Last time, Dr. Stuart Shanker shared that the missing piece in the DIR/Floortime randomized controlled trial study at York University was the mental health professional’s work with the parents about their own stress. This week, that mental health professional, social worker and DIR Expert Training Leader, Eunice Lee, joins us to discuss how we approach supporting parents in the self-regulation process.

Self-Regulation Starts With Us with Eunice Lee

by Affect Autism

A Strengths-Based Coaching Model

When Eunice was hired for the controlled randomized DIR/Floortime study in Toronto, her goal was to understand the child’s developmental level, to develop appropriate goals, and to deliver the treatment as a multidisciplinary team. She was interested in delivering it as a coaching model. They had to tailor the intervention not only to meet the needs of the child, but also to the needs of the parents.

I wrote about how Dr. Stanley Greenspan discussed on his radio show and in Engaging Autism that the whole dynamics of the family play into the DIR approach. Eunice says that starting with the child makes so much sense and is very logical because there is development that might be delayed and that is the first thing that’s flagged, but the role of the parents is key.

One of the things Eunice likes about the Developmental, Individual differences, Relationship-based (DIR) model so much is how the clinician understands what strengths the parent brings into it and how we individualize the approach for each family. We look at what’s already working and how to build on that which is a parallel process with the child’s program. As clinicians become more experienced working with kids in the model, we start to look at the caregiver and how we can incorporate them into the work.

A Family Approach

Eunice says that there are things we can massage or stretch but there are also things about the parents that we have to figure out how to work with rather than change. She likes to think about the common place where the parents and child can meet. So in working with a family, she’s thinking about the child’s profile, the parents’ style, their stress level, etc. She aims to find interactions and things they can connect on that are mutually enjoyable to both of them so the parents can support the child’s climb up the developmental ladder.

In this way, the DIR model is a respectful model by respecting that parents bring different strengths and preferences with the child along with the child’s individual differences and developmental level. She respects that and figures out how to work with it by first building a rapport with the family.

Eunice gave us an example of a family she worked with where the child loved being in the swing and required that vestibular input. The clinical team noticed, though, that the parent didn’t look comfortable in this interaction. Only through discussion they noticed the parent was prone to motion sickness and didn’t enjoy it but did it for the child. So the clinicians wanted to find something else they could do together that didn’t make the parent feel unwell, because that affects her regulation.
Looking at Regulation

Co-regulation, where the adult is supporting the child with their regulation, is really dependent on the parent’s regulation as well. The adult’s capacity to help the child stay regulated is limited if their own regulation is off because they’re overstressed or feeling physically unwell. That’s where we have to work. In a past podcast here, Dr. Kathy Platzman suggested figuring out what triggers your own dysregulation as a parent as a start.

Determining what dysregulates you requires self-awareness and Eunice says that parents in the study came in at very different points of self-awareness. Some needed a bit more support to be aware when they are starting to get frustrated and dysregulated. What it looks like in one person can be very different in another person.

When it comes to us being triggered by our child’s behaviour, Dr. Glovinsky had told us that it often goes back to the way we, ourselves, were raised as children. Although this could lead into an in-depth psychoanalysis, Eunice said that the main goal in the DIR study in this realm was simply to understand the parent’s regulation to the extent that it affected or impacted the interaction with the child.

Look for the Cues and Knowing What Doesn’t Work
Eunice reiterated what Dr. Shanker told me last time: that they take a preventive approach by not only understanding when the child is dyregulated, but determining when they are starting to get dysregulated. Once it’s already happened, there aren’t a lot of options. So they look for the triggers or indicators that the child is getting dysregulated. If you catch it before it happens, it is much easier for the parents to grab the strategies they have in their head before they get triggered and dysregulated themselves.
Once you become dysregulated, you are in what Dr. Shanker called ‘red brain’, which is a limbic response where you are only reacting rather than thinking. You lose your ‘blue brain’ capacities of rational thought. Access to language and comprehension is also compromised as is our ability to understand reason, so our options are limited. Instructing your child to “Use your words!” rather than scream just won’t work.
So not only do we need to adjust our expectations for our child’s ability to respond when dyregulated, but we also need to determine how to communicate what I need to communicate with the child in this very moment. We have to remember that the child’s profile is different depending on where they’re at in the moment. They drop down on the developmental ladder when dysregulated. They are not choosing not to understand, but rather they have lost their capacity to understand in that moment.
What Does Work
Eunice says it shifts our expectations when we realize it’s not a choice but a matter of not having this capacity. We want to communicate the emotion the child is expressing in a simple way, without complicated language. Acknowledging the frustration and emotion is not ‘giving in’ to a child’s meltdown. It’s recognizing that it is not ‘bad behaviour’ but rather ‘stress behaviour’ as Dr. Shanker told us, and then supporting the child.
Eunice gave us an example of how children in the study who might want to open the door and run in the hallway and leave the therapy room. They made sure to acknowledge this wish rather than saying, “It’s not time to go yet” or “Only 10 more minutes” or “We have to stay here” because those statements don’t tell the child that we understand what their idea was. They could go to the door and say “Oh yea! Let’s try to open it!” or “Oh no…, oh no!” in a disappointed voice as you try to pull it open, using the tone that matched the child’s emotion in order to support the child.
We want to convey that we understand the child’s idea and we empathize with them. You want to let them know that you know that “This is what you really, really wanted.” So you try to co-regulate it before it gets intense. If we raise our voices or explain to much, it can escalate their regulation. They might think I have to be louder or more insistent instead of “maybe they do understand“.
Calming Strategies
We really want to identify the markers of dysregulation when it first happens before it boils over. For some kids it can be more challenging because escalation can happen really quickly. It could be about seeing the signs of sensory overload. It will vary from child-to-child. Eunice also encourages not only looking at the stress behaviours that the child is starting to get dysregulated, but also to use techniques to calm the child since parents know how to calm their children best.
Rather than notice that things are starting to be difficult for your child, you can also add what can be regulating for them such as certain songs, certain kinds of interactions that are calming, etc. before it gets going because this might not work once the child is already dysregulated.
What About Us?
As parents, our regulation affects our child’s regulation. We can realize in ourselves when we are getting stressed and determine what can calm us. For some families, Eunice said that simply working with clinicians, a quick check-in–that is, giving a brief update once each week without having to do that and play at the same time was very helpful. In two-parent households it can help when both parents know each other’s strengths and help each other out by switching off with each other, for instance, when one gets stressed.

It’s helpful to understand your own regulatory style and patterns and to know when it’s becoming a lot for you, and then also figuring out what makes sense in your family. It can be more challenging with other children in the home or in single-parent families. But it’s really like what they say on an airplane: to put on your oxygen mask first before tending to your child. When it’s possible that’s really important because a parent who is regulated will be much more available for the child.

Chase the Why
Eunice gave us a great tip: to try to encourage the idea around not a specific activity working or not, but thinking about why it is working. Delve a little deeper. If a certain song helps regulate your child, what do you think it is about that song that helped? What qualities of the song was it that helped? Is it rhythmic? It might depend on who is singing it. So is it the song, or the way it’s sung?

We are always trying to broaden out what’s supportive.

Eunice Lee

Trial and Error
Dr. Gordon Neufeld talks about this process as a dance. It’s very much trial and error figuring out what works with your child and in your family. DIR doesn’t offer a cookie-cutter solution. Also, what works for awhile might stop working in certain situations and with development. It’s always dynamic. Eunice says this keeps our work interesting, but it can also be very frustrating. What works for Mama in the morning, might not work at night. And we are the same: the music we listen to in the car on the way to work might not be what we want to listen to on the way home from work. It’s what makes DIR interesting and it’s challenging figuring it out.
You’re the Best Bet

Of course, we want to help our children and not see them upset. It may not even be anything in particular that they want, it might just be they want you. Sticking it out during that really uncomfortable time, because there might literally be nothing you can do, might be the best thing you can do. Just be there with them. In the moment, it takes awhile for the child to calm down but it’s still so important the parent is there.

The regulating piece is knowing someone is there giving you their full attention, being present and attuned to you.

I hope you have taken from this podcast some points to think about that are really helpful! Please consider sharing this post on Facebook or Twitter and do share any feedback, relevant experiences, examples or general questions or comments in the Comments section below. Next post, it’s time for another early literacy update.

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

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