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This week we have Dr. Josh Feder with us from sunny Solana Beach, California where he is a father of a grown autistic son, a child and family psychiatrist using the Developmental, Individual differences, Relationship-based (DIR) model and an Expert DIR Training Leader. He is also a faculty member with both the Interdisciplinary Council on Development and Learning (ICDL), the home of DIR/Floortime, and Profectum, and an adjunct faculty with Fielding Graduate University in the Child and Infant Development PhD program.
Two years ago, a study found that repetition may limit scope in skills in people with autism. However, we know that kids need to repeat activities to learn. This leads to the question of what is good and what is bad repetition? For some answers, let’s listen to Dr. Feder.
Repetition in autism therapy with Dr. Josh Feder
Limitations of Repetition
The mainstream “intervention” when a parent gets a diagnosis of autism spectrum disorder for their child is Applied Behaviour Analysis (ABA). In ABA therapy, one of the principles is to repeat things the same way each time so the child has a better chance to learn the skill correctly, but in developmental approaches we observe that children don’t tend to adapt to new situations with the new skills.
Dr. Feder gives the example of teaching the child to say hi to people and ask a question such as “What’s your favourite colour?” When the child asks a person their name and favourite colour, they seem strange because it’s not natural.
So the question is, “What do we want our children to learn when they begin to communicate with others?” We want them to reach that back-and-forth continuous flow that DIR/Floortime aims for but Dr. Feder points out that developmental psychologist Dr. Edward Tronic talks about how it isn’t the way things actually are.
As an infant develops, the communication between baby and caregiver is often interrupted when the phone rings, etc. and the infant learns that either Mom will return or (s)he can initiate an interaction to get Mom to return then resume the back-and-forth interaction.
In a developing infant, the baby learns that (s)he is separate but able to connect, develops a sense of self, and a sense of confidence in his/her competence to reconnect when there’s a break in the interaction.
This didn’t happen in children with challenges in development so we try to re-create these interactions in Floortime. We do things over and over in Floortime, but it’s different than repetition because it’s always a little bit different each time.
What Kind of Repetition is Good?
Floortime is sharing joy through play with your child to facilitate their Development, respecting their Individual differences, within a warm and nurturing Relationship. In Floortime repetition looks more like Dr. Feder’s Lego example. We want to join the child in an activity of interest, such as Lego, where we’re continuing and building upon the interactions.
“I’m not sure if you want this block or that one? Do you want two blocks or three? Should I put them here or there?” It’s in a natural setting that we’re providing practice in these interactions for the child. Once you get this continuous back-and-forth flow of non-verbal (and maybe even verbal) interactions mastered, it gives you the power to socially problem solve and think of ideas that aren’t present in the moment.
This developmental leap into symbolic thinking becomes possible because of the repetition–which is a little bit different each time. I gave the example of my son building towers and knocking them down over and over again for longer than six months, every single day, but in a natural setting, having fun with interest, and doing it a little differently each time.
It may have started with my son building a tower and knocking it down with his arms. Next he might have kicked it down. Then he might be swinging into it in a sensory gym, and then driving a scooter into it. With each repetition of knocking down the tower in a slightly different way, he’s also developing his visual-spatial skills, his motor planning and sequencing abilities by enacting his ideas in three-dimensional space, and having fun with his play partner.
What About Learning Skills?
Typical kids in school get drilled on things all the time and go and use them in meaningful ways. But this isn’t the case for children with developmental challenges, Dr. Feder says, who often can’t do that because they lack these foundational capacities to do so.
A lot of early learning is identifying things such as pointing to “green” but that doesn’t mean you actually know the concept of what “green” is. Using someone’s interest as the basis for learning makes it so much easier. You can discover new things about your interest in so many ways and not necessarily verbally.
What’s the feel of the blocks, then, how do they fall on you? Then it turns into a monster falling on you, and then the construction of tower technology. In Floortime it’s about taking ideas and building on them over time, rather than training someone based on a standard.
That’s not to say that learning skills isn’t necessary. But your ability to use those skills in real life, when you need to do so, is predicated on an ability to adapt. This relies on the foundational capacities including being able to work creatively with ideas. If you do it without a base of relating and social communication problem-solving, then your ability to use it in a productive and adaptive way is very limited.
What if we’re stuck in Floortime?
How do we help our child if they don’t know what else to do, and we don’t really know what to do next? Dr. Feder says that the key is “affect” or emotion. If the play is emotionally sterile, we’ll get bored pretty quickly. If it’s exciting or even frustrating with emotional content, then we’re both more engaged and it’s more interesting, then the creativity comes.
Think of the hobbies or other things that get you excited and interested and how you feel when you’re doing these things (both frustrations and triumphs). That’s the feel we want in Floortime. A lot of it is pleasurable but even when it’s not, you’re still learning from each other, Dr. Feder tells us.
It’s not just following what the child does, but also truly taking an interest in it. One of the principles of good therapy is that pretty much any idea is a good idea even if it’s not an idea you’d go with.
If your child wants to order 10 pizzas, it’s a pretty cool idea. What would that be like? Wow, wouldn’t it be cool? Yeah, that would be pretty interesting! How would that turn out? What would we do with all those pizzas? Could we eat 10 pizzas?
You can think about and embrace any idea without actually carrying it out. It’s more thoughtful work.
None of us has to do this work in a vacuum. We all need support. We are always thinking with colleagues and wondering what would make Floortime go better. Parents rely on the therapist for support, the therapist relies on their colleagues for reflective practice. You’re less stuck and for less time when you’re working together with friends and colleagues.
What about the child who does Repetitive Play?
How do we help our child if they’re stuck and don’t seem to have ideas, so they do the same thing over and over again? Dr. Feder says the child might need to revisit certain sequences over and over again.
For instance, there are kids who turn the lights on and off. Instead of saying “stop”, try to do something with it and be excited about that with them. It’s possible that the reason they are interested in taking control of the lights is they may have been frightened by the lights being turned off at some point in their life.
Having control over turning them on and off allows them to play this out. Part of our job is to remain empathic about that, but to also work with it to shift it to how long can the lights stay on or off, or what happens when the lights are off for some period of time.
We always want to encourage initiations of ideas from our children, rather than treating behaviour as bad. If you are just scolding your child, your child is not learning anything. Through the rich, playful interactions with you is how they are learning.
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Until next week… here’s to affecting autism!