See VIDEO BLOG posted on April 18 2017

Podcast with Dr. Gil Tippy, clinical director of the DIR/Floortime® Rebecca School in Manhattan

by Affect Autism

We ended our last blog post talking about how even a child or adult who is higher on the developmental ladder can still retreat to lower levels, just as we do as adults when flustered in heavy traffic, for instance. This week we will delve into this topic a little deeper discussing how in Floortime™, we are always moving up and down the developmental ladder.

We spoke with clinical psychologist Gil Tippy, clinical director of the DIR/Floortime® Rebecca School in Manhattan, and co-author with Dr. Stanley Greenspan of the book Respecting Autism about this topic which you can hear by clicking on the Podcast box above. But first…some background knowledge.

What is the Developmental Ladder?

In DIR/Floortime®, we are focused on helping our children reach their potential by challenging them to move up the developmental ladder. There are six core developmental levels, or Functional Emotional Developmental Capacities (FEDCs), that neurotypical children reach before entering formal academics:

Functional Emotional Developmental Capacities

Using DIR/Floortime® we are encouraging our developmentally delayed children’s brains to make the new connections necessary to reach these capacities. Once children get to the abstract in the higher capacities, they really have the capacity to think, relate and communicate and are well on their way to reaching their potential.

What is Moving Up and Down?

In DIR/Floortime®, we attune ourselves to the child, follow his/her emotional interests, and try to get that shared attention (FEDC 1). If you get that, you work on engagement (FEDC 2). Once you get that, you work for the back-and-forth communication (FEDC 3), and so on, working up the ladder of developmental capacities listed above.

This is moving up the developmental ladder. But what can happen is that we might be moving along nicely when something frustrates or excites the child to the point where we lose engagement and shared attention. We have now moved down the ladder and have to again attune ourselves to the now dysregulated child to co-regulate and get the shared attention back (FEDC 1) before we can move up again.

Now…Highlights From, and Elaboration On, the Podcast with Dr. Gil Tippy

What Guides the DIR/Floortime® Intervention?

As Dr. Tippy says, one of the most important pieces of the DIR/Floortime® intervention is that the practitioner has to have in his/her mind where the child is on the developmental ladder. At each given moment, what guides the intervention is knowing where the child is developmentally, thus a thorough understanding of the functional emotional developmental capacities (FEDCs) is essential.

When the practitioner is attuned enough to the child to be with the child in each moment, at the appropriate developmental level, then (s)he can appropriately challenge the child at the next developmental capacity up the ladder. This is where the art of Floortime™ comes in. Dr. Tippy says this is like driving with your foot on the gas and brake at the same time.

“(A great DIR/Floortime® practitioner is) someone who can walk that line where there’s just enough tension and not too much tension–and that’s the space in which we grow.”

Dr. Gil Tippy

So the goal in the Floortime™ session is to help the child grow without ‘blowing a gasket’ (i.e., becoming dysregulated). We have discussed how the Relationship is a must for trust and being together, but you also must be able to read the child (i.e., attunement)  to know just before the child blows a gasket so you can step back (the ‘brake’).

Attunement: ‘Reading’ the Child

Being attuned to a child means really being ‘in it’ with him or her. It is truly sharing an experience together. It is not only having empathy for the child’s experience. It is not only being able to read the child’s signals. It is not only understanding the child’s individual differences and his/her sensory profile. But it is also, on top of all of these things, adjusting and continually gauging your responses and initiations accordingly.

How Do We Apply Just the Right Tension?

In our podcast, I provided Dr. Tippy with an example of how I play with our son and he can be ‘cooking’ at FEDC 4 as we problem-solve socially together to build a house out of big pillow blocks. But he might begin to get stressed if he tries to balance a flat block on a pointed triangle block and it keeps falling off.

The Tension: This is where we get the tension Dr. Tippy is talking about. I want to keep my son in that place of being challenged while he is frustrated without him giving up and moving on to something else, or getting so frustrated that he becomes dysregulated and “blows a gasket”. I told Dr. Tippy how I would say things like “Oh no… hmm… it’s not working! The block keeps falling off” looking at my son with an understanding on my face of his distress.

The Co-Regulation: This is the co-regulation piece: “offering a slower and lower way of being” as Dr. Tippy said. But he corrected me explaining that if my son does get upset, I wouldn’t expect him to self-regulate; rather, through my support of co-regulating with him he will eventually learn to self-regulate in time.

Knowing When Not To Challenge: Second, I mentioned that I might say to my son, “Hmm… what should we do?” Dr. Tippy explained that this is no longer co-regulating (working at FEDC 1) but is expecting more of a child by challenging the child at a higher level. We would want to hold off on this until we see that the child is ready for us to ‘press the gas’ again.

The Signal to Challenge: I explained that in those moments where my son might ‘lose it’, I notice that he will giggle as he sees that I’m empathizing and ‘in it’ with him, however, I’m not solving the problem for him. It is a mixture of frustration and eager anticipation (because he is so motivated to build this ‘house’) and this is the good tension where I have my signal to ‘press the gas’ again and continue to challenge him.

How Would I Challenge Him?

Play Dumb: I would continue to ‘play dumb’ by saying things like “hmm… the block is not staying on top!” and perhaps turning the block pillow on different angles to get it to stay on, acting frustrated that it would keep falling off. I’d continue to be puzzled and use gestures of “what next?” and “I don’t know!” without saying any words. I would make the noises Dr. Tippy did that acknowledge my son’s disappointment.

Cruise Control: I’d want to keep my son in this place as long as I can (social problem solving at FEDC 4) without him losing interest or getting too frustrated because eventually, my son might try something different or realize that the triangle block won’t hold up another block. We can sit in this spot for months if that’s what it takes…as long as he remains emotionally motivated.

Stay In It: We have to have the resolve to stay in the problem-solving/frustrated mode while he is motivated and not solve it for him. If he can eventually figure it out (in my example, how to get another pillow block to stay on top), this is a great moment of success. If he can’t, we continue to support his efforts and co-regulate his emotional frustration as he tries to figure out how to get what he wants. This promotes thinking, relating, and communicating.

What we want to teach our children through Floortime™:

“When you encounter problems, if you take some time, and you marshal your resources, you can probably solve them.”

Dr. Gil Tippy

Parents Are The Key

Parents are the ones who know their children the best. They can get away with pushing the child more when the child is frustrated more than anyone else can if the relationship is warm, nurturing and safe. The child will be willing to tolerate frustration with you. But many parents mistakenly solve the problem for the child because they can’t tolerate seeing the child frustrated.

Another challenge many parents have is the urge to judge how children play and impose rules during play. But this is problematic for both children who are not yet abstract and those who are. As we discussed last blog, before you’re abstract you cannot understand the consequences of your actions, and you can’t teach kids about abstract rules until they’re abstract. Floortime™ helps kids make that jump into abstraction with loving guidance and support.

For children who are abstract, functioning in capacities 5, 6, or higher, it is essential to allow play without consequences. So it’s OK for kids to have pretend play that is disturbing because it’s symbolic, which helps them not have to actually act everything out in real life. You can discuss consequences after playtime with children at higher capacities to gain insight into what emotions they needed to work through during play that might have been disturbing.

 

In Occupational Therapist and DIR/Floortime trainer, Maude LeRoux’s latest blog about play, she says “Play allows for a world where mistakes can be made and easily forgiven or corrected”…”It is simply easier to work difficult things out in play rather than real life”. She goes on to say that “when a child has missed these essential building blocks in play, it is more difficult for them to consider social nuances in conversation with others”.

“Being deeply connected and being present in the relationship is actually the hardest thing and if you can get out of your way and do that, and be with the person, then you have 99% of the relationship”

Dr. Gil Tippy

Dr. Tippy suggests that parents try to remember what it was like to play as a child. We need to put our adult-ness to the side during Floortime™. He says that joy of being connected to someone else and enjoying their thoughts and their feelings is something we’ve given up as adults, so we want to bring it back up to the surface because it is still there inside of us all.

The Right Way To Teach, The Right Way To Learn

Dr. Tippy says that the big secret about DIR/Floortime® is that it’s not just about folks with neuro-developmental challenges in relating and communicating, it’s for everyone. We always want to be giving children time to think and be slightly bored. “It’s really just good educational practice and good child development” says Dr. Tippy.

By fostering these opportunities to think, we promote development. Development leads to bringing out our child’s highest potential. What we really want for our children is for them to be able to choose the path they want. That is true freedom. DIR/Floortime® helps get them there, because we focus on moving children up the developmental ladder into the abstract.

“Freedom is the ability to choose the path that you want to take.”

Dr. Gil Tippy

Moving up and down the developmental ladder, or ‘driving with your foot on the gas and the brake at the same time’ is a real art and a golden skill. An essential piece of making this happen involves scaffolding: supporting your child while encouraging development. This will be the topic of our next blog in two weeks.

Until next time… here’s to affecting autism!

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