Photo: Michal Parzuchowski

Occupational therapist Maude Le Roux returns this week to discuss how regulation changes across the functional emotional developmental capacities in the Developmental, Individual differences, Relationship-based (DIR) Model. Maude runs A Total Approach clinic in Glen Mills, PA, runs the Maude Le Roux Academy where professionals and parents can take courses and watch webinars, and writes a fantastic blog called Maude’s Children’s Corner. She also is a trainer with the Interdisciplinary Council on Development and Learning (ICDL), among many other credentials.

Dr. Gil Tippy refers to Foundation Academics as the early social-emotional developmental capacities that neurotypical children typically achieve before they start school. Many of our children with developmental differences struggle mastering these early capacities due to their biology and struggle with the very first capacity, Self-regulation and Interest in the World where we want our children to be calm enough to focus and be able to learn. Maude talks about how struggles with self-regulation can look very different depending on the developmental stage your child is at.

Co-Regulation in terms of Modulation

Most of us understand self-regulation at the first capacity as how a child’s sensory processing system is adapting to the world around them. We see some kids covering their ears when sounds are too much for them, and the child who can’t sit still and always needs to move. The sensory system is driving the arousal level which can be under- or over-aroused.

The Relationship with the primary caregiver is what helps to set up the co-regulation. In the DIR Model, Greenspan talked about co-regulation emotionally. In the Occupational Therapy world, Maude talks about co-regulation in terms of modulation. The modulation piece is about the sensory trigger, Maude says, while the co-regulation piece is about the emotional trigger, but they overlap and interrelate at the first capacity. 

Is this child able to have a balanced response between his vestibular system and his proprioceptive system, or between his auditory system and his proprioceptive system? The different sensory systems have to come into balance so the child can stay in a regulated state. If a child is listening to a teacher, they have to keep their body in their seat, hold a pencil in their hand so they can write, all while watching to see what she’s teaching while hearing what she’s saying so that while all this sensory information is coming in, a balance is maintained. This is the modulation piece of arousal.

Sensory Integration is the Foundation

The regulatory piece, our first level, sets up our sensory adaptive response. From there as a baby we start to notice cycles such as the nutrition cycle where mommy feeds me then she goes, then she comes back and feeds me, then she goes, etc. Then we notice the sleep-wake cycle. I sleep then I’m awake. The cycle starts to put a rhythm on top of the regulation of the soothing mechanism between me and mommy, and these become intertwined.

As you continue through the process of adding more skill during this first year of life, the sensory system and emotional regulation are developing, building a reciprocity of a continual safe and secure relationship. This sets the foundation for getting the system in gear in order to register information in a regulated way from both the relationship–the emotional co-regulation–and the sensory adaptive response from the sensory modulation piece. 

Once these systems are in place where the body can use them, you have the capacity to build skill. Next we develop our visual space and audio space as we move and put our motor system together, and then the cognitive pieces and language begins to come. It’s all part of the integration.

Building skills is impacted by the foundation

So many of our kids have skills without the foundation. Your Individual differences can constrict your capacity for Intentionality and Two-Way Communication (FEDC 3) and Complex communication and Shared problem-solving (FEDC 4). This is especially true for visual-spatial skills which can easily be overlooked. If a child is using vision to compensate for another weaker sense, then they are using vision in a constricted way and developing vision in a constricted way.

As you build these skills, you also start to get ready for Executive Skill: Once you have the sensory pieces in place, how do you regulate that skill in order to pay attention? How do you take that into attentive regulation? How do I know in my body how long 5 or 30 minutes is? Many of our kids get very anxious when they can’t really understand what is next because they don’t understand the span of time. The child is not regulated in terms of the time piece which later impacts pacing your child through a test.

Regulation at each stage

FEDC 1: Self-regulation and interest in the world At this first stage in the DIR Model, or level 1, the child is a victim of their senses. The child cannot handle more than one sensory system at a time and tends to have very short spans of attention. The system overtakes the moment. The child MUST respond to that system when they cannot attend.

FEDC 2: Engagement and Relating At this second stage in the DIR Model, or level 2, we see longer spans of engagement and joint attention, being in an enjoyed moment together. This is reliant on the automaticity of how the sensory systems are coming together. This is still a part of the sensory regulation piece.

FEDC 3: Intentionality and Two-Way Communication It’s only when you get into level 3 where you get into the Timing Regulation piece and focus on reciprocity. I speak, you listen. You speak, I listen. There is simple problem solving of 3 to 5 circles of communication. The rhythm and timing is still being set up, so there’s still bracketed circles of communication.

FEDC 4: Complex communication and shared problem solving Then when you get into level 4 and you get 60 circles of communication, the ideas are beginning to flow. You begin to see visual-spatial structure of building a story with a beginning, a middle, and an end. You can start to entertain Theory of Mind and it comes together as the timing comes together.

Impulsivity is often link to timing, Maude says. I can’t wait because I don’t get time. If I don’t tell you this RIGHT NOW it will leave my mind. I gave Maude the example of how my son asks over and over again during every car ride when we get to a red light or stop sign, “Why did we stop?” I reply, “Red light.” He gets anxious and says emphatically, “I wanna go!” over and over. It’s different than it was at the first capacity. It has a different origin or place of being, Maude says. This is related to his sense of timing which hasn’t developed yet.

The triggers and behaviours are different, Maude says, but we will always be working on sensory for life. My son is thinking of the goal where he wants to be: the car will get him from point A to point B. At the stop he has to fill the space of waiting which he can’t fill when he can’t pace himself. Then he shows hyperarousal, which looks the same as he did at level 1, the first capacity. So he tries to find support in his sensory system to cope with waiting.

We use our sensory systems to cope with our own fatigue, for instance, if we only have four hours of sleep. We will always seek support in our regulatory system. What we need to focus on is whether the behaviour is for the sake of sensory, for the sake of attention, or something else, etc.

FEDC 5: Emotional ideas The fifth stage in the DIR Model, or level 5, bridges between level 4 and 6, so in effect is a transition between Timing Regulation and Executive Regulation.

FEDC 6: Logical thinking and building bridges between ideas At this sixth stage in the DIR Model, or level 6, the child is building the capacity to pace himself through an attentive activity. This is about Attention Regulation where we are learning to put a certain timing to a microscopic level more quickly. We require regulation between systems where we have to put language together with emotion, together with cognitive logic, problem-solving ability, etc. This is all a higher level of integration.

Handling regulation challenges at the fourth capacity

When a child is struggling to understand timing at the fourth capacity like my son currently is, Maude suggests using a lot of “First we …” to help de-escalate the anxiety that comes from still working on entertaining sequencing. Sometimes, just giving him a foothold supports the timing process. Saying “First…“, then holding him with affect, anticipation, and other non-verbal cues will help him de-escalate the anxiety.

He’s not asking over and over again because of behaviour; he’s doing it because he can’t comprehend the passage time and doesn’t understand the regulation of time in that moment. Thus, when that happens, he can’t wait. This sense of timing is different than the cognitive sense of time–knowing what day it is, the months of the year, etc. which is different than having a sense of time in the body. The child with timing needs won’t understand what it means when you say “pretty soon” or “only a few more minutes“.

Through the free ICDL-Affect Autism Online Parent Support Drop-in group, a parent told me about how a child had book about how to bathe a cat that involved “Step 1…, Step 2…“. The child absolutely loved this book so they began to apply the “Step 1…, Step 2…” to routines in his life and it worked like a charm! But recall that there is no script in Floortime. What works for one child won’t necessarily work for every kid. It’s always trial and error, but certainly these examples can help give you a starting point.

Behaviour issues I described to Maude some spitting and kicking issues during transitions at school. Maude says this is the same issue. When he has to transition, he can’t engage anymore with what he was doing and he has no idea what the time space is between this activity and the next activity. Once he isn’t paying attention to any physical cues, he loses time. So he digs in my brain and finds something to get himself through to a resolution. He doesn’t know what to do with that space in this time lapse and is searching for that physical cue. It’s hard for us to relate with because we just take it for granted.

I also described the example of when my son is very restless sitting in the shopping cart at Costco. Maude says since he isn’t actively engaged, he is just waiting for me to finish shopping. She suggests that a weighted blanket on his lap might help, or even wearing Soundsory headphones (which should not be worn in the car due to the movement).

Thank you to Maude for taking the time to share her knowledge and experience with us! If you found this blog post and podcast helpful please share it on Facebook and/or Twitter and feel free to post questions, relevant experiences or comments in the Comments section below. 

Until next time… here’s to affecting autism through playful interactions!