The following initial draft is based upon my eleven years experience as a developmental 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 with his affect reciprocal motor-planning with others for any meaningful praxis to occur. Often when we assess the presence of developmental challenges with respect to a child's emotional-cognitive, language and social functioning due to either complex neurodevelopmental challenges and/or a challenged primary caregiver/child dynamic we find heterogeneous differences not only with respect to the child's emotional-developmental milestones but with respect to his/her specific underlying affect sensory-motor planning challenges.
For example, one child's natural intent or affect sensory motor planning (i.e., tactile, auditory visual spatial processing) 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 affect sensory-motor processing areas are challenged at any particular time or circumstance.
Unfortunately, despite the many advances that have
been made during the past forty years with respect to understanding the
asynchronous (disassociated) affect sensory motor
connections of children diagnosed with ASD or related challeneges (i.e.,under, over and
mixed responsivities in auditory, tactile, visual-spatial,
proprioceptive and vestibular domains) we still, nonetheless, find
among a majority of practitioners and school practices a superfluous focus on targeting the child's "surface behaviors" (i.e., compliant vs. non-compliant or "appropriate vs. inappropriate").
There are a multitude of reasons, some of which include, expediency or convenience with respect to time constraints, agency profits and school budgetary concerns and thus "managing the child behaviors" to more or less conform with peer typical surface behaviors and teacher control by conditioning the child's "surface behaviors" becomes the overarching desired outcome, rather than
begin the more arduous and important endeavor of addressing, understanding and
targeting the child's primary underlying affect-sensory motor processing
connections that make relationships with others painful or difficult
and in fact precipitate or exacerbate the child's "external
behaviors." Thus, the child's self-regulating sensory-affect-motor challenges in relationship to others often remain insufficiently addressed and poorly if at all understood For example:
Auditory exchanges: certain distinct sounds or frequencies can be felt
as extremely discomforting and can appear to others at times, as a
child's inattentiveness; Tactile exchanges: 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 exchanges:
too many scattered objects or movement by others in a room can be
experienced as extremely disorientating and result in severe meltdown
tantrums, etc.(see, http://spdfoundation.net/research.html )
The infant/toddler's emerging developmental milestones, which includes the child's ability to connect his/her natural intent to praxis or executive functioning and regulate his/her unique affect-sensory processing differences (even when compromised by the presence of any predisposed biological-genetic, environmental, nutritional or medical conditions) is never a predetermined, fixed or unalterable trajectory but is always guided from birth by early infant/caregiver attachment practices. Early positive based interactions will always lead to more nuanced emotional preverbal and verbal circles of child/caregiver engagement along with more complex typical patterns of affect-sensory motor integration and an emerging healthy "sense of self" with others.
What has been conclusively neuroscientifically demonstrated during the last twenty five years is that basic healthy primary caregiver/child attachment and deepening engagement from infancy help co-determine not only the efficiency of brain functioning but the architecture or structure of the child's neuronal pathways. Conversely, neglectful or abusive caregiver/child practices can compromise healthy synchronous mind-brain affect sensory motor connections resulting in the infant/toddler not experiencing his/her world as "safe and secure, for example, moderate to severe compromises beginning in early attachment, in the child's simple rhythmic back and forth reciprocal affective nonverbal engagement with gestures and verbalization supporting the foundations for a secure and integrated emerging "sense-of self" with primary caregivers.
Neurophysiologically, compromises in the child's sense of secure based engagement with others can be observed/measured with respect to an increase in cortisol (hormonal stress) levels that externally manifest in the child's constant "freeze, fight or flight responses." (Center on the Developing Child at Harvard University (2007). A Science-
based Framework for Early Childhood Policy: Using Evidence to Improve
Outcomes in Learning, Behavior and Health for Vulnerable Children. www.developingchild.harvard.edu )
Now, if the infant/toddler clearly has underlying constitutional challenges, for example, biological and/or environmental insults resulting in compromised synchronous biopsychosocial affect-sensory motor connections and, for example, later diagnosed with a pervasive developmental disorder (i.e., ASD), then the combined additional lack of existing healthy nurturing parent/child attachment and engagement and the neuroplasticity of the neuronal pathways and synaptic can become even more compromised with respect to optimal functioning.
Irrespective of typical or non-typical development, what is first and foremost important for all educators, therapists and parents, et al. to understand is that the relationship between healthy primary caregiver/toddler nurturance based practices and the infant/toddler's healthy or challenged core "sense of self" (i.e., how neuronal pathways and synpatic connections are formed) are directly linked with the child's ability to increasingly pleasurably engage, integrate and thrive with others. (for a general - and for new parents a required overview - see http://www.helpguide.org/articles/secure-attachment/what-is-secure-attachment-and-bonding.htm For a more detailed history on the origins of attachment theory, see http://www.psychology.sunysb.edu/attachment/online/inge_origins.pdf)
Nevertheless, quite remarkably there remains a most curious tradition for more than fifty years among practitioners who work with children using applied behavioral analysis of either poorly understanding or decidedly diminishing the tremendous and critical role of child/primary caregiver relationships. This becomes even more significant and an absolute necessity when guiding primary caregivers' to learn how to synchronize and form relationships with the child's unique underlying developmental and affect-sensory motor processing differences. (The latter, particularly with children diagnosed with autism is for the purposes of facilitating the basic dynamics of healthy emotional-reciprocal interactions and in turn, at each stage, supporting the emergence of the child's healthy functional-emotional Developmental capacities.*)
Instead, from a "Behaviorist perspective" all infant/toddler and older learning and development, aside from any initial underlying neurophysiological compromises, are viewed predominantly as environmentally learned responses (or in more common vernacular the child's appropriate or inappropriate reinforced antecedents and consequences resulting in "appropriate or inappropriate behaviors"). Thus, distinctions in child/caregiver co-affective or emotional signalling, which is much more nuanced and complex and involves a heterogeneous synchronization of sensory affective motor and executive functioning (i.e., affectiveor social emotional motor planning and language) either in typical or atypical development in child/parent dyads tend to become viewed in alarmingly simplistic and reductionistic terms!
For example, a child learning to comply to the demands of the "task" or targeted behavior(s) by instructors manipulating the antecedent or consequence rather than the more real underlying core challenges in developing and maintaining internal regulation-and-co-regulation in the context of complex everyday reciprocal empathic relationships. The latter representing greater neurodevelopmental authenticity and respect than merely labeling or evicnicing changes in the child's surface behaviors and marking off as completed on a checklist!
Now, what this typically means when treating children diagnosed with autism spectrum disorder or related thinking, relating and engagement based challenges, when using applied behavioral analysis (ABA) the primary focus will be centered on redirecting a child's surface compliance to a targeted or series of discrete targeted behaviors to adult commands. This typically involves training the infant/toddler or older child to mechanically learn the steps (sequences) involved in executing routine tasks. However appealing to many parents at first glance (i.e., child learning to execute simple or routine tasks) these are simply not the primary core challenges with children diagnosed with ASD and related developmental based challenges. In fact, the idea of the execution of tasks or , i.e., learning the mechanical steps of motor based tasks, cognitive tasks and language based tasks is a direct insult and contradiction to the more comprehensive understanding of the primary core challenges of ASD, which directly entail, deepening child/primary caregiver affective reciprocal attachment of emotionally relating and engaging around the child's natural affect or intent and unique presentation of sensory processing differences in the context of social relationships.
In the process, they alarmingly dismiss or give lip service to not some abstract hypothetical but the actual neurodevelopmental components that comprise each child's unique Developmental, sensory processing and child/primary caregiver profile (i.e., complex relationship dynamics) and thus embarrassingly dumb-down simple to complex relating and engaging, which includes focusing on the child's emotions and sensory processing differences and guiding synchronization of primary caregivers and others to the child's unique affect sensory motor processing challenges, particularly in cases with children diagnosed with autism and related based non-verbal and verbal communicating and affect-sensory motor based challenges. Instead the focus is on changing the child's "surface behavioral responses." There is a tremendous difference in teaching a child new replacement behaviors (which through drilling and repetition is of course naturally possible) and the child actually wanting to initiate and sustain spontaneous simple to complex back and forth meaningful engagement with others.
The latter requires a complex internal understanding by the infant/toddler and older as s/he begins to read non-verbal gestures and cues and spontaneously begin to co-regulate with the affective intent of others. This necessarily includes the child pleasurably(from the child's emerging sense of self with other, curiosity and ideation) beginning to read non-verbal cues, i.e., bodily language, emotional gestures understanding inflexion or tone of voice and intent of others and the increasing ability to [neurophysiologically] self-regulate increased sensory calm and integration from a healthy core sense of self. Engagement is much more complex than simply learning a new checklist series or sets of behaviors! Obviously "new behaviors" (new ways of responding to conditioned tasks) can be taught. However, actual engagement is infinitely more complex. It requires a growing and reflective sense by the infant/toddler and older understanding of emotional reading, understanding and synchronization with others. Moreover, this is not something beyond the capabilities of the child diagnosed with neurodevelopmental challeneges, but neither can it ever be broken down and taught as steps in a task. a sequence of externally taught instructions ( i.e., first we do this, then we do that and so on). The organism is not a machine!
This is in fact how all infants/toddlers begin to learn! They initially begin to learn in their post natal environment recognizing mommy's voice, opening and closing and widening their eyes and using their facial muscles, for example, smiling in co-response (emotional co-regulation) to mommy or daddy smiling. Thus a smile begets a smile; a frown a frown; a widening grin, etc They begin to learn not "extrinsically" as in "replacement behaviors" (i.e. as in "Do this!"/"Good job!") but through pleasurable receptive and integrated experience (intrinsically) how to read and co-regulate with the co-emotional signaling of others. The dyad cannot be reduced to a series of behaviors; it consists of human to human (child brain/adult brain) co-interedependent co-regulated nuanced exchanges. It is this which forms the basis of all learning. It is these steps that need to be rebuilt and Not the adult commands to follow tasks on cue, which is simply replacing one form of repetitive or scripted behaviors with another. The child learning how to respond on command and demonstrate new "surface behaviors" through task reinforcement might appear to be more "functional on the surface."
However, learning through repetitive drilling of new "replacement behaviors" (i.e., training/surface memorization) is not the same thing as the child using his/her own organism, spontaneously expressing with abandon, that is, as a fully natural and integrated part of the child's internal (emerging) "sense of self" and his/her spontaneous interactions with others! It is not the child's newly "trained replacement behaviors" but rather the child's natural ability to engage in spontaneous novel interactions integrated to his/her growing core "sense of self" with the world, which by necessity involves internally learning through rich and dynamic engagement (co-engagement) with others how to integrate and navigate the map of his being; how to regulate his arousal states; how to register and adapt in and across each of his sensory-affect-motor strengths and challenges, all of which at each moment are directly connected to the child's expanding executive functioning (praxis). All of which are so important for real comprehensive Developmental growth and learning!
The historical hostility toward the child's unique emerging "sense-of-self with other" and the critical role of parent/child nurturing based practices which co-regulates the strength, connectivity and direction of synaptic connections begins with early infant/parent attachment/engagement practices (Bowlby; Winocott) and is in direct accordance with a neurodevelopmental understanding of the infant/toddler emerging rich and complex psychodynamic "sense-of self with other" (i.e., emergence of infant/toddler self-with feelings and the child/caregiver back and forth deepening attachment/emotional signaling that regulate and support the growth and development of a full autonomous self-with others) is simplified for purposes of "observable test-taking" across the spectrum. from rats to people in terms of simple "Behavioral reinforced conditioning" (i.e., reward/punishment; behavioral avoidance, behavioral compliance).
For example, instead of viewing pervasive developmental disorders, such as ASD, in both the core and the larger perspective of complex relating and engagement based challenges, the focus is on changing the "problem behaviors of the child" rather than the more developmental understanding and undertaking of both emotionally/empathically and neurologically understanding and engaging the complexity of the actual child's biopsychosocial connections, which imperatively includes educators and therapists guiding synchronized child/primary caregiver relationship practices in facilitating those developmental processes (i.e., the nature of executive functioning and its direct relationship to the complexity of the child's unique affect-sensory motor strengths and challenges). It is the latter and not antecedent based conditioning (i.e., changing the surface behavioral based responses of the child) that presents the core challenges of relating, thinking and engaging.
In general, what we find among behaviorists is a certain abhorrence for critical reflection with respect to the complex nature of the human psyche (i.e., dispensing of Freud to the role of attachment - and any internalized or affective sense of self) and instead a shift to the psychology of what extrinsically motivates human beings by way of "stimulus response conditioning." Perhaps ever since the smashing success of motivational or stimulus response conditioning with the birth of mass advertising that sought out to prove that the individual can become a "salivating consumer" (Watson), there has been an astoundingly persistent but misguided folk appeal to dumb down and simplistically deconstruct the complex social-behavior of any organism, man, animal, insect or otherwise as fundamentally consisting of a combination of learned responses and blind instincts receptive to classical respondent conditioning (Pavlov) to a greater evolutionary environmental-learning capacity for more complex "behavior modification" in higher functioning organisms, known as "operant conditioning" (Skinner).
B.F. Skinner demonstrated that through a functional behavioral analysis of the antecedent conditions that motivates any organism (rat or child) to a particular set of desired outcomes or consequences (i.e., "external reward") we can, once we ascertain the function that those particular behaviors are serving to reinforce, begin to "scientifically" analyze the recorded observable data and in turn modify the antecedent conditions that lead to those undesirable or "inappropriate behaviors." Therefore, we can begin to successfully and consistently modify the child's responses to more adult desired "appropriate behavioral outcomes or consequences."
For example: Johnny throws a tantrum as he knows this will result in being removed from class, thus achieving his goal or a younger child throws a tantrum and mommy turns on the video to calm him down. Thus, as we begin to selectively target those "undesirable behaviors" and implement strategies in order to change the precipitating conditions or antecedents leading to the child's anticipated reward or consequence, we can begin to change or modify those "inappropriate behaviors" to more "appropriate behaviors" or outcomes Applied behavioral analysis (ABA) ushered into prominence in the 1960's/70's by psychoanalyst turned behaviorist, I.O. Lovaas. Lovaas began to take Skinner's basic operant conditioning principles and systematically apply them to address moderate to severe "behavioral deficits" in older children with pervasive developmental disorders such as autism.
Lovaas' focus was on training the autistic child or older to learn how to become proficient in reducing inappropriate responses or behaviors and mastering appropriate response behaviors or tasks rather than ever once pausing to conceive of the possibility of gaining access to the child (or older) not by focusing on changing the "externalized behaviors"* but by understanding, respecting and engaging the child's functional emotional and sensory processing differences by building with the child an underlying secure Developmental foundation of calm, and trust, where the possibilities of co-engagement, reciprocity, initiation ideation/symbolic thinking and verbalization become as we know now much more probable along with peer typical higher levels of critical thinking and pragmatic communication
*Astoundingly, without any symbolic attribution of the "behavior" and what actually, beneath the surface fact of its occurrence is being pre/symbolically interpreted by that individual along with any challenges in the (underlying) affect-sensory motor processing and, most significantly, understanding of the "how to" interact with that individual's differences that, in turn, sets a more secure and meaningful foundation that enables more typical meaningful engagement and social communication with others. Thus, the focus in applied behavioral analysis is on the raw fact of the "externalized behaviors" with almost a complete bankrupt understanding of the biopsychosocial dynamics that precipitates them and primary caregivers and others relationship dynamics that either help regulate or exacerbate them.
The problem with operant conditioning and all behavioral oriented thinking in general which remarkably continues to present day presents an embarrassingly distorted and gross over simplification, a caricature of what biopsychosocial Development actually entails. To begin to understand and address typical or atypical challenges in human primary caregiver/infant-toddler dyadic pairs with respect to a "scientific" reductionist account of how children are motivated by "extrinsic rewards" or "behaviorally complying in contrast to non-complying" to a set of commands or instructions, etc., we find it to be an extraordinarily impoverished perspective, even in cases of noted severity of impact on functioning, such as in moderate to severe autism spectrum challenges. (1)
(1) Beginning with the deepening of infant/parent reciprocal attachment through the exchange of simple facial/bodily affective gestures to increasingly more complex two-way emotional signaling with the expanded use of gestures/ideas and communication of utterances. The latter seen through PET scans directly correlates with expanding prefrontal cortex (executive functioning) with subcortical competing heterogeneous sensory processing responsivities and the synchrony/dyssyncrhony of child/primary caregiver relationship dynamics (or more precisely, the complex affective exchanges of intersubjective child/primary caregiver dynamics co-structuring the child developing neuronal connections). The child's natural intent or emerging "sense of self" beginning with the
tremendous significance of early infant/caregiver attachment patterns
and any accompanied sensory processing based challenges has always been
met with tremendous resistance by the Behaviorist school of thought. This is especially evident when addressing
the complexity of functional-emotional developmental, heterogeneous sensory processing and relationship challenges which are instead
simplistically conceived as appropriate vs. inappropriate learned behavioral responses.
The stock phrase commonly used when discussing children who present with autism spectrum and related disorders, "The child's behavioral based challenges" immediately proceeds by way of simplification and distortion by providing surface name tags (i.e., "inappropriate/appropriate") to what always must be viewed in much more mature biopsychosocial sense. In other words, to look at the "function of a behavior" (i.e., provide a label to an action positive/negative and proceed to redirect its surface function, child will not line up toys or avert gaze but play with toys and make eye contact "appropriately") without any consideration of its internalized or affective meaning pertaining to that child (and all associated challenges conferred by that child's overall affect-sensory motor profile) in the context of dyadic (i.e., child/primary caregiver) exchanges brings to question the proponents of behavioral based methodologies basic neurodevelopmental understanding-and-childhood functional emotional development in both theory and practice.
A basic neurodevelopmental framework equally applied to infant/toddler and older typical and atypical development (i.e., DIR/Floortime) does not focus on first assessing then implementing a plan of task labeled "surface behaviors" observed and noted by the evaluator demonstrated by the child - often without a shred of developmental insight (i.e., crudely labeled, "inappropriate vs appropriate"). (2) Instead, the focus is widened to a larger scope with respect to the actual complexity of the underlying prefrontal and subcortical and sensory-motor affect regulatory connections that at each stage is evinced by the emergence of the infant/toddler's developmental capacities or milestones. (3)
In all stages of development, irrespective or typical or non-typical, the enormous plasticity of each child's neuronal connections is procured or nurtured by dyadic child/primary caregiver co-emotional signaling (beginning with back and forth smiles, frowns, etc.) which sets the trajectories and organizes the foundations for these dyadic (child/caregiver) developmental capacities or milestones. When atypical developmental challenges (i.e. ASD) are present this inarguably and unequivocally needs to be informed by therapists, preferably with a comprehensive Developmental background, guiding primary caregivers in deepening the emotional reciprocity around the child's natural affective interests. In other words, building relationships (i.e., relating-and-engaging) as opposed to "redirecting behaviors" around the child's natural intentionality in order to promote further positive integration and development Since this biopsychosocial focus is largely absent in behaviorally driven or antecedent based methodologies, or at best met with ambivalence, this further brings to question their time honorific but arguably vapid use of the phrase, "ABA the only scientifically proven methodology." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266398/
(2) For example, in early intervention typically beginning with child performing a series of "performance-based tasks" on a checklist. This includes, "touch nose" "show me ball", "point to dog," "give me shoe", etc. Unwittingly, this actually reinforces stereotypical behaviors as the child is focused on executing repeated "functional-tasks" rather than the messiness of RELATING. It is the Intentional affective RELATING between co-respondents (i.e., child/caregiver) which is the ALL critical factor and sets the foundation for the Developmental milestones. This includes co-regulating simple to more complex emotional relatedness, i.e., reading facial and bodily cues and others intentionality. It does NOT include the repeated execution of single or generalized functional-task routines, which - regardless, either single or generalized - isolates the "task" from the variables of natural engagement, which is necessary to be read/processed by the toddler or older.. The reason that "performance-based tasks" are made the dominant focus is that essentially they are more "easily measurable" with the variables accounted for (i.e. "distractions"). It is, therefore, open to be quite deceptively alluring as it substantiates its validity on the basis of the recorded data of the child's performed-tasks under the mask of "objective", "empirical" and "scientifically proven." However, It is precisely the assimilation, integration and adaptation of the "child-with-other" affective or emotional variables and not their de-limiting (i.e., controlled environmental variables) where true Development actually begins to occur! We will return to this point later. Suffice to say for now that the child directed toward "performance based tasks" entirely fails to comprehensively, if at all, address and furthermore, risks inhibiting the integration of the primary core Developmental challenges associated with ASD and other developmental related challenges, i.e., spontaneously co-regulating, co-relating, co-thinking and co-communicating which are necessary as the primary focus with all children from day one (typical/atypical distinctions not withstanding) in contrast to an arbitrary checklist of performance based tasks.
(3) The Developmental capacities which naturally emerges in typical child/primary caregiver development or must be re-addressed in non-typical development, includes what is commonly referred to as the six basic functional emotional developmental milestones: Self-regulation and shared attention; engagement or falling in love; two-way purposed communication; shared social-problem solving; creation of ideas; creation of logical bridges between emotions and ideas. see, http://www.stanleygreenspan.com/ppt/Lecture%202.pdf
Often the majority of therapists in early intervention says to parents, "We are here to help your child prepare for pre-school readiness skills." Unfortunately, while immediately appealing on the surface to many parents is often in reality an absolute shame and travesty, as what actually constitutes relating, engaging and processing differences, that is in the context of the preverbal affective functional-emotional developmental milestones, that ever single child without exception must first master is often left unaddressed. Often not only is this not addressed by special educators and other therapists but shockingly is not even understood!
Despite its four decade proud arsenal of antecedent based methodologies and countless tomes of carefully analyzed recorded data to achieve appropriate behavioral responses or outcomes, for example, from labeled "inappropriate to appropriate behaviors" in a child who in fact (if we dare put all absurdity aside) demonstrates complex and unique affect sensory-motor and functional emotional-developmental differences - or even with more typical development intact and simply "child acting out", represents a perspective which in fact yields very little useful or empirical value with respect to a much more mature psychologically substantive and demanded query, namely,
Who is the child (or older) as social participant or image of "self-in-relationship to other"? The latter in fact requires a radically different approach and dare we say a more sober, comprehensive Developmental psychological-and-neuroscientific understanding of the competing cortical and subcortical heterogeneous pathways of that particular child and of tremendous significance the dyad (i.e., child /primary caregiver emotional co-connecting and relating) than simplistic behavioral based interpretations can proffer or worse care to even entertain!
A Developmental understanding of the dyad (infant/toddler parent relationship) is based on a comprehensive neurological biopsychosocial framework (i.e., how the less experienced infant/toddler mind-brain-nervous system in synchronization with the more experienced adult brain begins to deepen attachment, co-regulate, and integrate simple to complex biopsychosocial based interactions). This is in sharp contrast to a simple reductionism or fitting the child into a caricatured, polarized, scale-down and mock either/or designation (i.e., "appropriate vs. inappropriate") and the associated deprecating view that essentially everything is behavior on the brain with a certain amount of anatomy beneath.
We do not argue that applied behavioral analysis does not work or has not shown success in producing surface functional changes in behavior (indeed, as the brain is enormously plastic) rather we argue that its proponents understanding of the natural complexity of infant/toddler development (irrespective of any diagnosis) is extraordinarily misguided (and misses addressing the larger Developmental picture) as the focus is on "targeting selective or isolated surface behaviors or skills to generalized behavioral-skill routines." Rather, a focus needs to be on attempting to truly understand the child's "behaviors" (i.e., developmental-psychological underpinnings and meaning) from an understanding of the child's perspective along with the primary caregivers' and therapists' understanding of the child's associated affect sensory-motor heterogeneous based challenges that make calm, regulation, simple interaction to complex engagement typical or challenging.
When we begin to place our focus in the context of a Developmental biopsychosocial understanding, we begin to address the underlying core developmental challenges associated with calming, relating and engaging experienced by infants, toddlers and older not by conducting a functional behavioral assessment of the precipitating or antecedent events leading to present consequences and once the latter is done then the therapists begin to implement "intervention" to have the child redirected in terms of "goal-oriented tasks." Rather we begin by using both our intuition and our functional emotional developmental knowledge in conjunction with that child's affective sensory processing differences by slowing down, pausing, listening and meaningfully attributing and conveying meaning and purpose to the child's current affect -- by meeting/joining with that child where s/he is in her/his current affective expression.
The following video by Dr. Stanley Greenspan filmed in 1990 is as strongly valid today as ever with respect to the emotional-empathic understanding of "joining with" and perspective taking from the child's point of view in order to facilitate and to deepen basic reciprocal child/caregiver engagement which then leads to further functional-emotional actualization of each child's developmental capacities. The principles of adult to child shared-perspective taking and the natural further encouragement of emotional-cognitive emergence shown in this video equally applies to typically developing children or infants/toddlers and older with pervasive developmental challenges, such as ASD:
Those antithetical to the attribution of the child's internalization, intentionality, meaning, purpose, symbolism and affect denoted as pure subjective and pointless vagaries is extremely unfortunate. We may refer to what we see in this above video as the most fundamental rule of shared perspective taking or attempted shared empathic understanding - that is by the adult to the child. It is indeed extraordinary, astonishingly arrogant, to assume that any "child's behaviors need to be changed" when we do not at all consider for a single moment the possibility of slowing down, feeling and joining in a meaningful rapport and thus "perspective-taking" from the infant/toddler and older.
What we need here to make emphatically clear is that the child's total, bio-psycho-social dynamic in the present needs to begin to be respected and understood by all primary caregivers, therapists and educators who can, or who are at the very least willing, to begin to be guided how to slow down and meet the child where s/he is rather than attempt to grossly and ignorantly attempt to "shape" the child's behaviors through an "adult directed/child compliance management efficiency model." The latter typically consists of arbitrarily defined and from a Developmental psychological perspective perfectly meaningless, cognitive-behaviorally compliant vs. non-compliant skills (i.e., stacking blocks according to size, pointing to pictures, sitting
quietly in circle time, following directions on command, mechanically
repeating utterances, etc.) marked off on a checklist and called,
"progress" when accomplished. Unfortunately, they have very little to do if anything with the core capacities of social-cognitive-emotional development, let alone does not address in the least the core challenges associated with pervasive developmental disorders, such as ASD.
The potpourri laundry list (small list above) is promoted and faithfully followed by a majority of early intervention special educators with the admonition to families of the necessity of "Your child's "pre-school readiness skills" as thus being able to "follow the routines and skill sets of typical peers." Understandably, this may appear on the surface to make perfect common sense and, therefore, quite appealing to many families especially with their toddler who demonstrates developmental and communication based challenges. Not coincidentally, this also dovetails nicely with numerous decades of mass advertising in all media, i.e. "Getting your child up to speed as quickly as possible", etc. The fact is, it could not be further removed from what constitutes the typical dynamics and/or underlying challenges of basic social-emotional-cognitive communicative engagement.
Nevertheless, the severely misguided thinking of the "adult directing child to follow appropriate tasks and routines" is the blind, compulsive and rubber stamp script found in virtually every child's IFSP (i.e., the child's achievement of performance task-based routines with objects by following adult directed commands). Often this has very little to do, if anything, with respect to addressing the toddler's (or older) core Developmental based challenges. The core Developmental based challenges are not, we repeat not "behavioral." When we use the term Behavioral (or "a child's behaviors") in any capacity (typical/atypical) whatsoever we are, in fact, tagging the most banal external definitions or external observations of what represents neurodevelopmentally a more complex series of biopsychosocial interactions. Dyadic co-regulated emotional signaling through co-interactions, including play and two-way emotional problem solving scenarios, is much more complex than devising antecedent based methodologies to change a child's surface behaviors to learn a "specific series of commands or tasks" and then to generalize those tasks throughout daily routines.
The nature of the child/caregiver's interactive or social engagement (affective dynamics) includes deepening child/caregiver attachment, reciprocal emotional engagement and calming. regulating and integrating sensory processing differences and associated levels of anxiety through initiated back and forth emotional problem solving circles where the child is continuously challenged but increasingly comes back for more engagement. In the process, we are concurrently strongly supporting and guiding the foundation of the child's emergent autonomy or healthy "sense of self." The latter always involves deepening affective reciprocity around the child natural intent. The empirical based results are, for example, reductions in levels of high arousal or anxiety and correspondingly as the data clearly shows a significantly reduced activity in the amygdala (primitive flight or flight or All or nothing responses) and an increase in prefrontal cortex or executive functioning activity; an increased activation in the fusiform face processing area (reading facial expressions) as well as other areas - and thus building the functional-emotional developmental milestones. These empirical results are not as the majority of behaviorists would like to maintain, phantoms or subjective realities unobservable and therefore cannot be subjected to "scientific evidence" and effective and meaningful intervention. The fact is they resoundingly are. And any argument to the contrary is not just partially but entirely misleading and contradicts the neuroscientic evidence to date.(4)
(4) The following for an extensive review of
research evidence and practice supporting a comprehensive Developmental
systems theory (DIR/Floortime) approach, https://docs.google.com/a/icdl.com/viewer?a=v&pid=sites&srcid=aWNkbC5jb218aWNkbHxneDozNThkNWUyNWY4N2ZkMTAz
Also, for a more theoretical basis of the leading role that the child's intentional affective states have in facilitating executive functioning and co-regulating the affect-sensory motor connections in both typical and atypical reciprocal communication, see http://sponderworks.com/wp-content/uploads/2011/08/affect_diathesis_hypothesis.pdf
The following is a brief video clip from an ongoing fully controlled randomized clinical trial being conducted at the MEHRI Foundation, University of Toronto. Those assigned to treatment group are receiving DIR/Floortime therapy and control group receiving community based treatments, that includes ABA. The actual systemic changes of re-wiring of the brain that are shown here in real-time PET scans of this child in the treatment group are extraordinarily impressive. The scientific proof is not in the recorded data of the clinician's functional behavioral observations but more significantly in the core systemic changes viewed in real-time of neuronal pathways:
Essentially, we do not want a child who is simply following commands or completing performance object oriented routines (i.e., touch nose, point to dog, give me ball accompanied with the vapid and automaton-like response from the special educator of "Good Job"). Instead, we want and can have by an understanding of what constitutes basic calm, regulation, co-engagement/co-interaction with respect to infant/toddler development, a child who is not only answering, complying or performing on command (i.e., "Do A, Show me B, Give me C") but rather a child who is spontaneously initiating, engaging communicating, reflecting and, in fact, building the crucial milestones of true healthy integrated functional emotional development. The latter is different than a surface cosmetic peer compliance or makeover (i.e., where child responds on cue, prompt or command rather than addressing the primary core challenges of dyadic emotional engagement, spontaneous communicating and critical thinking).
The state evaluation teams, special educators and others who begin to set the initial bar that the toddler (or older) who supposedly(5) demonstrates "non-compliance to adult directions" and thus becomes written in the IFSP as, "child will begins to follow simple adult directions" does not in fact address let alone evinces one iota of understanding of the simplest functional-emotional developmental understanding and, therefore, needed targeted developmental capacities of infant/toddler development of "the child wanting to attend." How? By the adult respectfully (and emotionally) attending to where the child is, i.e., following his/her lead and thus wooing him/her to want to stay in meaningful back-and-forth engagement. The differences here between the two cannot be emphasized enough! Moreover, it is sadly not understood by a majority of practitioners in the field that once child becomes successful in initially following simple rote commands or directions on cue (dutifully checked off on a test protocol checklist) is at all a child who has learned or as a result is in a "better position to learn" any of the fundamentals of basic spontaneous diversified simple back and forth co-regulated emotional engagement with his/her primary caregivers and others.
The confusion here is that a child who can attend first to "simple adult commands then s/he can begin to generalize their routines", However, the fact is that it is not a cognitive question of the "child's ability to attend to what is adult requested" but rather the ability for the child to feel an internal safe and secure foundation of permitting others to participate in his/her world which involves addressing problems of hyper and hypo arousal and competing affective sensory processing differences and not their mistaken conflation or superficial interpretation of "child seeking or avoidance behaviors adjoined to the demands of the task." Even, for example, when the child receives separately occupational therapy to address sensory processing challenges, this egregious behavioral interpretation (that dominates the child's interventions) merely acts to suppress the child's underlying complex neurodevelopmental realities at the expense of training the child to be reinforced to follow surface task oriented commands. It is not a cognitive challenge of the child having to learn the simple broken down "steps of the task" but rather the challenge of the adult learning how to emotionally engage the child's affective (emotional/sensory) world and differences which then in turn allows "tasks" or rather co-activities of co-interactions to become mastered.
(5) That is, from a Behavioral in contrast to a comprehensive Developmental interpretation.
Meaningful developmental intervention is not about addressing the child's behavioral challenges defined in terms such as "stimulus control" and "the child's avoidance of the demands of task" and nor is it about understanding the child's "extrinsic based rewards reinforcing the present antecedent inappropriate behaviors." All the foregoing is archaic nonsense based upon a purely superficial interpretation of otherwise complex interactions, thus often not a partial but a complete lack of understanding of the role of the emotions and heterogeneous sensory processing responsivities that guide competing executive functioning and subcortical functioning from simple internal/external calm and attentiveness to simple to complex affect reciprocal emotional problem solving connections - that guide infant/child/primary caregiver interactions and subsequently the meaningful emergence of each Functional Emotional Developmental milestone. To understand and address the affective or emotional reciprocal based interactions - that indeed form the basis of all relationships with respect to receptive and expressive language, social functioning and associated neurology is not to revert to adopting a platform of interpreting and targeting "behavioral based responses", which are not only crude but are entirely misinformed, misleading and can in many instances actually curtail a child's greater functional-emotional developmental emergence, integration and trajectory.
It is precisely the affective preverbal foundations and adjoining underlying child specific sensory motor affect regulatory capacities (i.e., over, under, mixed responsivity across sensory-motor affect processing domains in the context of reciprocal engagement) which are the most crucial and often the most ignored or poorly understood by naively and mistakenly bringing the child online in compliance to the behavioral demands and completion of the "task" (often guided by and exploited under the tacit assumption it looks/feels good to teachers and parents on the surface) rather than meaningfully addressing the child's underlying core capacities (challenges) of basic social emotional engagement which sets the directions for the child's emerging healthy "sense of self-with-other" and the adjoining and emerging true cognitive capacities or overall functional emotional intelligence including verbal communication.
It is a sensitive and empathic focusing on the child's natural intent or emotions beginning with simple to increasingly complex dyadic emotional problem solving scenarios (i.e., looking for a ball that becomes playfully stuck by parent) with co-referencing facial and bodily gestures and adjoining rich use of ideas that builds the developmental steps that enable greater sensory motor integration and intelligence and not "teaching to the task" which often and naively circumvents or places further unnecessary delays or roadblocks in addressing the core developmental challenges associated ASD and related challenges. In fact behavioral based approaches such as ABA often further inhibit or delay these early and quite necessary critical foundations of spontaneous co-regulated back and forth engagement..
Although on the surface the child's rote compliance to commands and "rote tasks" often initially satisfies a certain immediate visceral sense of families' and practitioners' "empirical account" that the child is "making progress", i.e., the child is complying and following age-peer typical routines, it in fact frequently leaves the child's emerging "sense of self" and individual processing challenges in the arrears (suppressed). Consequently, the core milestones of spontaneous thinking, relating and communicating frequently remain unaddressed. I would argue in many instances that it is more than a shame. It is egregious. There is an imperative need to urgently revise how we perceive, approach and understand and place into practice infant/toddler-and-child/parent developmental practices.
Unfortunately, many early intervention practitioners do not make this critical distinction, that is to say, specifically between the child's rote "performance of skills on cue" in contrast to the child's spontaneous initiating, engaging relating (emotional facial and bodily gestures and meaningful verbal/communication use) paired with original novel use of ideas and symbolic thinking. The unadmitted reality is that in many cases many practitioners either do not at all or sufficiently understand infant/toddler development or have been blindly taught to follow by their uninformed superiors evaluative protocol/tools that involve having the child arbitrarily complete items down a inventory task checklist rather than more maturely bring to the table novel and clinically meaningful Developmental insight and reflection and address the fundamental core essentials of primary caregiver/child relating and engaging and associated, underlying, processing strengths and challenges that pertains to that individual child and by co-extension the larger primary caregiver/child relationship (dyad).
The only possibility that I can conceive this will substantively and meaningfully change is if state policies and guidelines overseeing Early Intervention agencies are required to be guided under the direct supervision of those who have a Developmental psychological clinical background, i.e., attachment theory and practice and the typical developmental stages of dyadic primary caregiver/infant/toddler development and furthermore require those practitioners who they contract or employ to have in their training significantly the same.
Frequently, we see children who know their shapes, letters, colors, numbers; can name hundreds of items, etc., but cannot maintain the simplest back and forth spontaneous engagement and use their skills (i.e., connect their skills as an increasingly integrated part of their natural affective curiosity and intent, reflection and self-regulation) in a purposeful, meaningful and emotional-pragmatic fashion. When we say, "a meaningful and emotional-pragmatic fashion" we mean the child's ability to want to stay in back-and-forth engagement, initiate and expand upon simple novel ideas during two-way emotional problem solving and symbolic play. Developmentally, the latter is guided with the primary caregiver's and therapist use of basic back and forth nuanced co-referencing with facial and bodily gesturing inflected varied verbal intonation, inflexion. These are the core essentials, the A, B, C's of relating, engaging and communicating.
In the former instance, the child knowing his/her shapes, letters, colors, numbers, labeling items, despite common-folk sense to the mass marketing appeal of Baby Einstein books, etc., often leaves not only unaddressed the basic underlying challenges of true spontaneous relating, engaging and communicating but can actually further (unconsciously) reinforce those original underlying challenges (i.e., stereotypical or perseverative behaviors that prevent or curtail spontaneous relating, engaging and communicating). How? By replacing (or transferring) the child's perservation (albeit seemingly on the surface more "functional") to a new path of stereotypical obsession with nice compliant well trained cookie-cutter, tasks, skills and routines.
It is important to note with respect to the above, that the child's "cognitive advance" as typically measured by itemized or discrete skill sets on an inventory checklist indeed may increase. However, what needs to begin to be understood is that, arguably beyond a certain primitive and bankrupt or idiotic surface interpretation (i.e. child does not comply, therefore, lacks receptive understanding of the task) they are often not in question to begin with as "receptive and cognitive understanding" in the vast majority of children diagnosed with mild to moderate ASD, and with no other comorbid indicators, is generally not problematic, even though, again, it commonly appears to be so prima facie.
This is often due to the fact that "traditional diagnostic standards", for example, arcane testing combined with an uneducated or non-developmentally trained eye that attempts to determine the presence of "rote selective or isolated skills" in contrast to the adult evaluator/practitioner attempting to guide, enhance and deepen meaning (meaningful relationship) around the child's natural intent and comfort zone and engage the child where s/he is. Without exception the latter in majority of cases would evince a different evaluative interpretative level of "cognitive performance." In the latter instance primary caregivers being guided and practitioners being trained to attribute purpose and meaning and emphasize engagement around the child's natural interests yields a different set of results as the focus is on the deepening of underlying trust and developmental psychological dyadic process. Consequently, the one size fits all economic and fear driven mentality (i.e., "child fitted to the test") would be courageously and Developmentally removed from the equation as the emphasis would shift to the relationship and the connecting with the child's individual processing differences (and guiding the guiding the primary caregiver/child dynamic) rather than an entirely vapid and meaningless emphasis on "task completion."
The fact is, once underlying co-regulated engagement becomes established (through the activity pf deepening pleasurable engagement around the child's natural intent) we tend to see a moderate or even dramatic increase in what is generally and mistakenly formerly perceived as often moderate or very moderate "cognitive deficit."
It is the underlying core challenges of internal secure-based engagement (i.e., child's "sense of self" relating and initiating with others) and the concomitant or adjoining integral processes of internal affective regulatory sensory-based processing (i.e., hypoactive, hyperactive and mixed responsivities across auditory, tactile visual-spatial processing, proprioceptive and vestibular domains) that constitutes what we can term some of the demonstrable and primary underlying core deficits in ASD and related challenges.
This includes not simply mirrored or reciprocated responses after primary caregiver or therapist modeling, but rather the child's initiated emotional engagement and sustained proactive reciprocal emotional engagement around the use of two-way emotional problem solving activities (i.e., toy becomes playfully stuck by mom; child uses simple reciprocated gestures, facial and bodily co-gestures and verbalization with mom to make it "un-stuck") to the further use of novel ideas in symbolic play eventually leading to higher logical based thinking; comparative thinking, grey area thinking , etc. What should be noted is that throughout the latter the increased proactive exchange of simple to complex ideas (i.e., object stuck to Elmo being chased by the tiger) with others is an adjoined or integral part of simple to nuanced complex language/communication - up the developmental ladder). The foregoing, approaching and well into the second year of life, represents some of the many primary core challenges we see in autism spectrum and related disorders.
The child/primary caregiver relationship is the most fundamental relationship or dyad which always implies a myriad of opportunities (even in non-typical development) for subtle preverbal and verbal dialectical and dialogical exchanges with the infant/toddler or older. It should never be turned into a "set of behaviors to be managed" or a caricature (i.e., preschool glorified nonsense, Johnny is compliant vs non-compliant typical of his peer group) as it is often done in EI practice in typical and non-typical child development, such as pervasive developmental disorders Moreover, this is thrown into the bin or dumb down under the so-called, "only scientifically proven methodology" by the ABA industrial complex, or dare we be a bit more honest and phrase differently and say placed at the doorstep of the mercy of practitioners' pathetic lack of developmental understanding and education or simply disinterest or inability to probe deeper beyond the surface of the child's symbolic "external manifesting behaviors."
Labeling or defining a behavior(s) is always meretricious, that is, it is a mere simple description of incident or occurrence on the surface. Saying., for example, a child is doing X and resulting in Y and proceeding to identify causal factors that precipitates X in order to change Y often completely fails to describe the tremendous dynamics of interaction, let alone provide necessary opportunities for the much needed (imperative) reflection by primary caregivers and others with regard to the child's core Individual Processing Differences. Essentially, they fail to capture the beauty, intimacy and complex challenges of the parent/child dyad, as well as the underlying systemic bio-psycho-social differentiation of child's heterogeneous (individual not uniform) processing challenges.
This latter by necessity includes, at the very least by all practitioners, a peripheral understanding, of typical and non-typical infant/toddler developmental milestones or stages. This should also entail a basic understanding of children's developing cortical/subcortical differential competing emerging dominance (e.g., prefrontal cortex or executive functioning vs. limbic or primitive impulses during typical development) which can be an enormous benefit to practitioners going toward a deeper understanding of the child's present affect functional-emotional developmental differences, rather than practitioners in the field (especially Early Intervention) mindlessly focused on having the child complete a series of routine and monotonous tasks, which does not generally reflect any infant/toddler or older Developmental understanding in the least.
The above includes a most fundamental Developmental understanding that must always be placed into practice irrespective of the designation. typical and non-typical developing child: The encouragement of primary caregivers, therapists and educator to fully support the child's need to explore with primary caregivers and others his/her emerging "sense-of-self." Now, contrary to what is consistently found in a typical IFSP (Individual family service plan, that every child receives upon entering the Early Intervention system) this necessarily implies the opposite:
1) The child must be encouraged to be "self-directed" rather than adult directed. Instead, what is, almost without exception, embarrassingly and typically written up as an IFSP goal or outcome for majority of toddlers is, "Child will begin to follow simple adult directions." Unfortunately, this is terribly misguided as it often reflects a complete lack of Developmental understanding and insight. We should expect more from Early Intervention therapists and special educators in the field working with infant/toddler development and older rather than the common-folk sense that is found in many not all daycare centers for toddlers, many which are nothing but glorified baby sitter activity centers, where children are taught to pay attention, follow the rules sit quietly in circle time, etc.
2) From a Developmental perspective what we mean by "self-directed" is that primary caregivers and therapists slowly begin to learn to appreciate and support the child's unique differences and healthy "emerging sense of self " (irrespective of typical or non-typical). Furthermore, primary caregivers and therapists should never begin to direct the child to complete a hierarchical set of predefined tasks. This is fitting the child into a uniform cookie-cutter mold. Instead, particularly when there are functional emotional developmental and processing challenges, primary caregivers and therapists need to begin to understand the individual "functional-emotional developmental and processing differences (i.e., underlying strengths and challenges) of that child, which, again, should never be conceived of and proceeded to be directed to a set of predefined "task-oriented routines" (i.e., pre-school readiness skills, completing puzzles, colors, names shapes, pointing and labeling pictures on cue, which often looks magnificently wonderful "on the surface" but in reality often have not one iota to do with child's individual Development and unique processing differences beneath the surface).
The therapist always first needs to learn how to respect, embrace and enter into the child's world (deepening reciprocal emotional attachment, entering into a "dialogue" with the child) while at the same moment guiding primary caregivers to do the same for purposes of supporting the exploration of the child's environment and addressing the child's differences and encouraging (fostering) the child's healthy growth and integrated functional-emotional development. (leading to wanting to explore, wanting to initiate wanting to engage). This also deeply helps meaningfully developmentally educate and empower primary caregivers with respect to the unique individual needs (i.e., strengths and challenges) of their child and thus help allay underlying or unvoiced feelings of inadequacy and guilt (we will return to this point later).
From an organic way or systems theory way of thinking, it is not self directed versus adult directed. This is polarized depiction is a distortion that lacks nuance, that lack Developmental-psychological insight infants/toddlers grow, develop learn and begin to want to initiate and engage. Moreover, it is a necessity when a child has underlying sensory-motor processing challenges to first learn how to identify and engage those processing differences. (Otherwise they are viewed and I am sad to say by many professionals in the field as "off task behaviors", which is a homogeneous, one-size fits all, a cursory encapsulation and a complete lack of Developmental understanding and insight).
Auditory exchanges: certain distinct sounds or frequencies can be felt as extremely discomforting and can appear to others at times, as a child's inattentiveness; Tactile exchanges: 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 exchanges: 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, when we look at either typical or non-typical development any meaningful Developmental intervention approach that attempts to consistently and meaningfully address the integration of the child's emotional-cognitive, language and sensory-motor processing based challenges in contrast to traditional behavioral based approaches (e.g., where the child's surface behaviors are targeted for "pre-school readiness success" and "compliant outcomes", which often shows a complete lack of understanding of developmental and processing differences), must be strongly grounded in a comprehensive dyadic affect-developmental based foundation.
A comprehensive dyadic affect Developmental foundation will consistently take into account a basic understanding of how to deepen caregiver/child reciprocal secure attachment guided by the child's unique affect sensory-motor processing challenges; functional emotional-developmental levels; accompanied biomedical challenges, nutritional deficiencies and an overall focus on expanding primary caregiver/child and peer dyadic relationships.
When pervasive developmental challenges, such as autism spectrum disorders, are diagnosed, therapists and educators who use a dyadic Developmental based approach consistently refrain from focusing on antecedent conditioning. Antecedent conditioning attempts to produce a different set of appropriate outcomes as a result of successfully modified or re-enforced behaviors - i.e., redirecting inappropriate or non-compliant behaviors (often misinterpreted as perseverative behaviors; repetitive running, spinning, staring, hand flapping, lining objects/toys). Instead, Developmentally based therapists and educators begin to guide primary caregivers and other therapists in art of learning how to reflectively pause, slow down and modify the impact of their own interactions with respect to becoming more empathically attuned to their child's perspective and his/her underlying affect sensory-motor processing differences (i.e., less underbearing or less overbearing to the child's affect-sensory processing based differences).
During the latter process, primary caregivers and therapists (a triadic process) begin to significantly Developmentally and emotionally understand how the child organizes and interprets his/her world. As this two-way affect developmental process begins to unfold, we begin to empirically gather data with respect to the consistent strengthening and integration of the underlying neurodevelopmental foundations of each child's healthy emerging affect-social developmental milestones. The hierarchical steps of the functional emotional developmental sequences that we typically observe include the following:
1) Deepened secure dyadic child/caregiver attachment accompanied by increased initiated shared attention with respect to diversified facial and somatic gestures with and/or without verbal single and combined pragmatic utterances.
2) Increased shared attention accompanied by an increased desire by the child to express small to longer meaningful reciprocal emotional problem solving circles of communication (i.e., co-referencing back and forth pointing) combined with increased repeated and spontaneous gestures and pleasurable vowel/consonant sounds, utterances/words with others.
3) Increase in the integration of underlying affect-sensory motor processing challenges (i.e., less aversion to touch over reaction to sound, etc.) expressed in a wider range of new opportunities for the child's complex co-regulation (a greater confluence) with the use of novel ideas during functional play with others (e.g., child throwing ball to child looking up at caregiver and hiding ball in shirt with a wide smile and gleam in the eye) to a noticeable increase of emerging symbolic play sequences (e.g., child places baby to sleep, looks up smiles, imitates therapist, puts finger to mouth with "Sh! "; child touches tiger, tiger bites finger, "Ow!"; Elmo falls down, "Boo, boo!").
4) Spontaneous affective gestures (i.e., increased nuanced and dramatic facial and bodily expressions) beginning to increasingly combined with integrated short phrase to longer sentence usage; more complex syntactical constructions and pragmatic (social) language/communication throughout play and daily routines.
5) More complex dramatic play scenarios: The logical use of reasoning and articulation between different characters during increasingly complex symbolic play (e.g., Child: "Oh, the pirate is climbing, up ladder." Therapist: Why is he climbing up ladder? Child: "To get to the flag, see! Oh, help he fell down!" Therapist: "Where? What happened?" Child: "In the water help, run, the sharks coming?").
Affect-Developmental based thinking in contrast to Behavioral based thinking with typical and non-typical developing children.
In an affect-developmental approach the focus is on the child's relationship, engagement and underlying processing differences with others. In behavioral based approaches the focus is on performance driven tasks, for example, beginning with simple isolated or discrete tasks to generalized task routines. In the latter, the rules for competency is often based upon a basic misunderstanding that the child with ASD lacks "receptive understanding" of what is required to carry out simple adult directed instructions. Instead what we find from a relationship/engagement perspective is that once the child desires to engage with others (i.e., preverbal co-referencing, showing, telling, participating), the child's core receptive understanding (visibly) exponentially increases. It is by no coincidence that the latter is always predicated upon internalized sense of safety, trust, curiosity and desire to explore.
This makes sense not just from a psychological perspective (i.e., once secure based and pleasurable relationships are established the desire for engagement with others increases) but from a more comprehensive biological-social-psychological perspective, as core receptive communication processing skills requires a complex coordination of the senses and ideation (i.e., executive planning/thinking and emotional regulation) in order for the child to attend with others. Receptive understanding or attending to the interaction or engagement, which is in fact a primary core challenge for many children with ASD, does not mean directing the child to carry out primitive telegraphed requests or commands given by the adult to the child; this is not how cognitive-or-language skills or emotional-intelligence (development) works. Instead, it necessarily means, first and foremost, a desire, willingness and curiosity by the child to participate and initiate with others.
The act of breaking down the required performance to carry out a task (a set of to-do instructions) for the child in order to make it more easily cognitively graspable (comprehensible) is based upon a gross distortion. of what often appears to be a core Developmental challenge with children on the spectrum. Unfortunately, it not just partially but entirely misses the point as it is based upon a complete misunderstanding of core receptive and expressive language and thinking the child has with others. This has to do with the child feeling internally safe and secure and increasingly desiring to stay in affect reciprocal back and forth engagement with others rather than a "developmental need to show/explain" the mechanical steps of a task, which often appears to be a receptive communication or cognitive understanding challenge but in the vast majority of instances is not.
Receptive and expressive language and thinking work in a much more fluid, overlapping nuanced and organic fashion, in the context of back-and-forth simple to complex co-emotional problem solving around the child's natural intent or affect; around the adult learning to slow down and engage the child's natural intent or affect; hence the deepening of dyadic affect reciprocal attachment. Thus the differences here from a Developmental in contrast to a behavioral based perspective cannot be underscored enough.
To many behaviorists (and unfortunately to the myth of common folk sense appeal) everything can and should be broken down into (adult conceived.child friendly instructional) bite size and made to be understood by any child with receptive communication deficits. Thus the goal often put forth is to "make clear" to the child - again, based upon the erroneous understanding that the child lack "receptive understanding" rather than processing challenges that makes receptive understanding problematic, i.e., If I shout in your ear chances are you will not hear me - what is required by the demands of the "task" by breaking down tasks for the child into their simplest components (i.e.. First we do x, then we do y, then z; first we turn on the water, then we use soap then we wash our hands, etc.). Thus tasks by common conception and execution are based upon the simplistic notion of mechanical-based performance routines.
Human beings and engagement are much more complex and nuanced. They cannot and should not be submitted to such artificial nonsense which simplifies and insults the child's natural emotional intelligence and moreover fails to address the child's underlying core challenges, which are pleasurable secure-based engagement and regulated sensory processing challenges in the context of back and forth complex engagement (i.e., sight, sound, touch, movement, space) and not a "How to step by step mechanical guide."
This is utter nonsense and I can assure you deeply insulting to the often much wider range of the child's emotional-cognitive intelligence.
In general, behavioral based approaches often begin with what is commonly used with toddlers and older with ASD known as discrete trial training (DTT). For example, the child is prompted to perform a series of simple requests (i.e., touch, blue, touch ball, give me ball, etc ) and is provided upon the "correct response" each time with a re-enforcer or reward to re-enforce or to maximize appropriate behavioral responding and conversely help fade inappropriate responses. As the the child performs correctly, s/he is routinely is given monotonous verbal praise (i.e., "Good listening", "Good job") combined with a concrete re-enforcer (i.e., child favorite food, Ipad, etc.).
Many parents have commented to me for over a decade that this seems like dog training or robotic training. Unfortunately, their intuition is not off by any stretch of the imagination, as this is not how clinically meaningful and clinically significant "Development" occurs. We need to begin to seriously educate others to understand that the primary core challenges in ASD is not proceeding to have the child initially follow one-step commands on cue and then once "mastered", branch out to more complex performance-task based routine-demands. This is unfortunate and should not be a primary target or regarded as core challenge of children with ASD. This is often based upon a mistaken hypothesis of "cognitive deficit" with respect to a problem in the child's receptive understanding. For example, we proceed to ask the child, "Touch blue", or "Touch cat, " baby, dog; "Give ball", etc., and child does not comply (or does understand the SD, discriminative stimulus, or the demands of the simple queried task). Unfortunately, this is often a surface interpretation and a developmental blindness, whereby many educators and therapists conclude that the child lacks core receptive communication skills, this often could not be further from the truth.
One of the primary core challenges of many children with ASD is not what often appears to be a primary cognitive deficit with respect to receptive communicate skills, such as following simple commands (requests, instructions). Instead, what at first glance often appears to be a core deficit in the child's receptive understanding/receptive communication skills is actually a core challenge with respect to the child's underlying processing challenges:
The child's desire to want to stay in simple pleasurable engagement with others; to further want to continue and begin to spontaneously initiate simple back and forth co-regulated attention and engagement around shared pleasurable based experiences with others. These are often not problems of the child's receptive cognitive understanding but the act of engaging let alone initiating and sustaining back and forth preverbal and verbal engagement which is registered by the child as too frightening or overwhelming. This often leads to the speculation that "my child has a hearing issue, s/he does not respond when I call him/her." When auditory function is normal this then this then typically leads to a conclusion of the professionals determining the child has significant receptive communication deficits and shortly thereafter depending upon frequency, range and intensity combined with the child frequently avoiding eye contact along with some stereotypical behaviors, a developmental pediatric evaluation which not unoften results in the child receiving a mild or moderate diagnosis of autism.
When the child is engaged in simple shared pleasurable experiences, i.e., joint attending with expressive affect facial diversity in numerous instances of smiling, frowning, grimacing during dyad child.caregiver peek-a-boo; or even child allowing/tolerating caregiver to spin the ball that the child just spun, then adult takes ball lifts to eye level, child cries as caregiver slowly puts ball down, but stays in relative zone of proximity and allows for this primitive shared experience, etc., this begins in both instances and to varying degrees, to quiet/calm limbic based Amygdala All or nothing, fight or flight responses with an increase in prefrontal cortex action (that is, praxis, the ability to see, co-reference, understand and execute simple actions, such as back and forth simple joint attending) and calm hyper-over responsive or excite hypo, under, responsive sensory challenges for the child-with-caregiver.
Now, in order to begin to embark upon this critical process of social/joint attending this crucially involves the exact opposite of what appears to be "rational, observable, measurable behavioral-based thinking", that is, precisely not having the child to begin to arbitrarily execute a series of broken down, extracted, simple routine-based tasks (e.g., "Touch, nose", "Touch book"). Breaking down things (defined as "tasks") into their simplest components so the child can better grasp the complexity of the demands of the "task" appears at first blush to make perfect common sense with respect to developing the child's basic receptive understanding but in actuality it is extraordinarily Developmentally misleading and unwittingly reenforces stereotypical behaviors rather than encourages social interaction and true dyadic engagement. The latter involves prefrontal cortex or executive functioning in conjunction with limbic or subcortical based connections utilizing all the child's senses in and across space with others (visual-spatial, tactile auditory and so forth) and not simply the child's compliance with and to a series of fixed routines or differential rote responses.
Thus, instead of adopting the common-folk non-developmental and non-empathic position (telegraph input/output model, adult the "teacher"/child the receptacle) of child learning to follow a framed simple set of externalized behavioral routine tasks, we look at what the child is doing in the present moment as part of a "meaning-making process", that is, as meaningful from the child current intent or perspective. We proactively encourage a position of adult empathic perspective taking. This is non-negotiable and critical. We encourage primary caregivers (and therapists) to begin to slow-down and how to attentively listen, see, feel, mirror and thus begin to emotionally attribute "intentionality" (intentional meaning) to the child's actions, as they indeed are both purposeful and meaningful.
When we begin to learn how to engage with the child in an affective intentional manner (e.g., attributing meaning to child's intent and thus meeting the child half-way in his or her world), we begin to allow for a purposeful and meaningful affect-joining or exchanging. We begin to co-narrate through activity of engaging with the child in his/her world the underlying developmental foundations by which this can and does occur. This becomes over time intuitively registered by the child in terms of affective preverbal changes, that is, affective perspective taking, translated by a greater calm, curiosity and willingness to engage. The latter begins a process (or deepens emerging processes) of social-developmental integration. We can correctly conceive this dyadic process as a two-way co-narrative (co-constructing) of the primary caregivers-with-the child. The opposite is to unconsciously attempt to re-enforce rigid or stereotypical behaviors (i.e., curbing, delimiting and restricting rather than encouraging joint-frames of spontaneous initiating by virtue of misconception of what we believe it means for the child to "learn") by having the child begin to follow simple commands based upon a very banal and incorrect surface interpretation that the child lacks core receptive communication skills as s/he cannot comply with simple one step or two-step tasks.
This two-way affect-developmental foundation that begins to naturally expand between dyadic pairs (child/caregiver, child/therapist) necessarily entails the following: the sustained meaningful emergence of pleasurable shared attention to simple back and forth initiated emotional signaling (e.g., primary caregiver/child reciprocal use of facial gestures, body proximity and verbal utterances) to progressively more complex two-way emotional problem solving, that is, with more complex gestures and utterances (i.e., requests for object/actions or people not immediately present in the environment). My use of the phrase "begins to naturally expand between dyadic pairs" means precisely that the complexity of engagement proceeds upon the basis of deepening relationship between child and caregivers and not the child learning to follow a set of instructional rules or performance based routines. As the child with primary caregivers begins to engage in the simplest back and forth dynamics of pleasurable based relationship this not involve - as in antecedent training and task re-enforcement the immense artificiality of the child learning an external extractable set of broken tasks such as. "Do this!" Touch this" Give this" or simple imitating on command, but his/her natural intelligence co-emotional signaling with the use of affect reciprocal and deepening facial and bodily gesturing between himself and others. This involves the utmost respect of meeting a child where s/he is and respecting and joining in his/her world.
Meeting the child half way, following and cultivating the child's natural intent (i.e., child's natural affective intentionality) is in stark contrast to the majority of applied behavioral based and positive behavioral support approaches. A significant part of applied behavioral analysis (ABA) or other cognitive behavioral management systems are largely reductionistic (e.g., practitioners observing measuring and analyzing the antecedents or "causes" that results in the observable consequences or the surface components of the child's behaviors) rather than looking at the "larger picture": The critical necessity to embrace and understand the child's sense of self in relationship to his/her - symbolic manifestation- of "behaviors", that is, his/her intentionality behind the behaviors and not just the fact of their occurrence and the trite surface behavioral interpretation of the objective or consequence for the child (i.e. child is doing X in order to obtain attention, food, toy, etc.).
In the latter we find a very seductive common-folk appeal of the emotionally detached objective "scientific observer", which is quite brilliant and notable in its attempt to preclude the basics of primary caregivers, educators and therapists joining-in and appreciate perspective taking ("basic theory of mind") from the child's (or older) perspective. This is both humorously ironic and tragic, as we all too often hear over the decades from professionals in the field who readily speak about one of the core deficit in children with ASD as a fundamental lack of perspective taking from the perspective of other.
Much of behavioral based thinking adopts an a-historical narrative, that is with respect to a fictitious image of a "non-biased objective observer" and thus attempt, what in effect possesses its earlier roots in the 19th Century historical positivist model, to reduce and oversimplify what can be otherwise be more insightfully observed, registered and reflected upon with regards to the inherent purpose, meaning and underlying processing of the child's sole "external presenting behaviors." A focus on the child's productive competence, for example, without understanding underlying or inherent meaning is emotionally bankrupt, as well as clinically and developmentally vacuous. A psychology of self (perspective-taking what it means from the child's perspective) that is, the "sense-of self with other" for the child is often at best given secondary status. Instead, what is posited is the image of the no-nonsense therapist/educator, emotionally detached and a "scientific focus" based upon devising contingencies of selective reinforcement, that is, a focus on targeting and reinforcing those behaviors typically deemed "positive" or "appropriate" or devising contingencies of reinforcement for conditioning positive replacement behaviors and reducing towards extinction those behaviors deemed stereotypically "negative or inappropriate."
Under such "scientific nonsense" of targeting that which can only be observed selectively or arbitrarily, certainly devoid or arbitrary with consideration to any semblance of symbol and self, such nebulous notions with respect to what the child (or older) is actually processing/experiencing, e.g., any concept of the internalization of a "self" and adjoining or associated feelings - and moreover (believed by some) "insanely" attempting to enter into a therapeutic (intersubjective) relationship (meaningful bond) of affectively mirroring or perspective taking (attributing purpose, intentionality meaning to what a given action/behavior/expression might mean and feel from the child's or older perspective) is afforded no value, whatsoever.
Any notion of the child's emerging individual "sense of self" is largely discarded except as it manifests in terms of "external presenting behaviors", that is, when it comes to the core essentials of what constitutes the therapy. In behavioral based thinking, the focus is targeted on understanding and changing the child's antecedent conditioning that contributes to maladaptive and producing negative or inappropriate outcomes. Thus the target is to understand and change current antecedent conditioning to produce "what we all consider" to be more positive behaviors and outcomes. This entails a detailed understanding of what is reinforced for the child by the current environmental contingencies (at home, outside with all significant and insignificant others) and what are the nature of the specific consequences of those current reinforcers that produces those current inappropriate behaviors that need to and can indeed be changed. A very simple example, would be as follows:
"Every time Johnny cries and throws himself down mommy give in and gives Johnny the soda." Johnny has therefore learned a very useful although inappropriate strategy to obtain his wants/needs, let alone poor nutrition. Therefore, one of the goals would be for Johnny to learn a more appropriate strategy, a better, shall we say, "more appropriate productive replacement behavior" to obtain his wants and needs by re-training Johnny's poorly learned antecedent conditioned responses (i.e., Johnny escalating tantrums, Mom giving in; Johnny obtaining his soda) and instead, teaching mom how to begin to ignore Johnny's negative behaviors and respond only to the new targeted positive behavior in order for Johnny to learn how to achieve his desired object, toy, reward, etc.. The logical simple success here would be Johnny with Mom learning more appropriate strategies (i.e. Mom learning not to respond to Johnny's crying but instead positively responding when Johnny, for example, stops for a moment, looks up, points or says please).
The fact that any and all behaviors are an integral part of a social dynamic of exchange, of simple to complex back and forth reciprocal communication (and thus should not be made into a caricature, good vs. bad or extractable taught tasks) and always represent the "external symbolic manifestation" of the toddler/child's (or older) intent and/or challenges (a diathesis of intent) in [the child ability] to be able to comfortably begin to seamlessly integrate/process basic feelings/emotions as well as sensory based differences, especially with individuals with pervasive developmental challenges (e.g., the ability to affectively/emotionally integrate, praxis, affect-sensory motor plans in the nuanced exchanges in simple back to back affect gestural preverbal to verbal communication) is often poorly, dare we say if at all, understood when working with this population.
Moreover, as a matter of standard practice the child's sense of self in relationship to other and his/her underlying sensory processing challenges - rather than interpreting everything as "behavior on the brain" which is standard fare, is often discarded amongst many practitioners as a distractor or distraction (in any case an unnecessary embellishment) to the primary target/goal at hand, which is devising antecedent based interventions and contingencies of reinforcement largely for the sole purpose of targeting fundamental "surface behavioral based changes" (a characterization that is accurate but alas many would object to).
The primary focus of behavioral based methodologies essentially is, "How the child or older will begin to act more appropriately or "learn to respond" to any given set of simple or complex environmental contingent demands in a more "appropriate manner." Thus, what we are basically concerned about is the cosmetic outcomes of productive competence (child will point to dog, will give ball on command and other such bs) and along with that reduce inappropriate behaviors (head banging) and learn how to properly request. Now, on the surface this many seem perfectly logical and reasonable. However, in reality it is anything but.
The enormous Developmental blind spot and problem here is that "targeting behaviors" is different than (toddler/child/older) wanting, willing and thinking about it, critically thinking about it from a diversity of perspectives tailored to the child's preverbal-and/or verbal emotional developmental capacities and heterogeneous processing differences and relational affective dynamics.. Learning to respond under the consumer popular label (too often folk mass appeal) of it is either, A or B, it is either "positive or negative" or 1, 2, 3, rock paper, scissors, stone (old child's game) is simply Not the same thing as child spontaneously initiating and diversifying from a healthy sense-of-self with other learning to executively plan-and-emotionally integrate, that is, the child learning to internally process, feelings, ideas, thoughts in back and forth preverbal and verbal communicative co-narrative, turn taking exchanges. It is by no coincidence that applied behavioral and cognitive behavioral view any psychology, psychotherapeutic practice or any internalization of self other than that which can be immediately touch, "observed" and measured as a phantom and anathema.
The above by necessity involves entering into the child's world and understanding his/her intentionality, "sense-of-self with-other" and building up those pre-verbal affect exchanges in a slow artful, respectful and meaningful way. It also of course entails understanding the child's (or older) heterogeneous affect-sensory processing differences (e.g., under, over mixed responsivites in proprioceptive, vestibular, auditory, tactile, olfactory and visual-spatial domains) and not merely fobbing them off to 1X60 OT (occupational therapy) per week or dubbing them, "Appropriate versus Inappropriate", which is embarrassingly simplistic, but from a marketing perspective tremendously effective, as we want changes, we want them now, we want them explained in black and white terms... However, fortunately our organisms-and-emotional intelligence both neurotypical and atypical are far more complex.
Although many of the methods deployed in applied behavioral based approaches differ (e.g., discrete trial to natural environment and pivotal response training) and can on occasion be initially useful as adjunct to a more comprehensive Developmental based approach, such as DIR or RDI (e.g. when there are extreme child behaviors manifesting in a complete lack of boundaries between self-and-other), the pedagogy for every child tends towards uniformity: The emphasis on data driven accountability with respect to the child's overall improved "behavioral managerial skills" with primary caregivers, teachers and peers and consequently, as a result of the child's improved formerly poor "impulse-control", the surface (but not complex) cognitive-behavioral acquisition of complied with attention to and execution of tasks on an inventory checklist.
The latter focus on directing (that is, "teaching" under the auspices of operant conditioning) each child to comply on cue to a priori sets of highly selective tasks, for example, to decrease or eliminate "off task behaviors", tends to impressively overlook each child's unique social developmental profile: preverbal functional developmental milestones, individual affect sensory-motor and modulation processing challenges and primary caregiver/child affect-relationship dynamics. The latter is critical for a basic understanding of how all children (typical and non-typical) begin to learn, grow, integrate and develop through simple back and forth reciprocal dyadic engagement through complex social meaningful relationships.
One of the primary core areas of Development we begin to assess as each child becomes more comfortable in simple reciprocal back and forth engagement with primary caregivers and others is not just an increase in the child's gross referential pointing but nuanced affect facial and bodily gesturing (e.g., not just pointing and looking to people and objects but affect inflexions in pointing; facial gesturing and co-referencing, which involve finely nuanced emotional signaling). Moreover, this new emerging ability for each child to express his/her intent through back and forth affect gestural reciprocity (i.e., simple primitive social somatic and facial gesturing, pointing, nodding, frowning, grimacing, combined with differentiated utterances) begins on a neurophysiological level to significantly strengthen underlying synapses (e.g., pre-frontal executive functioning, praxis) in conjunction with the limbic hypothalamus pituitary axis (e.g., impulsive All or Nothing reactions).
When these basic affect-reciprocal dyadic engagement connections begin to expand, this neurodevelopmentally begins to position the child's emerging functional-emotional developmental milestones in relationship with primary caregiver affective dynamics for their most propitious and healthy emergence. As previously mentioned, this includes spontaneous and consistent use of nuanced affective gestures and utterances during simple two-way emotional-problem solving; the emerging symbolic facilitated use of novel ideas between objects and characters during play (e.g., two and three part symbolic play sequences) and increasingly toward the logical reasoning between characters during symbolic scenarios and throughout daily activities with primary caregivers and others. All of the foregoing are critical functional emotional-developmental milestone stages during the child's healthy emerging and continuing to strengthen developing sense of self with others.
I have worked with many families whose child prior to the start of therapy or shortly thereafter diagnosed with high-functioning to moderate autism spectrum disorders or non autistic but moderate to very moderate communication challenges, that included no functional gestural reciprocity and verbal utterances along with mild to very moderate affect sensory processing modulation disorders, was
eventually able to achieve to various degrees using both standard and
non-standard assessment criteria, each of the above functional-emotional
How the Child is Orientating and Perceiving his/her world: Embracing the infant/toddler's emerging sense of self.
The child's internal sense of self is absolutely critical to not only how he is interacting with others but to his overall sense of well being with others; the qualitative nature of his interactions and the overall growth and development of his emotional-cognitive and social intelligence. As a general developmental rule, any emphasis on performance based skills (i.e., selective functional cognitive or routine and adaptive tasks) can only emerge in an integrated manner when "social interactions" become affectively connected to the child's present sense of self. The latter entails primary caregivers and practitioners consistently following the child's lead and validating what s/he is doing as both intrinsically purposeful and meaningful).
Unfortunately, this is often not an integrated part of some six decades of traditional behavioral pedagogy (from B.F. Skinner to O. I. Lovaas, et al), where the main emphasis is placed abundantly on "how the child behaves" (e.g., child historically and unconsciously perceived as "object" or a discretely acquired set of human responses determined by a combination of biology and environment) and, therefore, the child's progress is measured in terms of evidence gathered responses to his/her external environments and the rote or selective memorization or repetitive drilling of new performance based routines that, in turn, becomes the targeted outcomes of adaptive functional behaviors (e.g., in contrast from a developmental perspective to intersubjective or affect reciprocal co-created engagement) and peer comparable cognitive performance task-routines (e.g., in contrast from a developmental perspective to the child's underlying affective intentionality co-integrating processing differences and co-organizing with peers social-emotional-cognitive exchanges).
We find this in abundance in various constructed methodologies within Applied Behavioral Analysis (ABA) which can initially appear impressive to many primary caregivers and classroom teachers (e.g., especially where classroom management is the primary concern and the developmental psychological preverbal or affective foundations that would otherwise begin to meaningfully constitute a core basis of emotional relating and communicating unfortunately take a backseat). Thus when the toddler (or older) can follow adult commands, e.g., "Give me ball"; "Touch nose" and as a result begins to comprehend basic consequences,"When Johnny does 'X', Johnny gets 'Y'", on the immediate surface it represents a great breakthrough, indeed for many a great sigh of welcomed relief!
However, what the proudly proclaimed, "Only scientifically proven treatment for autism, ABA" tends to brilliantly overlook is that the child is not a
tabula rasa where new "adaptive behaviors" need to substantively replace perseverative or "maladaptive behaviors" before moving on to "more complex and appropriate behaviors" (e.g., from hand flapping, echolalia, lining up toys to labeling and playing with toys as they are meant to be played with). What is learned in this manner raises some serious concerns, as it tend to leave out the toddler's (or older) present individual will, intent, intentionality guided by his affect/emotions and makes the grand and inaccurate - or simplistic assumption that the way animals and human beings learn from infancy onward are either habitually conditional reflexes or adaptive or maladaptive responses to their external environments in concert with a certain set of underlying genetic predispositions.
Nonetheless, under the proper (i.e., behavioral certified behavior analyst) supervision, even when there are significantly present adverse biological and genetic events resulting in complex neurodevelopmental disorders, such as autism, can to varying degrees (or even in very moderate or severe cases, with the correct recommended combination of psychotropics and behavioral thinking) be reconditioned or re-programmed to more peer appropriate behaviors. It is thus this just-so narrative becomes implacable truth and subsequently the message often seamlessly conveyed to families is, "Your child can be taught to 're-train' his/her 'over-selective responses' (i.e., 'poorly learned or maladaptive behaviors') to become more 'increasingly adaptive responses' typical of his/her peers, including more natural language usage which essentially is a combination of externally conditioned learned responses to the environment along with a built-in genetic facility code for language acquisition (i.e., universal grammar encoded in every brain) and of course the necessary biological hundred fifty thousand year old finale accoutrements of an evolved pharynx and larynx."
Perhaps not explained in such language to families as in the above, nonetheless the hope embodied in this perspective appears quite reasonable and attractive to families of children who have been understandably devastated when their child is diagnosed with ASD. The appeal is, "Just because your child (or older) has been recently diagnosed with autism or varying degrees of underlying complex neurodevelopmental challenges does not exclude your child (or older) from the possibilities of more functional or adaptive behaviors with the rigorous training of a behavioral modification program (i.e., applied behavioral analysis, ABA)." Indeed, on the surface this appears quite convincing: "My child's maladaptive behaviors can be trained to become more appropriate or peer typical."
However, beneath the surface it is an insult to the child's greater emotional intelligence and reflects a systemic historically antiquated and a wide inter-cultural misunderstanding of what role the emotions play in actually guiding and building the foundations of every child's moment to moment interactions and, correspondingly, the more reactionary or primitive (subcortical) areas of the brain, e.g., the limbic system (i.e., the amygdala, all or nothing catastrophic reactions). Recent decades of empirical findings do correctly indicate in ASD and related neurodevelopmental disorders that some of the brain's pathways (synapses) are overconnected others underconnected and consequently accounts in part for the child's (or older) maladaptive behavioral responses. Unfortunately, this then (conveniently) serves as a basis of misguided operant conditioning reasoning, for example, "My child (or older) under adult supervision, i.e., an adult behavioral trainer (preferably a BCBA) will be trained to learn how to suppress, bring under self-control and re-program his maladaptive impulses to more peer typical adaptive functioning."
The behavioral thinking contained here is that to begin to properly prepare the child for adaptive behavioral responses due to disruption of underlying neurological bio-genetic compromises or otherwise is also at the same time to prepare the child for true (i.e., task by task) higher cognitive functioning or learning. What this weltanshuung fails to take into account is that this is a false and antiquated view of how children (and all higher primates) learn (e.g., from simple task to more complex tasks) or that this type of highly selective surface learning involves conditional responses related to highly specific contextual situations (e.g., "When mommy asks me___? I then in turn respond to mommy in such and such a manner as I have been conditioned to respond."). Rather all sentient beings begin to learn from nurturance based validation from the mother/dyad facial and somatic preverbal social-emotional cues. It is this emotional signalling of higher and more integrated neuronal connections. This deep back and forth coordination between mother and child (and others) begins to serves as the foundation for the infant/toddler's intentionality (the affect sensory motor planning coordination of mother and child looking at each other.)
However, the focus in the former is on rote memorization not true integration with the child's affect sensory motor processing challenges (e.g., the child's motor planning and sensory processing differences pleasurably forming the basis of interaction and from there the child's use of novel ideas through spontaneous back and forth affect nonverbal and verbal engagement with others). This is much more than the child learning a new repertoire of conditioned responses, it is a more empathic and developmental understanding of engaging the child particular unique qualities of affect as part of his or her intentionality. It is the child intentionality that guides coordinates and facilities meaningful coordination of executive motor planning and emotional regulation. This process of pre-verbally engaging the child then deepens the child's natural intent/desire to want to participate (initiation)with others and not merely learning to select a "newly acquired script" on external prompt or cue. The child learning to coordinate his executive planning in synchrony with others is not the child re-selecting a newly acquired set of more appropriate responses.
Each child learns how to learn through regulating all of his/her multifaceted senses; touch, sight, hearing, smelling, etc. through warm, pleasurable, secure dyadic based relationship with others; child/primary caregivers, et al. What the former fails to realize is that it is in fact the child's natural affect or feel, his/her emotions and not simply operant conditioning or his/her newly instructed responses to external stimuli (or the hierarchy of manufactured artificial tasks) which is in fact the architect of infant/toddler's emotional-social and cognitive intelligence in collaborative dance with others. Furthermore, what is of great concern here is that the latter represents one of the primary core challenges with children with autism spectrum disorders (i.e., the child's ability to coordinate affect sensory processing motor integration in conjunction with the spontaneous verbalization of novel ideas or executive functioning - praxis).
When the child (or older) becomes more comfortably engaged in dyadic secure based attachment and comfortable in registering and acting within the threshold of his underlying sensory processing based differences, and caregivers and clinicians and educators learning how to pre-verbally (emotionally) attribute meaning to the child's affective state (his/her intentionality and different ways of processing/regulating senses) this begins in turn to enable social relationships to intelligently and meaningfully form and pragmatic receptive and expressive language skills to emerge. Firstly, it is important to note that from a Developmental perspective we are looking at the toddler (or older) as already knowing what s/he needs and guiding caregivers and practitioners to become more attuned to those needs and differences. Secondly, we are guiding caregivers and practitioners how to make (guide) those differences as an integral part of back and forth meaningful deepening social relationships. This empathic Developmental understanding (i.e., validating the child's current actions as meaningful) is unmistakably and unequivocally different than focusing on changing
(i.e., re-enforcing through surface behavior modification) the child's (or older) responses to his "external environment."
From a behavioral perspective, the toddler's (or older child's) primitive, unsavory or "maladaptive behavioral impulses" or sensory based systems (e.g., excessive spinning, jumping, flapping; lining up or staring at objects; playing or perseverating with parts of objects) are unfortunately, from day one, explained to both practitioners and practitioners to caregivers as maladaptive behaviors when compared to peer typical norms and thus conceived as "unworkable, that is, in their present affective state or adaptive physiological and emotional expression without the adult initially teaching the child to respond more appropriately and without a rigorous behavioral based approach, such as ABA (the so-called, "Only scientifically proven blessed and supported methodology") which can provide the quintessential and necessary step by step behavioral modification re-training modules desperately needed by the child
In contrast, from a Developmental perspective we focus on the dynamics of dyadic back and forth reciprocal emotional signaling. We focus on the child's natural intent. We give affective validity to the child's current behaviors. We honor and respect the child's emotions as being both purposeful and meaningful and once we woo the child into a simple back and forth circle of communication (dyad) we add affective variations (e.g., we might spin the wheel of the bus that the child has turned upside down to spinning the wheel with slight different rhythmic variations and ooh's, ah's and uh! oh's!"), that is, once the secure dyadic attachment of the simple circle has been established and, therefore, is now is in a position to be preverbally or affectively deepened; based upon knowing that the child's facial and bodily language is one of invitation; slightly greater calm, curiosity and interest rather than rejection and an all or nothing meltdown. Emotions are never reduced to a set of rote behaviors that are analytically deconstructed and parsed.
From a Developmental perspective with respect to to the toddler's (or older) healthy emerging autonomy, the child needs to critically begin to comfortably use his natural intent or affect (praxis) in concert with others to guide his natural emotional intelligence. This involves a focus on the utilization of the child's emerging milestones from a strong emphasis on the child's expanding sense of self (e.g., pleasurable shared attention, emerging novel ideas to eventually critical reflective and intuitive thinking) and not a simplistic emphasis on the redirection of maladaptive behaviors with a replacement of "newly learned functional adaptive behaviors." Indeed, newly learned functional adaptive behaviors are acquired but are done so in the proper Developmental context of deepening preverbal engagement, and as part of this engagement (i.e., adult going to the child's weltanschauung or world view) looking beneath the banal interpretative of polarized "behaviors" and while looking beneath the surface we begin to look at each child's unique array of affect-sensory motor processing differences.
This necessitates not an eschewing of the child's so-called, impulsive or "maladaptive behaviors" or an emphasis on re-programming of the surface, but a more respectful, compassionate and empathic embracing of the child's (or older) meaningful underlying affect-sensory processing differences rather than symbolically portrayed, replete in historical myth and distortion as, more or less, a dark and backward abysm of unsavory and primitive impulsive behaviors that need to be reined in (let alone, unconsciously complements historically distorted child rearing practices under the aegis of "Give a child an inch and they will take a mile" or if we may give voice to a pandemic of silent thinking on this matter, "Give a child who is on the spectrum an inch and they will add an additional ten miles!").
Now, admittedly, there are cases of children I have seen over the years, rare, where there is very little if any established boundary or sense of self between "affect and other" on the simplest of levels. Once I had seen a child who could not be approached within several feet without attempted biting of other or attempted self injury. In such instances, at least an initial focus on applied behavioral analysis (i.e., immediate re-enforcement of surface targeted behaviors) becomes both useful and necessary but only as preliminary tool to establish an initial cause/effect distinction or to decrease severe self-and-other destructive behavior. However, after that has been achieved the axis must shift from a focus on object-oriented tasks (which not by any stretch of fortuitous occurrence coincides many child assessment tools) to a focus on meaningful relationships (which has many shades of gray, and, therefore, are not as easily marked off as in a standardized one-size fits all object-task assessment checklist).
As clinicians begin to focus on a comprehensive developmental approach a strong emphasis from initial assessment to implementation of practice is given to the preverbal basis of relating. Strong preverbal foundations are the fundamental building blocks of the child's meaningful connection with caregivers and others. Frequently, the latter is severely underestimated (or worse dismissed) by clinicians beginning to provide services to families as the child enters the Early Intervention system. Strengthening the preverbal foundations are entirely different from the typical conventional notions of the child beginning to learn how to imitate rote gestures or syntactically sterile strings of utterances without affect (i.e., surface imitation). For example, typically the child through applied behavioral analysis or cognitive behavioral training reproduces or scripts back a given prompt given by the practitioner (i.e., "Say ball", "Touch square"). When the latter activity is accomplished, it is often egregiously marked on an inventory checklist as "child achieving partial skill proficiency"often shockingly without the practitioner once taking into crucial consideration the dyadic child/practitioner or child/caregiver relationship, that is, the qualitative nature of the child's affect (let alone the practitioner's own affective state) in the qualitative nature of the co-interaction.
Beginning in early intervention we often find a misguided emphasis on "pre-school readiness skills" with respect to the child accomplishing checklists of grouped tasks. Goals are ultimately geared toward each child's ability to obtain mechanically uniform (cookie-cutter) inventories of positive or adaptive behavioral responses. For example, attending nicely and quietly during circle time with peers; knowing basic shapes, colors, counting, etc.
What is so disturbing is that these goals often disregard or circumvent, often due to ignorance, e.g., lack of practitioner developmental-psychological training; time constraints geared toward management program efficiency - and thus who and where the child is; how primary caregiver dynamics impact in terms of pleasurable connecting/engaging or disengaging, what the child is actually "feeling-thinking" from his/her own perspective. Often targeted goals are on isolated sets of mechanical tasks and compliant behaviors irrespective of the child's actual affect emotional-developmental and sensory processing responsivity differences.
The universally adopted but often uncritically examined "positive" or "adaptive behavioral responses" appear as inevitably desirable and productive. Naturally, we want our children to transition from varying degrees of non-regulated and maladaptive to regulated and adaptive.
For example, children not throwing toys, reducing tantrums and following directions on command - essentially acting as typical peers and from many classroom perspectives for all intents and purposes, to be a bit honest, well-behaved little automatons. However, what is often not realized is that this is at the great expense of blithely ignoring the child's natural intent or sense of self , underlying sensory processing differences and core emotional intelligence which remains pitifully in the arrears [repressed].
Consequently, from a Developmental perspective we find an imperative need to emphasize a certain deeper affective or empathic awareness to primary caregivers with regards to significantly slowing down and more consistently focusing on the subtle nuances of back and forth affective gestures around the child's natural desires (i.e., "two-way emotional problem-solving") which in turn helps deepen secure dyadic attachment and allows for a core base between ideation, planning and executing actions (praxis) and sensory processing reactivities (i.e., sensory processing exchanges) to begin to become established in an empathic, intelligent and integrated manner during the child's engagement with adults and peers.
From a Developmental perspective considerable emphasis is placed on every child's natural emotional intelligence. By use of emotional intelligence we mean the encouragement of each child's spontaneous facial and bodily gestural and verbal reciprocity in synchronization to the sound-rhythmic patterns and preverbal or affective inflexion of the primary caregivers' and practitioners' voices and movements. This always involves, as previously mentioned, an understanding of specifically applied sensory based exchanges (i.e., tactile, auditory, visual-spatial, proprioceptive, vestibular exchanges) which are tailored to the individual child's affective reactive processing and "meaning-making" with others.
The role of every practitioner and educator is to guide primary caregivers to slow down, adjust and become emotionally and rhythmically attuned with their child (thus deepening the child/caregiver dyad) and thus building the foundation for sustained and meaningful circles of communication around the child's natural intent. To simply "redirect the child" under the label "maladaptive" is to disrespect the child and how s/he processes varying sensory channels of information with others, as well as to preclude the most basic and core aspect of a healthy family dynamic (i.e., healthy strengthening child/caregiver dyad) and reciprocally the nuanced internalization
(sense of self) that is vital to the child's sustained social cognitive-emotional growth and development in relationship to others.
As a part applied developmental dynamic systems theory and a core intervention team, sensory-motor planning and processing challenges should be thoroughly assessed by an occupational therapist well versed in affect-sensory processing reactivity strengths, challenges and differences in the context of dyadic interactions. Now, what needs to be clearly understood is that from a Developmental perspective the focus is not on changing what the child is doing - or in a classic puerile and misguided fashion defining the child's sensory processing challenges as "negative, maladaptive or aberrant behaviors" (e.g., spinning self or objects; lining up objects; excessive jumping; avoidance of touch or avoidance to certain surfaces, or excessive touching of certain objects/surfaces) but rather quite to the contrary.
Our core Developmental understanding and approach strongly adheres with the following thinking: Primary caregivers, therapists and educators learn how to fully understand, respect, and validate affect-sensory motor based differences as reflective of neurophysiological challenges as well as emotional-social meaning for the child. It is only when not boundary defined tasks or "isolates of behaviors" but sensory based processing differences are empathically felt and appreciated as perceived potential ground for two-way affect based reciprocal interactions (e.g., potential co-narrative meaning-making activity) by the adults' following the child's (or older) lead and [affect-wise] attributing felt meaning to those differences that deepening secure based attachment and developmental integration becomes not just possible but probable.
The above occurs as an integral part of emerging primary caregiver/child attachment and affect-reciprocal emotional problem solving scenarios based upon following the child's natural intent or lead. This is in direct contrast with all due respect to the embarrassingly antiquated and remarkably impoverished six decades of applied behavioral analysis and its close pharyngeal and laryngeal kissing cousin,"Verbal behavior." Although different philosophical contingencies of re-enforcement are employed by the latter, both equally regard the nature of the child's acquisition of language in behavioral practice as type of mechanical Morse code, that is, of accumulating labels (productive syntax in terms of empty signifers) for objects and desires; repetitive drilling, from emerging phonemes to referential-object labels - and in the process perfectly satisfied to ignore the core essentials that allow for the child's vocal system and communication to pre-verbally and meaningfully sustain a rich foundation that naturally enables the alignment of nouns and verbs, adjectives and modifiers in a pragmatically meaningful rather than robotic fashion.
The Deepening of Secure Attachment, the Basic Building Blocks of Life and Emotional Intelligence
The core essentials of this social dyadic process involves co-creating safe and secure attached relationships from the child's perspective with regards to what presents as the child's affect-sensory motor processing challenges that interferes with simple pleasurably connecting with others and thus generates feelings of insecurity and instability. Unfortunately, and often tragically, the practitioner and primary caregiver frequently interprets affect sensory motor based challenges as a "lack of compliance" by the child, i.e., non-compliant aberrant behaviors that need reining in - and thus this clinically misguided view generates even more existential distance and feelings of insecurity and instability from the child's perspective. Secondly, once dyadic feelings of safety and security are more solidly established, between parent and child, et al,
an expansive emphasis on emotional-problem solving with the use of simple to complex nuanced affect facial and bodily gesturing (e.g., pointing, nodding, smiling grimacing around meaningful simple social problem interactions from the child's perspective) helps develop the necessary [social] foundation, the precursors that are necessary for emergent and meaningful and pragmatic language/ communication usage. This is the opposite of robotic task compliance or mechanical verbal imitation and object labeling. From a behavioral perspective, the basic language acquisition and "functional thinking skills" are essentially viewed as learned cognitive-behavioral compliance to an isolated or a highly selective series of rote tasks.
In contrast, affect-developmental two-way emotional problem solving dyadic constructs between the child and primary caregivers begin with simple social-empathic scenarios that cultivate the child's natural intent/curiosity and encourage his/her basic spontaneous thinking, relating and communicating with others. As a Developmental rule, this begins by the caregiver or practitioner (and peers) becoming deeply interested in the objects the child is interested in. However, after object relations attachment is strengthened, two-way emotional problem solving begins. For example, those objects slowly, playfully and magically become "stuck" or "missing" by the adult (i.e., the adult takes the "lead") and thus begins to arise developmental challenges for the child. These Developmental or "social challenges" (i.e., co-constructed between primary caregiver and child) are in the context of deeply and attentively following what is of interest to the child, his/her natural intent or lead and wooing the child into pleasurable but emotionally challenging scenarios by primary caregivers, therapists and educators craftily struggling, empathizing and playing dumb.
This above simple but nuanced process encourages the child's healthy emerging autonomy and as a critical core indicator of the child's developing sense of "self-with-other" we find what emerges is the child's ability to incidentally stay longer within back-and-forth simple to complex co-affective signaling [dyadic emotional regulated interactions]. In traditional educational terms this is defined as "greater frustration tolerance." All of this is gently performed by using a Developmental-psychological foundation of empathically guiding primary caregivers to watch, wait, listen and feel (i.e., primary caregivers, therapists, et al., are encouraged to slow down and in the process gradually become more empathically attuned to the child's way of viewing and processing the world). As a result, primary caregivers can satisfactorily begin to cultivate an understanding of "the meaning of their child's actions" from their child's perspective!
One main aspect of the forgoing process, "following the child's natural intent or lead" is often erroneously equated with the ABA methodology known as "natural environment", whereby, for example, everything in the child's immediate environment potentially represents (i.e., from a behavioral perspective) a generalization of skills of the child's newly acquired cumulative inventory of "discrete learned tasks." However, this could not be more further from the truth. Developmentally our use of the term "environment" is fundamentally different. The disembowelment of teased out or defined tasks from "meaningful engagement" are never entertained. For example, engagement is neither disrespectfully or ludicrously reduced to a vapid series of "mechanically performed tasks" for deceptive caregiver management and the exegesis of artificial accountability in terms of checklists or emotionally-arrested laundry lists.
What we need to better understand is that all intersubjective actions or social inter-actions impoverished (reductio ad absurdum) to isolated tasks or "things" do not await the meretricious truism of a vapid "scientific labeling" (i.e., antecedent, behavior and consequence) that is frequently presented in a falsely neat and schematized fashion for purposes of promoting and framing minimalistic gains, however bankrupt, but the visceral and purposeful messiness of meaningful engagement which needs to be co-created between primary caregivers and the child in order for the hierarchical order of "things" (or tasks) otherwise extracted, labeled or desired by the child to truly take on "meaning" - or become intersubjectively meaningful! It is thus that the Vygotskyan zone of proximal development or "natural environment" begins to become Developmentally constructed.
Essentially, the organism (child/caregiver dyad) or the internal-external caregiver/child environment with others is an ever changing dialectical and dialogical dynamic, an organic systems based relationship, which cannot be either simplistically conceived or reduced, reductio ad absurdum, e.g., in terms of antecedent, behavior and consequence (or child + genes + environment) but is at once a simultaneous extension and co-creation of ever-changing dyadic intersubjective/co-interacting pairs. Furthermore, and contrary to popular misleading information to many families whose toddler has been recently diagnosed and enter early intervention (or older), what results as meaningful dyadic engagement ensues (i.e., child/caregiver; child/therapist building upon the child's affect) is both "scientifically objectively measurable" in terms of both specific developmental outcomes (developmental milestones) and overall skills.
From a Developmental perspective, we are not concerned with the child blindly complying or robotically following directions on cue but on continuous purposeful and meaningful engagement. Therefore, our focus is on wooing the child to spontaneously stay in simple pleasurable co-regulated to more complex nuanced engagement with others by tapping into the child's expanding curiosity or natural intent (or conversely said, the child's natural intent that is increasingly connected to what are referred to as the executive functions or developing praxis, for example, "I see it, I want it, what do I need to do to go about getting it?) by the child's increasing desire to engage because intersubjectively or non-scripted wise it is comfortable and pleasurable; it is securely self-and-other emotionally soothing/co-regulating - and thus it is meaningful, purposeful and manageable. The focus is on dyadic engagement and co-narrative or joint affect-problem solving in the context of the child's affect-guided interests. The Developmental foundation is what arises in the context of "you-and-me."
One of the cornerstones of a Developmental foundation is "My understanding of your sensory-processing differences and what we co-create together in a meaningful and emotional manner. " This is in direct contrast to, "I will train you, dear child, to do these skills because you lack in receptive understanding/ comprehension because of your autism." In reality, the latter frequently could not be more further removed from the truth (that is, the underlying clinical developmental facts and higher receptive understanding of the child than typically assumed).
What arises in the context of "you and me" (i.e., child and the primary caregivers) is much more clinically significant and meaningful than a focus on the child mechanically learning to comply to adult directed tasks. What we need to continually bear in mind is that thinking, relating and communicating are not simply responses, for, example, "Do this____", "Point to __"__, "Say___") but are carefully coordinated affect-social interactions with others to novel situations. Novel situations involve at each moment an underlying synchrony and coordination of tacitly understood affective or emotional interactions [Praxis].
In fact, the focus on child/caregiver dyadic execution of subtly coordinated affect-social interactions honors and embodies how all children (on and off the spectrum) learn, grow and develop . This serves as the core principle and foundation for strengthening the child's healthy autonomy and as a downstream effect produces all subsequently meaningful developmental pre-school and school skill sets. Here the watch-phrase is not "achievement of targeted behavioral outcomes" (i.e., typically and unconsciously defined as task achievement) but engagement of process where "tasks" are an inseparable part-and-parcel of human emotional interactions, social engagement, and cannot be artificially teased out as it were, but, nonetheless, have always been attempted due to time management and cost-effectiveness by an overwhelming majority of our clinical and school based settings.
In the course of child's desire to naturally engage and the adult's ability to willing meet the child where s/he is results in achieved Developmental milestones (but not as highly selective targets - but as a downstream effects or an extension of the child's increased willingness and desire to engage thus resulting in increased praxis or executive functioning or cortical/subcortical emotional or two-way affective regulation). Therefore, what is achieved is done so in an organic, systemically meaningful and integrated manner (that is, a genuine socially integrated child self-with-others) rather than in a socially compliant but disembodied and robotic fashion - and as "Behavioral thinking" as much as it advances in its many decades of refined and micro-managed techniques cannot phenomenologically escape from and cannot as much as it accomplishes in having the child learn the rules of surface social compliance and stilted but functional speech/language cannot replace with genuine social interaction with other, that is spontaneous affective social engagement and true reflective thought, language and communication.
This Developmental psychological reciprocal process of affect-guided engagement is extraordinary critical as it enables primary caregivers (and other practitioners) to gain more confidence in learning how to more deeply connect and adjust their caregiver/child relationship dynamics (dyadic emotional interactions) and become more sensitively attuned to their infant's, toddler's or older child's underlying individual affect-sensory motor planning strengths and challenges and, crucially, point-of-view or perspective.
One of the main Developmental goals here is to have both practitioners and caregivers gain an increased sensitivity and awareness to the child's bio-psychological social-environmental triggers and attenuation with respect to the child's underlying affect sensory-motor processing strengths and challenges (e.g., proprioceptive, vestibular, tactile, olfactory, auditory, visual-spatial, as mentioned above) and at the same moment to avoid blindly and superficially "re-directing" the child to "look good feel good behaviors" in terms of assessing, habitually re-enforcing and re-analyzing perfectly meaningless tasks (i.e., object-oriented compliant surface behaviors) on command (e.g., "Touch nose", "Show me car", "Give me blue") under the often severely mistaken assumption that the toddler or older is not following directions because if audiological concerns have been ruled out:
A) "S/he doesn't understand what is being asked , that is, 'receptive comprehension deficits' are present because of the child's bio-genetic cognitive deficits due to his or her autism."
They can appear on the surface as core receptive and/or expressive language deficits but frequently are affect-regulatory sensory processing challenges that can give the appearance of much greater language and/or cognitive deficits than in reality actually exist!
B) "Once s/he is able to follow and comply with simple broken down or discrete tasks or instructions s/he will be in a better position to learn."
However, systematizing or breaking down each functional activity to their simplest task component (e.g., forward chaining or backward chaining) to teach the "developmentally challenged child" may appear as straightforward and logical but in reality this is only one infinitesimal slice of the clinical picture and could not be more further removed from the wider and heterogeneous developmental clinical purview of how all human - and non-human primates utilizing all their senses (auditory, tactile, visual-spatial, olfactory, vestibular, proprioceptive) and deepening internalization (emergence of self and use of ideas or symbols) in the context of developing nuanced affect co-regulation (social communication) with others learn, grow, develop and thrive.
Learning (social-emotional intelligence) is clearly not a series of clear, delimited, precise, distilled, mechanical and meaningless instructions (e.g., an accumulated inventory of "things") but of caregiver/child or therapist/child deepening attachment and deepening pleasurable reciprocal affective engagement around the child's typical or atypical interests which is the basis of all preverbal, verbal, symbolic and higher critical thinking skills. The former, antiquated primitive view of learning in behavioral based therapies typically begins with ABA/discrete trial training.
Rather, we need to learn to Developmentally identify and better empathically understand how each child's very different (heterogeneous) processing strengths and challenges interpenetrate intrapersonally and interpersonally, that is to say, how background biological challenges-and-foreground affect-sensory motor based challenges cortically and subcortically, organismically and intersubjectively come together with others from a systems theory perspective (e.g., a unique caregiver/child organically connected and affect reciprocal psychological-biological-social relationship dynamics). This approach serves to intelligently and meaningfully set up a discursive foundation for what empirically constitutes a genuine Developmental model and treatment approach for families of infants, toddlers and older with complex neurodevelopmental disorders, such as ASD.
The above sharply differs from the more traditional common school based approaches, such as intentionally (or more habitually out of generations of learned behaviors) assessing the child (or older) in reductionist terms, for example, as an unruly bundle of aberrant behaviors, where the raison d'etre of some six decades of behavioral applied theory, which can at first glance seem to be the child's impressive inventoried acquisition of new skills and an elimination of some "undesirable behaviors" but too often in reality is a remarkably stilted or robotic assembly-line production of exchanging one set of surface responses for another (i.e., adult-directed command performance based routines completely divorced from the child's natural intent or affect guided child/caregiver dyad) and thus quite effectively failing to result in both clinically significant and clinically meaningful affect-sensory motor, emotional, cognitive and social language gains.
We often find largely due to many decades of deeply rooted institutional practices that focus on isolated or selective skills and standardized test score achievement rather than intersubjective process and reflection a profoundly non-developmental thinking and mechanical emphases placed on the external acquisition of itemized (checklist) skills. Alarmingly, this is a common emphasis among many traditional special educators, applied behavioral analysts and cognitive behavioral school psychologists. We often find a uniform consensus or "group-think" that is particularly fond at targeting and changing the child's surface behaviors, so the child will begin to "look good", less a classroom behavioral-management problem as s/he more rapidly complies with arbitrary non-developmental rules (e.g., child attending more compliantly or quietly irrespective of what is happening internally or inter-dynamically) rather than practitioners and primary caregivers attempting to effect a more solid, deeper and foundation of meaningful Development and integration by attempting to gain, much more comprehensively, an understanding the child's underlying core sensory processing challenges in confluence
(or incongruous) with primary caregiver affect dynamics. Whereas, the latter begins to humanely integrate and realistically incorporate a Developmental-psychological understanding, which includes fostering simple secure child/caregiver dyadic attachment to more complex two-way emotional signaling and meaningful representational ideas/symbols, the former, behavioral reductionist thinking, unfortunately, cannot be considered a viable and comprehensive alternative to a genuine Developmental based approach. We should regard it as a quite wanting or insufficient "neurotypical" attitude and stance of what is commonly attributed as representative of one that is in possession of "Theory of mind."
A Developmental understanding dramatically differs from the latter circumscribed rote educable focus or "behavioral-task based approaches", which often is unfortunately adjoined to the commonly misleading phrase, "ABA the only scientifically proven evidence based approach for the treatment of autism spectrum disorders." Significant numbers of traditional practitioners who have advocated behaviorally or task oriented approaches during the last six decades have had the tendency to either summarily dismiss or minimize the child's unique underlying sensory processing differences, or more recently (last decade) having positively admitted their existence still have an unfortunate tendency to uniformly and reductionistically interpret them in a primitive and puerile manner.
Thus enter, for example, the common early intervention and classroom vernacular of
"task completion versus task avoidance";"compliance versus non-compliance" or functional/adaptive versus non-functional /non-adaptive with respect to the child's receptive and expressive language, cognitive and social adaptive skills. Applied behavioral based thinking tends to blindly circumvent the necessary practice of secure child/caregiver and child/clinician dyadic attachment which would lead to a foundation that begins to integrate skills in a natural way. This typically includes a majority of practitioners who focus on repetitively training/drilling a child's non-compliant surface behavioral responses or non-adaptive behaviors to robotically respond on point and cue to comply to adult commands.
We should welcome a type of cognitive dissonance here that has gained traction in the field over the last decade. For example, many practitioners now willing to admit the "reality of the child's sensory processing challenges" that negatively impacts normative functioning but nonetheless at the same moment having the compulsion to stay with or revert back to designing protocols that are geared towards finding more suitable surface replacement behaviors. The latter sharply differs from a Developmental psychological perspective, which welcomes, examines, explores, entertains, respects and fully admits the reality of the child's emerging "self" not reducible to sets of behaviors and thus proactively seeks a functional-emotional social integrated understanding and is not seeking to replace admittedly or unadmittedly (with all due respect) one set of monkey-see, monkey-do performance behaviors with another but fundamentally attributes an impact of and demands in-depth reflection on the psychology of internalized meaning of the world from the child's perspective. For example, not just a focus on itemized, abstracted and "externalized behaviors" but the adult performers following/joining in; deepening dyadic attachment around the child's non-injurious behaviors and thus in the process extending meaningful dyadic emotional engagement resulting towards dynamic and organic integration, i.e., from spontaneous pragmatic language to nuanced symbolic sequencing and higher critical thinking). Nevertheless, it is a much welcomed improvement over previous decades of universal denial.
Although behaviorally oriented approaches that are often used with toddlers and older on the spectrum are understandably appealing to many families entering early intervention and the number one preferred choice (largely economically/politically driven) by public education and private schooling, with the perfectly understandable universal desire for the child to become indistinguishable from his/her peers as quickly and seamlessly as possible, it is in fact, gravely and emotionally-developmentally arrested, as the very core issues, secure dyadic attachment and deepening co-regulated emotional signaling leading towards greater spontaneous and nuanced symbolization and meaningful (not scripted) language are not adequately, if at all, addressed. In reality, to effect the latter would require not just a technical change of format but a revolutionary (Developmental) way of thinking that targets education not in terms of improved individualized test scores or surface based homogeneity (i.e., child mechanically following routines of his/her peers) but the cultivation of increasingly conscious and empathic small based communities where individualized differences and needs are fully Developmentally understood and respected.
The above would involve a widespread global commitment towards the continuing education and exploration of what constitutes healthy family dynamics, such as the understanding that both typical and non-typical development can only be understood in the context of healthy caregiver/child nurturance based dynamics; understanding how individual differences (i.e., each child's functional-emotional developmental levels and heterogeneous sensory processing strengths and challenges) creates different ways of seeing, describing and interacting with the world (that first and foremost must be empathically understood and developmentally respected); and a general commitment to educate each child from birth towards deeper critical compassionate, intuitive and empathic thinking and communicating. Although this might appear idealistic, it is not, or any longer, so much an option as much as a dire necessity.
Unfortunately, the general educational/therapeutic focus throughout clinical practice is still targeted towards the remediation of deficits rather than the understanding of differences, or the selective extraction and de-construction of the child's inappropriate or non-compliant behaviors with the overall goal to tame or "transform" the child's (or older) aberrant impulses to become task obedient (or task compliant). The widely held assumption here is that the child's poorly acquired learning habits (i.e., subcortical or primitive aberrant impulses driven by neurophysiological compromises) once re-trained to follow context-specific bound or simple referential tasks his/her generalization should thereafter follow and during this pivotal behavioral re-conditioning process the child's cognitive, language and adaptive skills should continue to expand.
Essentially, this antiquated mid-twentieth successful Behavioral thinking where the child's emerging novel sense of self is superfluous or individual differences are arbitrary (e.g., breaking down mechanical tasks to their simplest component for child's comprehension and rebuilding towards more child general comprehension) continues to be a grave misunderstanding applied to the systemic or deeper core deficits in autism spectrum and related neurodevelopmental challenges. A core Developmental approach must resoundingly not involve repetitively drilling the child with a set of a priori or arbitrary tasks (e.g., imposing the artifice of hierarchical task data driven protocols) but comprehensively address the child's underlying heterogeneous caregiver/child dyadic emotional signaling challenges with respect to the child's two-way pleasurable relating, communicating and engaging. For example, from simple pleasurable joint attention to increase used of reciprocal affect gestures adjoined to emerging utterances and higher symbolic thinking and reasoning between ideas.
A developmental understanding of two-way attachment and deepening engagement significantly involves an understanding of the fight or flight or all or nothing responses of the individual child (e.g., the limbic system and high hormonal stress response) and the regulatory functions of the prefrontal cortex or executive planning functions as mentioned (e.g., Ideation, "I want it"; Motor-planning, "How am I going to get it" and Execution "bringing it all together" with others). This necessitates an approach of a deeper intuitive understanding, specifically of joining with, focusing on and facilitating of the child's underlying clinically significant and clinically meaningful engagement processing challenges in a subordinate and superordinate systems theory oriented rather than mechanical splintered task based approach.
In reality, the emphasis on transforming or re-training the child's surface or maladjusted behaviors often serves to dissuade families and clinicians from a deeper appreciation and understanding of the child's otherwise greater and much more evident and natural emotional intelligence. Often and significantly it is not the child's lack of emotional intelligence or greater understanding (e.g., receptive comprehension) but our own adult conditioned and systemic blindness to meet the child (or older) where s/he is. To impute meaning to the child's (or older) current intentionality rather than to revert to simple or puerile labeling of the child as "compliant or non-compliant" in the polarized educable fashion (antiquated educational task- and behavioral methodologies) is absolutely critical to the child's sense of healthy emerging self and his/her functional emotional developmental milestones. What for many who fail to understand the crucial role of deepening of dyadic attachment around the child's (or older) current intentionality, and how dyadic back and forth emotional problem solving guides development is that compliance to task (i.e., the ability for the child to follow commands on cue) profoundly does not address the child's deeper receptive understanding and ability to meaningfully engage.
In fact, once a child is trained to follow commands on cue that child more often than not has taken steps away from the ability to spontaneously engage with affect and meaning, that is, his/her ability to naturally begin to organize his sensory motor planning and engagement or praxis with others, from genuine deepening of emotional attachment to shared emotional co-signaling or social reciprocity with others. Often all the child has learned to do is to be differently organized in his scripted or mechanical responses but has not begun to truly become spontaneously organized and more integrated in terms of his underlying core challenges, which strongly involves the child's preverbal understanding of his intentionality with others and the subtle diversity of emotional nuances (e.g., reading affect facial gestural cues and prosody or inflection of voice with others in order to facilitate back and forth meaningful emotional co-regulated exchanges). It is this conundrum, blindness, or combination thereof, that behaviorists, especially when using, for example, discrete trials, have entirely overlooked or simply not understood.
A more empathic and developmental-psychological focus on the "less redirecting" and the "more affective" (emotional) attunement to the child's unique affect sensory motor processing differences consistently begins to cultivate clinically significant and clinically meaningful processes of both deepening attachment-and- dyadic functional emotional circles of pragmatic language/communication. Primary caregivers and clinicians, and even the typical child's peers, once guided to slow down and learn how to attune themselves to the child's natural affect or intent, in turn, begins to meaningfully build the underlying and the necessary emotional-developmental foundations (or milestones) for the child's receptive and expressive language, social and cognitive skills, that is, in a clinically meaningful and integrated manner. This is quite different than having the child produce seemingly "productive" but mostly mechanically contrived cognitive and expressive syntactical strings of surface memorized or programmed stereotypical or robotic type responses to adult commands, as are traditionally found in applied behavioral or task oriented approaches.
Any clinically significant and clinically meaningful focus on the deepening of dyadic emotionally guided circles of engagement between child and primary caregivers demands primary caregivers and clinicians co-creating emotional-developmental bridges of pleasurably based interactions around what represents the current interests of the child.
Now, the past three and half decades long clinical behavioral treatment claimed successes, however clearly non-developmental behavioral task based methodologies, for the treatment of toddlers, children and adolescents with complex neurodevelopmental disorders, such as Applied behavioral analysis, utilize the principles of operant conditioning with schedules of re-enforced social-environmental contingencies. Initially, this begins by clinicians performing a functional behavioral assessment (FBA) on the child's current daily routines or behaviors. Essentially, the child's "surface behaviors" are isolated or decoupled from their underlying child/primary caregiver relationship based foundations. This is done into three seemingly simple, straightforward and noncontroversial components: Antecedent (i.e., what causes or leads to the child's current behaviors), the Behaviors themselves (i.e., what challenging behaviors is the child currently demonstrating) and Consequences (i.e, what present benefit does the child receive as a result of his/her expressive behaviors and how are they either being positively or negatively re-enforced).
Once clinicians gain a sufficient understanding (e.g., data collection of the child's surface problem behaviors but not necessarily a comprehensive systems theory and clinically meaningful perspective with respect to the child's underlying processing challenges), they attempt to modify or redirect the child's aberrant or unacceptable behaviors (by appropriately increasing or decreasing the antecedent driven problem behaviors) to what are considered socially acceptable on task performance. While the surface can be modified the underlying core (praxis) challenges or the soul of a child cannot. This is often gravely done at the expense of ignoring the child's larger clinical comprehensive developmental picture, which always entails functional-emotional and neurophysiological multi-systemic and interpenetrating factors, including family dynamics. We must, without exception, always attempt to understand (in both typical and non-typical development) not just what the child (or older) is capable of evincing on the surface (e.g., to satisfy generic school behavioral checklist protocols), but the child's biological and underlying constitutional heterogeneous differences, which developmentally speaking entails each child's affect sensory motor processing strengths and challenges; pre-lingusistic or non-verbal levels of affect engagement during simple (joint attention) to complex (symbolic to critical thinking) communication and healthy and attuned or dysfunctional and compromised primary caregiver/child relationship patterns.
Typically, beginning with discrete trial training (DTT), clinicians behaviorally condition
children through a selectively scripted series of re-enforced or repetitive adult directed commands to comply on cue in an automaton-like fashion to social, cognitive, behavioral and language discrete tasks (isolated skills). Upon successful completion of the aforesaid executed functional task or mand (request) typically given in a 1:1 by the adult to the child (e.g., touch nose, touch circle, give cookie, show me red, etc.) the toddler receives an externally desired object accompanied by verbal praise (i.e., a "positive re-enforcer" such as a desired candy or toy combined with a verbally positive re-enforced and drone-like response from the adult clinician/presenter of "good job."). Any deviation from the re-enforced task being taught (shaped/re-enforced) is often strategically (blankly) ignored by clinicians as an "off-task behavior" (this includes, affect sensory-motor processing based challenges often clinically mistakenly and pejoratively referred to as "non-functional repetitive behaviors" or stims). Naturally, the latter, so-called, non-functional ("negative behaviors") are frowned upon and the so-called positive or "socially acceptable behaviors" (essentially, robotic-like compliance to emotionless or meaningless tasks) are positively re-enforced.
Now, once the child begins to acquire sets of positively learn discrete (isolated or easily broken down and digestible) functional task behaviors then the child (all are led to believe) is in a "better position" to begin to learn how to generalize his/her new functional behavioral acquired skills (i.e., newly learned surface memorized responses) into newly transferred surface memorized functional daily living skills and social routines. S/he will have, if you will, mastered the "new steps" required (analogous perhaps to how a traditional school child learns to begin to play an instrument by rote, stern point and drill, minus of course the child with particular fancy or predilection for jazz). Thank God that the typical developing infant and toddler does not require an encyclopedia (e.g., an empiricist stimulus-response training manual along the lines of circle the letters and memorize the dots) with respect to affect preverbal or complex emotional signaling; but it is precisely this "non-developmental applied reasoning" that is egregiously just-so applied to children or older on the spectrum under the following common rationale:
1) Their so-called lack of receptive responsivity or "understanding" (narcissistically mind you, the child's not ours) and 2) The heretofore beyond dispute the so-called "only scientifically proven or evidence-based methodology, for the treatment of children with ASD", Applied behavioral Analysis.
It is clinical distortive and empathically misguided reasoning (an unforgivable neurodevelopmental and intuitive error) to assume that since many children across the spectrum appear that their emotional intelligence is moderately or severely curtailed or impaired that they, therefore, need to learn step by step the operant conditioning behavioral rules on better ways of maximizing task performance, that is to begin by digesting the appropriate modicum of adult carefully controlled and re-enforced environmental social contingencies to achieve functional task competency, somewhat analogous to the primary caregiver taking a piece of food for an infant/toddler and breaking it down into bits and pieces for greater ediblity (i.e., here unconsciously transferred or directly analogous to cognitive complex task to simple task assimilation) or maximum mental digestibility or "receptive cognitive understanding."
This passionate analogy which is often tacitly, seamlessly and effortlessly applied
(without much prethought or forethought to toddlers and older on the spectrum) is
entirely and resoundingly clinically wrong; that is, except as a minor tool that on occasion can without any question clinically be useful (i.e., when the child has no functionally minimal awareness of "other" or practical boundaries between self-and-other and severe self or other injury accompanies most actions). However, many behavioral analysts (whether it is of the applied behavioral or cognitive behavioral management variety) would like to convince others (by often exploiting the logic of the unimaginative and the emotionally frightened), that the one tool, ipso facto, ABA (or CBM) represents the entire tool chest. But it is precisely this kind of hoax (or fragmented truth with excessive regard to aspects of surface behaviors dominated by an over-zealous and blinded vision and accompanied by psychotropics as needed) that is perpetuated under the banner of the "Only scientifically proven methodology for the treatment of children with autism."
The so-called "learning" here and antiquated learning theory (1920's-1960's) that drives it, equates learning and moreover egregiously equates Development with surface or rote memorization.which is not only an insult to the child but to his or her greater emotional intelligence and humanity in general and even, if you will, B.F. Skinner's subsequent rat descendents to date. It does not take into account praxis or the child's natural emotional intelligence, let alone the admittance of a "self" apart from environmentally learned contingencies (i.e., a formula asserted here would be something like, self = subset of or reduction to environmentally learned behaviors, anything else is affectionately or fondly regarded by many as a la carte , that is as qualitatively interesting but empirically superfluous).
(In the above, who the toddler or older child is, how s/he feels; how s/he relates - that is from his/her perspective experiences the world; what is the nature of functional-emotional, developmental psychological and pre-representational or symbolic meaning, etc., is of little or no consequence to many practitioners in the field, that is to say, as long as the toddler learns how to acquire the look/see/do rote preschool readiness skills, which are in more cases than not almost entirely non-developmental as they are operating on a uniform or largely one-size fits all mechanical based mentality and thus fail to address, primarily due to a lack of comprehensive developmental orientation, the toddler's or older affect preverbal developmental milestones, affect sensory motor processing challenges and caregiver relationship dyadic patterns of interactions.)
It is thus the child begins to "learn", that is, according to applied behavioral analysts and cognitive behavioral psychologists 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 (e.g., what causes a particular behavior, or the antecedent; the behavior itself; and the consequence of the behavior) are properly determined and subsequently re-enforced schedules towards more desirable behaviors are properly implemented this is said to consistently result in empirical or scientifically proven and measurable reductions of inappropriate behaviors and measurable positive increases in on-schedule and on-task performances. For toddlers who have been diagnosed or suspected of falling in the autism spectrum range, early intervention typically begins with the data protocol and operant conditioning methodology known as discrete trial training (DTT).
*Applied behavioral analysis methodologies (beginning with discrete trial but much improved with pivotal response training) focus on the primitive and reductionistic analysis of the child's functional ability to comply with selective tasks, whereas the neuroanatomical foundations of affect-regulation or the child's individuated emotional differences that actually constitutes the healthy biological-psychological and social dynamics, i.e., Developmental milestones, are artificially separated from tasks and plays no role except as a utilitarian monkey-see monkey-do function for purposes of child-compliance and/or to adult-control.
For example, adult repetitive drilling of the child to 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" despite the abundant neuroscientific support for developmental relationship based approaches (which are beginning to clinically reveal greater heterogeneous neuronal pathway integration). The focus is predominantly on the child completing adult-managed and affect or emotionally detached object-oriented tasks rather than caregiver/child dyadic affect pleasurable joint attention to reflective and critical 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 synchronization with his/her affect sensory motor processing strengths and challenges, that is, in affect-guided social relationship based child/caregiver interactions, as opposed to a focus on, shall we say, the (adult clinician/suppressed mirror-neuron) more "predictable" and less messy selective rote outcomes (i.e.,"Touch nose", "Give me ball", "Say, ball", "Point to red", "Good Job!", etc.).
What is fascinating from a historical developmental psychological perspective is
that the socially conditioned perceived or equated with messiness of working with "feelings" (or the emotions) across many disciplines and by many generations, which in empirical truth constitutes the basis of all spontaneous reciprocal child/caregiver relationship based interactions and meaningful pragmatic language emergence (beginning in preverbal emotional signaling in human as well as non-human primate infancy, a smile begets a smile, a frown, a frown, a widening of eyes, etc.) cannot be neatly accounted for, or, shall we risk saying, at the extreme discomfort and inconvenience of providing organic and non-mechanical (systems dynamic theory) protocols.
It is thus feelings (or the emotions) that coordinates and guides functioning, from the simple to more complex functional-emotional developmental milestones (e.g., from meaningful attachment/joint attention, to symbolic play; emergence of pragmatic language and higher critical thinking skills), are either put entirely to the curb or given secondary stature at best by many behaviorists. This neurodevelopmentally corresponds into, or translates into practice, the toddler or older (who has not importantly acquired the crucial long chains of preverbal emotional signaling that is required for healthy developmental integration,which includes symbolic thinking and the emergence of true inflected and reflected upon language), instead acquiring a foundation of re-directed surface memorized responses . The child re-directed surface memorized responses are alarmingly held hostage (removed from internalized meaning or) 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/PrizantIsABAtheOnlyWay Spring09.pdf
What all educators and therapists need to developmentally have at their fingertips as the basic guiding 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 a few colleagues, the child acquiring a uniform set of emotionless tasks by way of the teachers' and therapists' admonition and exploitation of the families' underlying fears, for instance:
"Dear parents: One of the primary missions that we have is to help you educate yourselves on teaching your child the necessary routines to be prepared to enter and able engage in preschool readiness skills, when s/he turns three years old!"
If this wasn't the standard line/dissemination by special educators to parents in Early Intervention whose toddler (often on the spectrum) is not even able to engage in simple spontaneous affect meaningful back and forth interactions and thus simple praxis without selective drill and prompt to task and where DEVELOPMENT and not "pre-school readiness skills" (even with typical developing toddlers) needs to lead, it would indeed be amusing, a bit parody, instead it is criminal.
Specifically, what we are focused on both from an historical Developmental systems theory perspective and one that is fully supported in numerous areas of neuroscientific research over the last several 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 (e.g., emotional-developmental differences, underlying sensory-processing differences and caregiver/child dyadic relationship patterns) 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.
Using a developmental approach and following the child's lead, 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 in any sense 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 reactionary labeling or 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 (i.e., 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 (these new memories) 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 in the foregoing 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 exclusively focused on addressing the child's emerging sense of healthy autonomy, which can only proceed upon a nurturance based foundation and child/caregiver practice, which developmentally-and-psychologically 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!", "T-h-ere?! 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 by the latter is psychodynamically framing the child's actions (i.e., imputing emotional meaning/conveying existential validity) in a way that is meaningful to him/her . That is to say, in a manner that is connected to the child's 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 define, in an affective manner, as the zone of proximal development]
None of the foregoing generally involves the emotionally detached behavioral and traditional closed-ended system of attempts to assume the role of an objective (intersubjectively divorced) adult behavioral data collector technician and child subject with the methodological flaws of standing apart and identifying, framing and predicting a highly schematized or a priori set of noun defined precipitating factors (i.e., the antecedents of the child's behaviors) and the manipulation toward more desired (highly 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 affective desires or intent and increasing curiosity to form relationships with others, and the categorization of doing things, i.e. tasks follows like a ball bouncing and swirling down streams flow, not the other way around!)
In neurodevelopmental challenges such as autism spectrum disorders and related developmental challenges the so-called "off-task" typical behaviors can be re-connected (i.e., 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. The latter is not done so by a hierarchical set of performance based tasks (e.g., "Do A then B , say A then B, touch A then B, 'Good job'! Now, proceed to C", etc.) which misses the heart and essence of emotional engagement and praxis entirely (i.e., ideation, motor-planning and execution) which largely necessitates the child feeling centered and comfortable in his/her own skin while engaging with others.
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). One of the major challenges is that so many behaviorists are so enthused or 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 (and 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 meeting the child in his/her world or two-way emotional engagement is the primary engaged activity that begins to spontaneously integrate different processing area strengths and challenges; the core foundation of integrated and meaningful praxis and the essence of the 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 abstracted or optional downstream effects that simultaneously develop alongside or in conjunction with a deepening primary attachment based foundation. The latter varies from child to child depending upon what affect-sensory based challenges are present and the necessary redirected recognition (i.e., empathic-cognition) from primary caregivers and clinicians with respect to synchronicity with (or attuned with) the child's differences, which then begins, in turn, to form the deeper foundations of two-way reciprocal affective engagement.
Nonetheless, the child who is moderately on the spectrum is often deplorably and stereotypically viewed with respect to systemic deficits of basic engagement that mistakenly confers a general lower emotional intelligence (e.g., historically interpreted by the child's ability to comply or failure to comply with primitive robotic yes/no commands). This essentially translates in practice by training the child to pay attention to largely boring and meaningless tasks which is the height of idiocy and in reality insults everyone's emotional intelligence from toddler to adult, from neurotypical to neurodiversified.
This done by not knowing how to approach misconceived receptive understanding due to lack of attention but understanding underlying affect-sensory motor processing challenges the necessity of how to connect with the child's the preverbal levels of engagement, which forms the basis of development and engagement. from simple to complex ideation; from fixed representation to flexible symbolic usage and the emergence of pragmatic language usage. It is believed that some of the core deficits (non-developmentally interpreted as pay attention and complying on command) can only 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 and somatically 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 click and point "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 either necessarily 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 "reasoning" and "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 after years of having worked with many therapists, educators and families is that the shortcomings might not only be the nature of the toddler/child's current deficits with respect to establishing, for example, joint-attention and reciprocity and other more complex functional forms of engagement but our own. This entails discovering our own abilities, our own capacities, or developing our own capacities in learning how to slow down and find the means of deepening attachment and engagement by understanding, honoring, respecting the child's 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 and Developmentally where functional emotional milestones are transformed through affective reciprocity in dyadic pairs (preverbal-and-verbal co-narrative transformation) and have corresponding system dynamic neurophyiological 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
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
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 child's 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."
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.