed that autism is characterized by a lack of social or emotional reciprocity. In this article, I question that assumption by demonstrating how many professionals—researchers and clinicians—and likewise many parents, have neglected the true meaning of reciprocity. Reciprocity is “a relation of mutual dependence or action or influence,” or “a mode of exchange in which transactions take place between individuals who are symmetrically placed.” Assumptions by clinicians and researchers suggest that they have forgotten that 8 Or more precisely regulation based upon the co-regulation of deepening emotional attachment (or emotional-social-cognitive circles of communication). In other words, "true regulation" or a key difference between an "emotional-developmental approach" and "surface cognitive task based and behavior approaches." The latter (i.e., ABA or verbal behavior) addresses how a child responds (i.e., functional communication in response to commands or prompted verbal behaviors). The former (Developmental perspective) addresses not how a child responds but rather how a child coordinates the dynamics of his/her natural praxis or back and forth engagement with others (e.g., complex gestural-emotional facial and bodily signaling). What needs to be understood here, is that this take into consideration preverbal and verbal components of communication as a single biological-social piece. By naturally focusing on a child's biological-social affect sensory motor connections - which always co-exist in relationship to "others" - this represents the beginnings of true dialogue (i.e., guided though spontaneous complex nuanced coordinated turn-taking) which cannot be reduced (without severe caricature) to old style "telegraphic communication" (or yes/no responses). 9 C.f. Vygotsky's zone proximal development. (* For example, strenthening affect-based connections confers a strengthening of the neuronal connections between the amygdala, which significantly involves our emotional-and hormonal fight or flight responses and the prefrontal cortex or executive functions, which regulates how we plan and organize our problem-solving interactions with others. Neuroplasticity or the ability of the brain-nervous system to strengthen and re-pattern multiple synaptic connections in direct relationship/response to reciprocoal affect based engagements plays a tremendous role in the autonomous emergence of each individual's spontaneous thinking, relating and communicating with others. 10 The attempt to address surface cognitive-behaviors by having the child (or adult) "learn" how to better redirect and, thereby, self-control his "inappropriate behaviors", vis-a-vis applied behavioral methods, emphatically neither orginates from an emotional-developmental perspective which involves attachment theory at its core, and in practice guided affect reciprocal circles of engagement with regards to each child's emerging emotional developmental capacities and sensory processing differences, nor does it subsequently typically result in the same developmental outcomes (i.e., non-scripted or spontaneous affect based language, two or three part symbolic play and higher critical thinking skills). For a ten to fifteen year follow-up study on a subgroup of children who were originally diagnosed with autism spectrum disorder as early as twenty four months, and received an attachment (family -oriented based) approach using DIR/Floortime and attained high levels of academic and emotional-social functioning fully typical of their peer group and previously considered unattainable, see http://icdl.com/dirFloortime/documents/WiederandGreenspan2005Followupstudy.pdf Also, the argument could be made (and tomes of data can show) that one can of course effectively attempt and successfully change undesirable behaviors (i.e. ABA). However, what is most disturbing is that the "behaviors of the child" are viewed as an interference, an obstacle to learning, and once they are successfully modified (i.e., redirected in a socially compliant direction to adult commands and peerage compliance) then the child is in a "better position to further his/her academic learning." What is generally entirely avoided and thus not realized by the behaviorist mentality is that the fostering of the deeper bonds of attachment and challenging but pleasurably based interactions through emotional-problem scenarios in accordance to the child's natural affect and affect sensory processing differences (i.e.further integrated by Occupational therapist well versed in sensory processing disorders), then forms the true foundation for the child's emotional-developmental integrated autonomy. In other words, "behaviors" at each step along the way are not abstracted or detached from caregiver interactions, more specifically from co-regulated attachment and meaningful two-way interactions, which fully takes into consideration , honors and respect the childs emotional intelligence as a whole, from day one! The child is not reduced, openly or tacitly, as more or less a core compilation of problematic behaviors that need to be over analysed, deconstructed and modified but as having the core essentials but with interferences in executing interactions (e.g., compromised synaptic connections) that can be re-established from mild to strong extents through warm affectively pleasurable based co-regulated interactions subsequently resulting in or accompanied by higher language and emotional-cognitive functional skills 11 Agenda compelled by the historical socio-economic practices of a general public education system which feels overwhelmingly pressured to maintain, as much as possible, the homogeneity of "classroom performance, conduct and control" in contrast to and the tremendous developmental need for affect-guided reciprocal emotional attachment within the contextual constraints (or affect-co-regulated zones) of the child's strengths and challenges of his/her emerging autonomy and emotional-developmental and sensory processing differences. 12 Or from a comprehensive developmental perspective (or affect intersubjective or co-narrative perspective) we should paradigmatically shift - or playfully and maturely entertain shifting - from thinking in terms of "skills and tasks" to thinking in terms of interconnecting underlying processing based differences, that is, inter-individual functional emotional developmental stages or milestones and inter-individual affect sensory-motor planning processing differences, as no two children (on or off the spectrum) are generically alike nor should they be treated as such. 13 More complex here is meant as more nuanced or affect-deepened age appropriate receptive and expressive social language and communication. 1357962
Tuesday, April 6, 2010
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