DIR Expert Training Leader, Clinical Psychologist, founder of the developmental transition service called Dirty Hands Developmental Alliance, and co-author of Respecting AutismDr. Gil Tippy, returns this week. This podcast we are discussing an important distinction: that between the strategies that we use to get through day-to-day activities versus actual developmental work that supports our child’s growth. Please enjoy the audio or video podcast below.

"Strategies" Don't Support Growth with Dr. Gil Tippy

by Affect Autism

The Behaviour Trap

Caregivers all want our days to go smoothly. This is how people get trapped into behavioural interventions. Some of the point of an Applied Behaviour Analysis (ABA) intervention gives you control because you get compliance. But Dr. Tippy says that the problem is that when you fall too much for that, you begin to see the point of all therapies as, “Let’s pick a destination point and get there.

If you do that all the time, you end up making a situation where a person can’t actually make thoughtful, creative choices based on what’s happening inside of them, Dr. Tippy says. What you end up with is people who think there is always a right or wrong answer, and that they always have to choose the right answer to get what they want. When they don’t choose the right answer, they don’t get what they want. There’s no going back. There’s only one way. Those forced, fake, false dichotomies are one of the major problem with doing an ABA intervention, Dr. Tippy says.

Dr. Tippy says that sometimes you have to support a child with visuals. That’s very child-specific. It’s a very good strategy when it’s necessary. But it’s not an intervention; it’s a strategy. If you say, “I’m going to give you a visual tool to help support what you’re thinking inside of you that’s going to help you, and that this is specific to you” then that works. But it’s a strategy. Don’t fall for the notion that that’s an intervention.

The Developmental Approach

In DIR/Floortime or any good developmental intervention, we want to take what a human has inside of them and let that bloom. We do that by holding a space that allows them to have whatever processing time and supports they need so they can do the sensory integration, the motor planning, and what else they require to be able to put out the product that they want, which is a result of their creative thinking.

Ways to get through the day, such as Social Stories, are just strategies. Dr. Tippy says that Dr. Greenspan would have called that the “thinking about tomorrow” game. You say, “Tomorrow, we’re going to go in the car, drive down this street, into this office, where there will be a person behind the glass doors, we will tell them their names, they will tell us where to go and sit, a person in the white coat will come out, we’ll go sit in a chair with a bright light“, etc.

When you give someone a story of something that’s going to happen in the future, it’s your recognition that you’re stopping from doing a developmental intervention and instead harnessing and activating their very good memory so that they can remember an event that hasn’t happened yet, so you can put images in your head of what might happen in the future. It works because it moves people through important things.

The mistake that people often make is getting caught up in compliance or just moving from spot to spot, just to make your day easier or ‘look’ easier, Dr. Tippy says. The very first thing behaviour analysts do is get a kid to sit and put their hands down. When parents see this, they see that at least their child is capable of this. The problem is that this doesn’t allow for inner growth and the creative life on the inside, Dr. Tippy says.

The Idea of the Neurotypical ‘Ideal’

The notion that the road to development for neurotypical human beings is somehow this magic red carpet with no problems is false. Human development is bumpy and challenging, and children are challenging and aren’t there for our amusement. We are giving of ourselves when we choose to raise children. It’s always challenging. A typical teenager is someone who begins to come into their own, who wants to individuate and sees you as a challenge to their autonomy. And yet, many caregivers grieve about parenting children with developmental differences.

A few podcasts ago, we heard from psychologist Robert Naseef who talked about this Ambiguous Grief as being ours, and our alone, and although these feelings are valid, we can’t get caught up in them because our children need positive, energetic caregivers who value them for who they are. As parents we look for the best ways to support our child, Dr. Naseef said. We need to find a way to create the best atmosphere for our kids to grow so they have lives that are creative and beautiful, Dr. Tippy says.

It’s traumatizing to think you will be taking a different path other than school, higher education and career/family. But the autistic individuals and individuals with autism whom Dr. Tippy knows have beautiful, creative, wonderful lives who have perspectives entirely different than ours and their neurodiversity enriches our culture. It is incumbent upon us who want to help other people to help parents understand that this path is not identical in its particulars, but is a path like everyone else’s. It might be slower or different, but development happens. What we all want to support our children.

The Developmental Way

Strategies won’t move them developmentally. So how do we move them developmentally? You learn about developmental interventions like DIR/Floortime. You get support and coaching. You video tape yourself interacting with your children and get feedback from a coach. Get support, get practice. People need to see that everyone is having the same feelings and struggles and that play is not only essential, but it’s simple and fun.

ICDL Online Parent Support Drop-In

Affect Autism and ICDL offer a FREE online parent drop-in support group every other Monday that you can learn more about under the Events menu above.

Dr. Tippy runs parent groups and meets with parents all the time. You just need someone to say to you, “Wow, you really know your child. You’re doing beautifully. What if instead of asking all factual questions you asked questions you didn’t know the answer to?” This is the kind of work we do: reflective supervision. that’s how you learn.

It’s not as difficult to understand as an intervention as you would think. Dr. Tippy always believes he doesn’t need to see parents 50 times per year, but maybe 5 times per year to support them in what they’re doing. This becomes as effective because this is a parent-supported intervention. It is what parents inherently know how to do with their children and it works. The parent support piece is essential. It’s a big portion of ICDL’s training. Parents can do this. It is a parent-based model.

Choose Developmental over ‘As If’ Approaches

Nobody ever reinforced people in the way ABA does until 60 yrs ago as a way of working with human beings. Rather, humans grow up in Relationships with human beings. They open and close circles with other humans. This model has tremendous support. So Dr. Tippy advises to slow down. Get to know your child–the child you have in front of you, not a child you have expectations of having. When you meet your child where they are developmentally, once you take into account their sensory profiles and have shared joy with them (e.g., hide and seek, peek-a-boo), you see your child at their best.

Dr. Tippy asked how it is that we got to the point where something that is so counterintuitive is the way we work with children (in reference to ABA)? We are in a culture where you have to be presenting frenetic work all the time to justify what you’re doing. Dr. Tippy referenced this book making this point, that there is a natural pattern in different systems where jobs come up to justify their existence. Dr. Tippy says we have begun to do interventions with autistic children not to help them but to make it look like we’re doing a lot.

Dr. Tippy references Greta Thunberg as an example of someone who is neurodiverse who can think differently. It’s these minds we’re trying to support in the DIR model rather than the model that tells the neurodiverse how to think (like neurotypicals). That doesn’t support growth. Those doing the ‘As If‘ interventions are trained so heavily and Dr. Tippy wonders how they get to the point where they can withhold attention, punish people, and not treat people as they’d like to be treated themselves because they entered the world of intervention aiming to do good.

What happens is they have to convince themselves that what they are doing is the only right thing. To believe this they have to believe that anything else will actually hurt people. But this is false. Research from neuroscience and other areas is showing us that other options promote development much better. We help students move from anxiety to thinking. They’re anxious because society tells them there’s a right or wrong answer. 

Instead, Dr. Tippy says, we want them to say, “Hey, this is just a challenge, just like all things in life are a challenge. And I actually have in me those things that allow me to solve unique and ambiguous situations so I don’t have to be anxious about this. So when I come up on something ambiguous, I can simply think about it, use my abilities and come up with a new plan.” That’s what DIR/Floortime is about. You don’t get that by forcing people to pick the right answer to stuff.

Anxiety versus Thinking

I described to Dr. Tippy some of the daily anxiety that my son lives with such as repeatedly asking where everyone is going to sleep at night (even though it’s the same every night), and repeatedly asking
why we stopped every time we stop at a stop sign or red light in the car, then continually asking when we will be going again. It almost seems to be every minute of everyday with everything going on throughout the day. Even opening a wrapper from Hallowe’en candy, for instance, is anxiety-inducing. He is always giving up saying “I can’t do it!” and asking for help, even when he can do it. Our job is to scaffold and support him, even when he says he can’t do it.

Dr. Tippy says that that sort of anxiety arises when you are used to using your memory as a way to live your life, which is indicative of that developmental level that you are at. As you move up developmentally, you end up losing that. You realize there’s a flow and continuity to life. It’s a very difficult habit to give up, even when you begin to think creatively, Dr. Tippy says. We don’t want to run our lives by our memory. We want our children to have the confidence to be able to think and solve everyday problems that come up.

There are case studies in Dr. Tippy’s book, Respecting Autism, about parents not knowing what to do next, but thinking ABA must be the answer. One parent asked him to explain how an ABA intervention hurts a kid if you’re doing DIR/Floortime? We looked at a graph from Dr. Tippy’s recent presentation at the ICDL 2019 conference that shows you move up developmentally with each year of age along a 45-degree line if you’re neurotypical. Our children might have a flatter slope. They might not get to FEDC 6 until they’re 21-years-old. Once you get there, you are certainly capable of going to college.

What an ABA intervention does is it drops our kids down developmentally, Dr. Tippy states with confidence. Punishing and compliance knocks you back to FEDC 3 where you simply respond with simple circles of communication. Now it might take you to 25-years-old to get to FEDC 6. Then, if you add another ABA intervention, it might take until age 30. It’s damaging to do prompting and punishing because all you’re doing is delaying development. Humans develop in a certain way, so doing an ABA intervention that opposes that does damage and, or at the very least you are wasting time.

Suppress one behaviour, get another

I shared with Dr. Tippy an example of trying to deter my son’s recent screaming behaviour while driving in the car. He imitates the behaviours and stims of his peers and the latest one is screaming. He also loves to listen to his PJ Masks songs in the car over the car stereo. I decided to turn the music off every time he screamed. This upset him greatly. It also didn’t stop the screaming because as soon as I’d put the music back on, he would inevitably scream again. That day he heard Christmas music for the first time this season so I asked if he wanted a Christmas playlist for the next day in the car. He did. But I was busy and didn’t have time to search for the exact songs he was familiar with from past years and instead just played a generic kids Christmas collection. He didn’t like it and kept asking to go to the next song. After a few times of this I said that no, we were just going to listen to the entire song. He then screamed. 

Dr. Tippy found this quite funny. So, my son learned to scream when he wanted the radio turned off, and my goal to stop him from screaming was a miserable failure. Dr. Tippy says that’s the problem with ABA: you might achieve a certain thing, but you’ll also achieve other things that you didn’t want. So why not do an intervention where the worst thing that happens is you have a wonderful back-and-forth with your child as opposed to one that has disastrous fall-outs and long-term negative effects (just read the endless accounts online from adult self-advocates)? 

The problem here is that with ABA, a child doesn’t have a notion that they’re allowed to have a creative thought in their head that gives them a chance to have an action. They can be perfectly capable of solving ambiguous situations, but when they see everything that happens to them as a being a disaster and they don’t think they can solve anything, then why do that? Why not have an intervention where you can have a warm and loving relationship and support them in becoming the beautiful person they’re destined to be with the correct support? That’s what parents want. Dr. Tippy wouldn’t risk everything for compliance.

We want our kids to be in a place where people understand that human beings deserved to be treated respectfully, supported, understood, and to have ideas that are at least as good as our ideas, Dr. Tippy says.

Thank you to Dr. Gil Tippy for taking the time out of his busy schedule to share this important information with us! I hope you found it as helpful as I did! If you did, please consider sharing this post on Facebook or Twitter. If you have any related insights, experiences, or questions, please put them in the Comments section below.

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

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