Wednesday, May 4, 2022

Play, DIRFloortime®, and Neurodiversity Informed Practice

Over the last two weeks I have spoken at several conferences and events that were focused on neurodiversity, DIR, ethical considerations in autism services, and/or play. I received lots of questions about how we embrace neurodiversity in the play process of DIR®. So, I started a list of ideas. The following are my notes over the past two weeks. 25 points of consideration for therapists. See what you think. Let me know your thoughts. In part I am also writing this for all those out there that think DIRFloortime® is about imposing a neurotypical normalization agenda. It for sure is not. It is about helping the child grow and develop while respecting and valuing their own beautiful uniqueness.

  1. Play is strength-based building on what the child is doing and is interested in. Play is not used in a manipulative way to get connection to then switch to a deficit-based intervention.
  2. Follow the child’s lead in play.
  3. The action is in the interaction. Development happens in the interaction of play.
  4. Genuinely engage and join in the play with a child and help them expand and elaborate upon their own intentions, rather than coercing the child to play along with your intentions.
  5. Play is not used to teach neurotypical norms. We honor the unique profile of each child and seek to understand them and help them develop in their own unique and neurodiverse way rather than seek to impose neurotypical or therapist determined norms.
  6. Compassionate and naturalistic play is not enough. In many ways, more compassionate and naturalistic play that has the same goals of normalizing behaviors may actually be more problematic for the child’s psyche because it is a more sophisticated presentation of the same neurotypical normalizing goals of traditional behavioral discrete trial training, but just clocked in a pseudo loving interaction. This manipulation can foster the sense for the child that kindness and love are used to manipulate to get what you want.
  7. Therapists need to engage and join in the play and become a part of the play in a full way. This is key in helping the child develop their internal capacity to understand and manage their own being and their own behaviors. This is different than using play to manage, change, or control behaviors that are determined by the therapist or anyone else to be unwanted [autistic] behaviors.
  8. Avoid using rewards or punishments in the play. While some natural consequences will inevitably happen, it should never be the conscious intent of the therapist to give a reward or punishment. The child is not engaging in play to be judged by their play partner and we should not condition them to think that is the point.
  9. Play is a wonderful opportunity for learning based on exploration and discovery. Introducing exposure and memory based tasks only detracts from the beauty of the play process.
  10. Be very mindful of how modeling is used in the play. Modeling can be helpful in many ways, but modeling risks prompting a neurotypical and therapist led way of being. While some modeling will take place and can help in the development of communication, language, and other important ways, therapists need to be very careful not to impose neurotypical and therapist determined norms.
  11. There are never explicit or implicit goals of indistinguishability. Through a process of self-reflection, therapists constantly have to be challenging themselves not to allow implicit goals of indistinguishability through. Normalization is never a goal.
  12. Prompting should generally be avoided and absolutely never prompt for one single “right” response. Prompting for a single response is inherently based on a predetermined frame of reference that is often based on the therapist’s beliefs on what is normal or acceptable. When a therapist determines there is one right answer to a situation and prompts for that, they are determining the norm and imposing it upon the child.
  13. Play is naturally a developmental process. Children develop their core social-emotional capacities through play. Play should focus on promoting development more than teaching. Children will learn in play, but it happens as they explore, discover, and develop. Adults often take the joy of play and turn into, “Now I have you, I am going to teach you that this yellow ball is yellow. ‘Say Yellow’ [holding up a yellow ball]” Does a five-year-old playing with another five-year-old ever hold up a yellow ball they know is yellow to ask the child they are playing with to “say yellow”?
  14. The goal is to expand and to elaborate. If you focus on expanding and elaborating, you are promoting growth and development while fully valuing the child and avoiding imposing your own neurotypical and/or therapist determined perspectives.
  15. Engage in co-regulation and the development of self-regulation rather than simply how to manage behavioral dysregulation. Many behaviorally focused therapists talk about “managing dysregulation” in play. If the therapist is managing dysregulation or even trying to teach the child how to manage dysregulation, this ends up being a “top down” more externally driven process. Joining in play gives us the opportunity to engage in co-regulation, this helps to develop an internal “bottom up” development of the child’s own self-regulation. We can all learn techniques of self-control which is fine, but within play we have the opportunity to use a natural co-regulating process to promote the development of self-regulation which is that internal sense in ones body that I am calm and OK in the world and I don’t have to constantly rely on external controls or even self-control “strategies” to cope. Rather, I can be “OK” and regulated from within. A more sophisticated way of saying it is that subcortical regulation can develop in play and that should be the focus. Teaching strategies that relate to how cortical activities regulate the subcortical systems has its place, but that is a teaching process and not as much of a developmental process. We work to keep play focused on developmental processes.
  16. Engage with the child through their challenging moments that often present behaviors that some will refer to as “problematic” or “challenging” behaviors. This is different than focusing on changing or controlling behaviors. In the process of joining and engaging with the child through the difficult times, we foster the development of core capacities rather than simply extinguishing behaviors. For example, the goal should be to help the child develop the capacity to be able to successfully engage in shared social problem solving rather than to simply extinguish the meltdowns that can often happen when a child lacks this capacity. Extinguishing the meltdown won’t do anything to help the child create the requisite capacity for shared social problem solving that is needed to be successful in challenging social situations.
  17. There is never a goal of extinguishing behaviors. Our goal in play is to promote development and growth. As that development and growth happens, behaviors that the child no longer needs to regulate themselves or their world or that they discover get in the way of engaging with the world they want to engage in may diminish, but extinguishing those behaviors is not the goal. For example, we do not set a goal of extinguishing hand flapping behaviors. In many cases, if the child becomes more regulated, engaged, and feels understood by their play partner, we may see less hand flapping (or we may actually see more), but either way, that is being driven by the child, not the therapist.
  18. In regards to turn taking, therapists need to be more focused on engaging in back-and-forth circles of communication and interactions that will develop the capacity to engage in turn-taking in a meaningful way because the child wants to, not because it is a rule imposed by the therapist. Do not simply think of it as a social skill that needs to be taught.
  19. Play can develop the capacity for social connection, communication, and interaction. This is the focus and we do not use play to simply teach skills that are deemed socially appropriate.
  20. Seek to understand and to help the child feel and be understood. Feeling and being understood is the foundation for meaningful personal growth and development. There is potentially nothing more important.
  21. Therapists should not be forcing face-to-face interactions. Therapists should be engaging with the child. In most cases, this will result in face-to-face interactions that are rich in eye contact. However, for some children eye contact may be overwhelming and the intense face-to-face interaction may be overwhelming. So, the goal is meaningful engagement that respects and values the child’s perspective and way of being.
  22. Therapists should constantly adjust their actions and the environment to support the child’s individual differences. If something in the environment or in the actions of the therapist can be changed to better support the child’s individual differences, this should be done. (i.e. dimming lights if it is overwhelming; not wearing cologne if it causes discomfort for the child; not moving too quickly to accommodate a child with visual processing challenges) This can include sensory, motor, physical, or other individual differences.
  23. Play should always respect and embrace the culture of the child and family. In addition to following the child’s lead in play we are also following the family’s cultural lead.
  24. Always respect the child’s “no”. This does not mean the child will always get their way or be able to do anything they want, but we avoid forcing our agenda upon the child and we seek to foster a sense of agency for the child that includes the right to say “no” if something makes them uncomfortable.
  25. Have fun and be a play partner the child is excited to play with.

That's my list. Did I miss anything?

 I would write this a bit differently for parents, but the same concepts generally apply.  

Monday, April 18, 2022

ICDL's New Name

  

I am excited to announce ICDL’s new name! 

The International Council on Development and Learning

ICDL will begin doing business as the International Council on Development and Learning as of today. This change is happening for three main reasons. 

First, it represents our commitment to be a continually growing and developing organization that provides forward-looking leadership as the world continues to evolve. The concept of an “interdisciplinary” council was groundbreaking 32 years ago when ICDL began, but we have progressed so much further now and it is no longer groundbreaking nor does it sufficiently represent our current transdisciplinary work. But don’t be alarmed, we are not abandoning interdisciplinary work. The difference now is simply that we have developed from being interdisciplinary to being much more transdisciplinary. You’ll see how this is impacting our training program as we unveil the newly revised DIRFloortime® professional certificate training curriculum in the coming months. 

In the near future, I will be writing more about the importance of a transdisciplinary focus and even engaging in antidisciplinary focused work to further our understanding of the entire whole person and not a person defined by the scope of the currently existing disciplines. This is such an important area for consideration and reflection. ICDL will continue to lead and challenge the DIR® community and the world at large to understand humans more holistically than ever before and we will work to support practices in the field that foster meaningful holistic human development. 

Secondly, we are changing our name to the International Council on Development and Learning because of the incredible international movement that ICDL is leading to bring a DIR-focused understanding of development and learning to everyone around the world. I am proud to say that ICDL now offers DIRFloortime® certificate courses in 16 different languages taught by professionals that are native speakers of these languages. We know that there are at least three more languages being added to the list in 2022 with initiatives underway in other countries around the world to build the capacity to have DIR® experts developed there too. For example, I am off to Japan in just a few days to spearhead our efforts there. When I started with ICDL in 2013, we were teaching DIRFloortime® courses in 3 different languages. By the end of 2022, it will be at least 19! This is being international!  

Finally, ICDL is shifting to be the International Council on Development and Learning because it better represents our leadership role in the field. ICDL is the future of development and learning. While ICDL has a strong deep 32-year history, our focus today is on leading into the future. We can fully respect and appreciate the history and hold true to the integrity of the evidence-based approach DIRFloortime® is while at the same time progressing into the future as we learn more and more from research, clinical practice, advocates, and the broader world in general. 

This week ICDL will be announcing several new future-focused initiatives and developments that will help you see the progressive work that is happening. The name change helps us catch up to where we have been moving in recent years and helps to define who we are as leaders into the future. ICDL is not only the Home of DIR® and DIRFloortime®, ICDL is also the future of development and learning.

Friday, April 1, 2022

ICDL and DIR® Professionals are Supporting Ukrainians

 ICDL's main focus is to train professionals that then provide DIR® based support to their communities.  While there are services that ICDL provides directly to families through our DIR® Institute, most of the DIR® services and supports around the world are provided by the thousands of ICDL trained professionals in the 74 countries where we have trained DIR® professionals. 

ICDL is proud to be supporting the wonderful ICDL DIRFloortime® Experts we have in Ukraine to serve their fellow Ukrainians in this horrific time.  So far, ICDL has committed $30,000 in grants and direct support.  This will help to keep our DIR-based experts practicing and supporting families in desperate need.  

In addition to the support ICDL is providing, many ICDL DIRFloortime® professionals are volunteering their time to provide much needed support.  Did you see the article in the Washington Post that highlighted the work of many including Galina Itskovich and Irina Filonenko?  Please check it out.  I want to personally thank Galina and Irina and all of the other amazing people in the DIR community that have been working to support Ukraine, its people, and its refugees.  

There is no hesitation on my part in regards to ICDL providing funding and support for people in need to have access to DIR during this challenging times.  However, we can not do it without your help.  Please consider making a donation to ICDL.  I work hard to ensure that every dollar donated goes directly to advocacy, services to families, or direct support like we are providing in Ukraine.  I sincerely would appreciate any donation you can provide.  

I hope this awful war ends sooner than later.  I stand with Ukraine in support of their country and their people. 

Saturday, March 5, 2022

Promoting Development is Essential...and Different than Teaching

 When I was a child, kindergarten was not mandated where I was living and only available on a lottery system.  At the time, I was seen as one of the unlucky ones that did not get into kindergarten because I was not selected in the lottery.  While I was young and don't remember that much of it all, I do remember being in a K-Mart with my mother buying workbooks and supplies as she tried to figure out how she was going to teach me at home.  I still can recall feeling the anxiety she had that I was going to fall behind because I did get into kindergarten.  Well, after this study came out recently, I emailed my mother to thank her for not sending me to kindergarten! 

While the study is about preschool and not kindergarten, it does raise questions about how many are thinking about preschool and early education.  The frustrating part is that we have known this for decades, yet our systems constantly get lured into short-term immediate outcomes of things like knowing letters and numbers and struggle to see the value of a longer-term perspective that focused on promoting core development instead of rushing to teach. 

Related to the above cited study, a recent study at MIT found that the development of the language centers of the brain were better correlated with exchanges of communication than exposure to words.  Exposure to words and knowing words going into kindergarten shows better outwardly observable "data", but it really does not promote the requisite development that is essential for the brain to be able to make the most out of the words a child learns. 

Dr. Gil Tippy, co-author of Respecting Autism with Dr. Stanley Greenspan, often refers to the core Functional Emotional Developmental Capacities (FEDCs) of DIR® as "Foundation Academics".  This is so true. 

The world needs to move from thinking of playful and joyful interactions as an extra or something that is less important than teaching.  It is within these interactions that essential development happens.  In addition, this development is essential for children to get the most out of learning through more traditional classroom teaching.  But if we jump to the more traditional classroom teaching approaches before building the foundation, the child may be at risk of having more and more challenges as time progresses, much like the preschool study cited above found. 

Please share these studies with your decision makers in your communities.  The data they are being given to show outcomes of preschools and kindergartens may look shiny and nice, but it is the wrong data.  Just because it is outcome data, does not mean it is the right outcome data. We need to be looking more at developmental data than data simply focused on learning information.  

Here is a link to an article on the preschool research I mentioned above.  One thing I really like that is included in this article is the fact that the lead researcher did not expect the results that emerged.  In my opinion, that just makes it all the more powerful. 

Wednesday, October 27, 2021

Being Strength-Based is Important

 This is an important concept and one that I think people often say, but don’t necessarily follow through on.  Earlier today someone said that they were addressing a behavior because it was “dysfunctional”.  What does that mean?  Who is defining the “dys” in that judgement?  Even if, from our perspective, the behavior we are seeing does not seem to be helping the individual or if the person may genuinely be stuck, it seems better to me to reframe the “dysfunctional” to “it is the most functional behavior the person has at the time.”  The former is deficit-based and defined by behaviors and neurotypical norms.  The latter is strength-based and developmental in nature. 

I wrote the following in response to a DIR Research Forum post today about whether there is a place for stopping a child who is scripting:

“The idea of stopping anything that another human is doing that is not dangerous or infringing upon the rights of others always causes me pause.  Both personally and professionally.  From a professional standpoint, if an individual seems stuck I always think first about what I can help them develop that can increase their internal capacities and sense of agency so that they have more options for engaging in the world most fully, but in a manner they choose. That can effectively be achieved in a strength-based DIR process of following their lead, joining, expanding, elaborating, etc.”

Part of the concept of “following the child’s lead” is starting with what a person can do and where their interests are and joining them in relationship from there.  Building the foundation.  Building internal capacities.  Expanding and elaborating.  It’s all strength-based. 

I think at times there can be pressures from the world to “fix” kids or people and to make them “normal”.  This is not DIR and not what we do in DIR. 

DIR is about development.  Helping individuals develop while understanding and respecting their individual differences and engaging in meaningful relationships that will help fuel that development. 

I am just sharing a thought, but I’d be interested in anyone’s comments on what it means to you to be strength-based. 

Thursday, April 2, 2020

I Beg You


To honor Autism Awareness Month I beg you to do two things:

1.  If you have not already, sign up to receive the Autistic Self Advocacy Network's (ASAN's) newsletters.  One of the best gifts we can give to the autistic individuals in our lives is to increase our understanding of the needs and challenges that people on the spectrum face on a daily basis.  A simple and effective way to add to this is to read ASAN's newsletters.

2.  Please make a donation to ASAN.  Now more than ever, the autistic community needs advocates watching out for them, protecting their rights, and ensuring a brighter tomorrow.

Thank you!


Thursday, March 26, 2020

Supporting Your Child’s Emotional Well-Being by Just BEING


The other day I wrote about how one of the best ways to think about supporting you child’s social emotional health is to use the first six Functional Emotional Developmental Capacities (FEDCs) as a guide. With each capacity, we can do things that can help our children stay calm, regulated, engaged, active, happy, connected, thinking, and overall more stable emotionally and physically.  In the last blog, I focused on the functional emotional developmental capacity (FEDC) of self-regulation and interest in the world.  Today I am going to move onto the second FEDC of Engaging and Relating.

FEDC 2: Engaging and Relating

This capacity focuses on the ability to engage and relate with others.  It is a very simple, yet fundamental, process.  It is about the joy of BEING with someone else.  This goes all the way back to a baby in mom or dad’s arms with a big smile, laughs, and that pure joy and love of being in their parent’s arms, looking at their face, and being totally consumed by the connection. 

In our world of TVs, computers, tablets, phones and all things that fall under the word “devices” this pure engagement or just BEING with each other can be remarkably infrequent and even elusive.  But, in times of stress, like many are facing now, there is not much more valuable to our health than just BEING  with someone else that loves us.  

Being vs. Doing.  Many times as parents we think of time with our kids as doing something.  Going to the movies, playing on the playground, playing Chutes and Ladders, eating, or whatever it may be.  That is all great and there is nothing wrong with that.  However, all of those things are centered around DOING.  In our world of doing, doing, doing all the time, many have forgotten about the power and joy of BEING.  Please note, these are not mutually exclusive.  You can be with our child while you are doing.  However, you can also do with your child without being…and that is the danger.  Especially now with the financial and health stresses all around us, it can be very hard to just be.  How can we just be when we have so much to do?  The conundrum about this is that we are not going to be as effective doing if we don’t allow ourselves to just be.  Also, our children’s emotional health and well-being need time with us to just be with them. 

Here is the simple tip

Even just twice a day for a few minutes each time, make sure your child feels from you that they are the most important person in the world at that moment to you.  Don’t focus on the devices or the DOING.  Focus on the BEING.  It may feel strange at first.  What do I do?  How do I do it?  One tip goes back to an old saying that goes like this, “God gave you two ears and one mouth.  It is best to use them in that proportion.”  In other words, listen more than you speak.  And even if no words are used, the same idea applies and can be thought of as “follow more than you lead.”  This may sound overly simple, but I find that people don’t do this nearly enough with those they love.  And our children will eat it up because we are human beings, not human doings. Being in relation with others is a key to our emotional well-being and our kids need it now more than ever.  

Here is a cute example of a father hanging out with his son.  The content, or what they are DOING, does not matter.  But, this is great stuff.  And I am certain, knowing all we know about brain development and the importance of BEING on brain development, this is really good for this little boy.  I am also certain Dad is feeling great about it too.