Occupational therapist, DIR Expert Training Leader, owner of A Total Approach in Glen Mills, PA and the new Maude Le Roux Academy, Maude returns this week to discuss a topic that is important to consider when planning an approach to support the person you care about: Remediation versus accommodation. Please enjoy the video or audio podcast, and/or the blog content below!
Remediation vs. Accommodation with Maude le Roux
What is Remediation and Accommodation?
In the world of developmental difference and different approaches and supports, we know that the brain has plasticity which allows for change and growth. We have different strategies that we use in different modalities, including DIR/Floortime, and we want to know how much of the strategies that we are using accommodate the system versus remediating. People in the industry confuse accommodation for remediation.
Accommodation means that I’m doing a bypass around the child’s challenge and using something external to accommodate for what the child requires. Remediation is working on that pathway that is not in place and mobilizing it to get into place, knowing that if we keep accommodating, we might not get to remediation. But doesn’t remediation imply that something is wrong with my child and aren’t we learning now that neurodiversity is about differences and not about aiming for neurotypicality with our children?
Developmental Delay or Developmental Difference?
Maude believes that the term developmental delay has a significant meaning and it need not be negative like the way the word ‘behaviour’ is considered negative, when in fact everything we do is behaviour–positive or negative. When we look at Dr. Greenspan‘s six functional emotional developmental capacities that children move through, there are age ranges associated with those stages. If a child is not meeting those milestones at that age range, Maude says it is not negative to say there is a developmental delay–it is what it is.
You can say that a child has a developmental delay. He’s not on par with his peers. But he doesn’t have to be. It’s just a measurement for Maude to target so she’s not working in the dark, has objectivity, and can plan in an objective way. But in the therapy room, she is always focused on connecting by joining the child.
What is important is that how we approach that delay is respectful of the child’s individual differences. The Developmental, Individual differences, Relationship-based (DIR) approach draws the child to the Relationship by seeing what they bring and respecting who they are and that being good enough. In Maude’s mind she is also always thinking about what that next challenge is to present to that child to promote his development.
DIR/Floortime is about connection and empathy. Along the spectrum of approaches it is among, if not the most, client-centered, relational-based approach that is nothing if not respectful.
We need to ask “What do we remediate? How do we remediate? Why do we remediate? Why do I want to remediate?” In the DIR approach we want to promote the child becoming more communicative, more relational, more a part of what’s going on around him, and using his natural curiosity and intelligence by opening these capacities up for them, Maude says. In order to do this, we are comparing him with developmental milestones–however, we are not harping on the child not being there. Maude believes that semantics can take the attention away from things we should be working on to support and promote development.
In the Individual Education Plan (IEP) that a child in special education has, there is a section for specialized instruction, and within that there are instructions for different roles such as the teacher, the psychologist, the occupational therapist, etc. These instructions are accommodating for what we have found in the evaluation that the child may have an individual difference with. An accommodation might be that instead of sitting in a chair, the child can sit on a therapy ball.
Many children have prescribed sensory diets where they are provided accommodations to allow for their sensory differences, but Maude says that doesn’t change the brain. She wants to work on his brain in a way so that he’s not needing the accommodation that he is needing right now. Maude stresses that this is not about changing who the child is or remediating you as a person. What we want to remediate is the brain pathways that disallow you from showing who you are.
When Maude works with a child she is not thinking about whether or not he is autistic. She is thinking about their developmental ability and how to mobilize this child so he will problem-solve, so he won’t avoid the very things he’s going to need in life.
If a child is banging his head against the wall, Maude wants to remediate the pathway that stops him from having to bang his head and get him out of hurting himself, biting himself, scratching himself, saying to himself, “I’m dumb. I don’t know what I’m doing. I don’t belong.” But if the child’s system is giving him such a hard time just adapting to his environment and he’s really having a tough time with it, he’s going to avoid the very things he might enjoy!
What does remediation look like?
When considering remediation, Maude considers how the visual system is operating, how the auditory system is operating, are they are working together, are they correlating with the vestibular system, how does the child use touch to engage in their world, what does the child avoid, and what does the child seek?
She then wants to switch that around so that the child will not feel an intense need for something beyond the learning that the child might want to do but can’t. You can see from the child’s behaviours when they are frustrated at not being able to do something they want to.
But you can’t do any of this without assessment and performance standards that you can measure yourself against. Maude developed a Functional Developmental Autism Assessment Protocol that we discussed in a past podcast that looks at all of these pieces. Maude says that many current assessments conclude that a child is impulsive, rigid, or controlling but they never explain why. Nobody pops out of the womb and says “I’m going to be a behaviour issue.”
When we talk about remediation, we aren’t saying remediate the person or remediate the autism, but remediate some of the individual differences that are stopping you from being your true self.
Maude says there’s an environmental consideration, a consideration of nature/nurture, pieces of relationship, pieces of sensory, pieces of individual differences that have to come together. And if we don’t analyse every step of this developmental continuum–where these pieces have fallen in place, and maybe where they have not fallen in place then we may be beating around the bush instead of going through the bush and building the tunnel. If I do it I can feel successful and I’ll do it again. If I don’t feel successful, I’ll avoid it like the plague.
Maude’s stages of remediation
Maude starts by working on Foundational stage which includes regulation, typically seen in the first two years of life. Next they work on Organization on top of the foundation, which is your timing, sequencing, and integration pieces, and then comes the Executive stage. Her assessment looks at all the pieces then they determine what is holding him back the most? Development hasn’t changed. What we expect from development has changed, but development hasn’t changed. We all follow the path of development.
You’re building the pieces through the child’s wanting to be with you. That’s true Floortime. And as soon as you get that want, you have intrinsic motivation which is like bells going off inside of the brain. And when the brain fires, that’s remediation. The nervous system is firing in a way that causes growth to happen.
What remediation is really about is if you can respectfully harness the core of a child so that the child will follow the developmental trajectory himself because intrinsic motivation has been captured and you’re working on neural system activity to make the nervous system fire so we have a changed system, but not a changed little guy or girl.
Thank you to Maude for taking the time to share her expertise in the area of remediation. For more information about Maude’s services please visit A Total Approach or the new Maude Le Roux Academy. Please feel free to comment, ask questions, or share your experiences below and please consider sharing this post on Facebook or Twitter.
Until next time, here’s to affecting autism through playful interactions!