This week I’m thrilled to introduce Dr. Stephen Porges and the Polyvagal Theory as it relates to autism and the quarantine, and its therapeutic listening application, the Safe and Sound Protocol. Dr. Porges is a Distinguished University Scientist at Indiana University where he is the founding director of the Traumatic Stress Research Consortium, a Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland and he has published more than 300 peer-reviewed papers across several disciplines.
Polyvagal Theory and Regulating our Bodily State with Dr. Stephen Porges
I met Dr. Porges at the ICDL Conference hosted by the Rebecca School in early March right before the quarantine, in the epicentre of the pandemic in New York City. Dr. Porges gave a fabulous keynote address entitled, “Social Connectedness as a Biological Imperative: Implications of Polyvagal Theory in Understanding and Optimizing the Lives of Individuals with Autism“. You can see some slides from this presentation at the Affect Autism Twitter site if you scroll back to March, 2020. He says that indeed, the world changed us after that conference because humans need to co-regulate and interact with each other, and that our bodies want to be in proximity with each other, but we were told to keep physical distance.
Autism and Polyvagal Theory
I read an excerpt from a paper Dr. Porges shared with me from Spectrum News in 2019 shown below. Dr. Porges said that when we talk about individuals on the spectrum, we’re really talking about individuals who have difficulty regulating their bodily state. What is it that families of autistic individuals say? It’s that the child has difficulty regulating.
He says this often causes a reaction of irritability in fathers because our bodies are always requesting a reciprocal interaction. He says that this is a function of the physiological state of the individual. The mother tends to be the one with more prosodic voices who can calm their kids.
The neural regulation of our bodily organs influences our emotional responses and behavior toward others and our environment. Many people with autism have difficulty regulating their behavior and emotions. Their initial reaction to threat is often anger, irritability or aggression that may be expressed as an uncontrollable tantrum. These responses constitute a fight-or-flight reaction that can be difficult to manage.
We (as a society) have been treating autism as a behavioural phenomenon that can be manipulated through reinforcement, meaning if you’re not social, you make people social by getting them to look in the eyes. Dr. Porges says that it’s not in a spontaneous way, though. It means that you’re making eye contact in a state of terror because your physiology is uncomfortable looking at the eyes.
There’s an evolutionary reason for this, Dr. Porges says, that has to do with being primates. Eye gaze is a threat response unless you’re welcoming. Our bodies respond to this intrusion. Any type of intrusion will result in a destabilization of behaviour, so the real issue with children on the spectrum is, “What is their physiological state at the moment you’re interacting with them?” and “Can you find that portal to calm that physiology down?” We have to find our way into that nervous system to give them the cues to give up that defensive system.
Safety is not a removal of threat
We have a misunderstanding of safety as being medal detectors and police in schools but our nervous system is far more sophisticated, looking for cues of safety. How does the good-enough mother calm a tantruming baby? She uses vocal intonations to reassure the child that everything is ok. Dr. Porges would observe parents in airports when he travelled. He’d see little toddler boys go with the father to the bathroom, only to return screaming to the mother who instantly calmed the child, leaving the father frustrated due to lack of control.
There’s lots of things we need to learn about giving signals to our nervous systems. Fathers will use prosodic voices with their pets, which is easier for them to do than with their children or spouses. So they do have the skill set. It’s just that our culture relies on the father as the discline or boundary maker. Dr. Porges always thought as a father that it was all about keeping your kids safe, but the real responsibility is to communicate with them that they are safe in our presence.
It’s really what the Developmental, Individual differences, Relationship-based (DIR) model is all about, too. The first capacity is all about feeling safe.
Friendship with Dr. Greenspan
He says that Dr. Greenspan’s insight was to get on the floor, which metaphorically meant, don’t intimidate the child. Another great insight was to follow the child’s lead which was to allow the locus of control to reside in the child and then to support the child. Functionally, you’re witnessing the child and empowering the child’s behaviour so the child becomes more expressive. He says that his discussions with Dr. Greenspan had to do with wondering how to get the systems open and accessible, and developing a language for this.
If you accept that, then you accept that if you can shift the physiological state, then different emergent properties come out. Social behaviour becomes spontaneous and that shifts the model of how you treat the child from the behavioural models where we behaviourally modify social behaviour to instead getting the child to feel safe and comfortable. If they do, they spontaneously look at me, have curiosity, and co-regulate with me, then eventually become a self-regulator.
Some of the treatments that are pushed onto parents make parents feel like they have to go against their instincts, I suggested to Dr. Porges. He said that many discussions with Dr. Greenspan were about how people working with autism want to fix the ‘disorder’, so they put pressure on the family unit and take away the resource that is there.
Dr. Greenspan saw Floortime as a family approach. He brought the family unit into the treatments. When you include the mother there is more relaxation, and more progress would occur, he believed. Over the years DIR/Floortime has become more flexible of that family unit, leveraging it in supporting the child, and the child within the family.
When a child goes into a tantrum, and we say they don’t have control, we are blaming them when in reality, the flexibility to be able to self-regulate emerges from the historical experiences of learning how to co-regulate. If you are doing Floortime or effective parenting, you are in a dyadic interaction that allows the child to be more independent, more exploratory, and more self-regulatory.
The Sensory Profile is Not Static
What’s happened with the autism diagnostic criteria is that the sensory part is critical, but it’s part of the optimistic story, Dr. Porges says. People start to believe that the sensory features are a biological or genetic part of that person, but they’re really a function of the physiological state the child is in, he says. The hypersensitivity to sounds or lights, the irritability of ingested food, being uncomfortable with the novelty of food, and gut problems are all emergent properties of the body being in defense.
The body has this defensive physiological state. We don’t know where it came from, but that’s irrelevant, Dr. Porges continues. The focus is, “Can we provide cues to re-tune that autonomic nervous system to enable the child
to spontaneously engage, to hear human voice in background sounds, and to be exploratory in this world?” That’s where Polyvagal Theory interacts with the world of autism.
If you can get the body in a calmer state, these sensory challenges start to drop out. It doesn’t ‘normalize’ the child, but the sensory components are no longer a disability and life goes on in a more prosocial, interactive way.
I shared the slide from Dr. Porges’ March keynote presentation. The SNS, or Sympathetic Nervous System, the part that prepares us for fight or flight includes hyper arousal and hypervigilance. One is tuned for a predator coming. People who have had trauma show that their bodies are in a state of threat. As children become more comfortable, even the way children give hugs changes. You see social withdrawal when in a state of threat and these are all adaptive behaviours.
Many of these sensory features are there in other mental health and physical health disorders, too. When the body is in a state of threat, these are the behaviours that are there. You start to see all of these co-morbidities. It’s all part of the body in a chronic state of threat. The treatment model is, “Can we move the body into a calmer state?“
These Behaviours are Adaptive
I shared that my son has always turned around backwards to give hugs! Dr. Porges said, “I’d say he’s a very smart kid!” The dorsal side is like a turtle’s shell; it’s protected, so he said that my son is saying with his body language, “I’m not letting you in my ventral side. That’s where I can get hurt. I know you want to give me a hug, but my body says I’m vulnerable so here’s my compromise. Take it or leave it!” It’s about being trusting. Dr. Porges says that our goal in life should be to be a good-enough co-regulator.
Parents often feel emptiness because they give how they know how, but the reciprocity isn’t there how they expect it. They tell Dr. Porges that they love their child but aren’t sure their child loves them in return because they aren’t getting the cues from their child we’re used to. When we learn how to co-regulate and calm our child, it enables growth of relationship to occur. It’s about neuroception, Dr. Porges says. Our body is always doing what it thinks is best for us. It decides what is the range of behaviour that’s easiest in a certain physiological state.
Behavioural models place the intentionality on the individual. Polyvagal Theory says it’s very easy for the body to be aggressive, angry, and frustrated when in a state of defense. Parents of autistic children will tell you that the threshold is low for a child to lose that state regulation.
In the absence of an active social engagement
system, the mobilized state provides an efficient neural platform for fight and flight behaviors.
The range tends to be greater in neurotypical children and is being regulated by a calmer physiological state involving a different neural pathway from a newer mammalian vagus. The regulation of that cranial nerve in the brain stem is also linked to the facial expressivity, vocalization, and ability to extract the human voice in busy environments. In autistic kids you often see that they modulate their voice with volume and not in tonal quality. That is, our voices convey our physiological state. When you slow it up and have a calmer melodic voice it helps to calm your child.
Saying things like “Calm down” doesn’t work. Our nervous systems don’t work that way, Dr. Porges says. Being accessible and welcoming is how our body calms down. Putting intentionality on the child suggests that if you are asocial or oppositional, you want to be, and thus I have to punish or reward you to shape that behaviour. We really need to convey to parents how important it is for the child to feel safe. We as a society have a difficulty relating to it, so it is a challenge for many families.
The Safe and Sound Protocol
The Safe and Sound Protocol has two components: It has to be delivered in a very safe context, that is, no low frequency sounds in the environment and no distractions (i.e., respect for the physical context in which it’s delivered). And second, the elements of the sound which is a neuro-physiologically-based model that’s saying that certain frequency of vocalizations are critical for social communication and are only available when we’re in states that aren’t states of threat.
When our bodies are in a safe state, we can enhance the neural regulation of the structures to extract human voice and dampen background sounds. If you’re in fight/flight, you will just stay startled. The Safe and Sound Protocol triggers the nervous system to detect acoustic cues of safety. It is based on a feature within Polyvagal Theory that identified the frequency band where the cues would be delivered.
Our nervous system processes human voice different than instrumental music, so the program uses filtered vocal music to modulate the frequency bands to send the distilled cues of safety and love. This gives the nervous system no choice. It has to relax to this change in physiological state. It calms us down, then we have the accessiblity of neural structure to extract human voice from background sounds so your ability to process language becomes better. You become less reactive to background sounds. Pupilary dilations are also linked to vagal regulations, as are gut problems and selective eating disappears with treatment. It’s not based on neural plasticity. It’s simpler, Dr. Porges says.
You already have the structures in your nervous system, they’re just stuck in a different state like water being steam or ice, but it’s still the same molecule. This treatment says to the body, “Give up the defenses and become accessible.” It’s 5 one-hour sessions and Dr. Porges has received great feedback after day three, even, that the child’s behaviour is different–less defensive. If the social world cooperates, it can be relatively permanent. However, if the child gets a fever or ill, the child’s system can revert back to an earlier state.
The frequency of positive effects is really high with children on the spectrum, Dr. Porges says, because they come in with their loving caregiver and an experienced provider. He estimates that they see quite noticeable results in over eighty percent of cases. With adults, he said it’s a different story because they are on their own. They could have vulnerability or trauma history where cues of safety can be vulnerability, so you have to work more slowly. Dr. Porges likes to see these major changes in the sensory profiles and language processing, which are their two outcome variables.
Integrated Listening Systems is now owned by Unyte in Toronto and they have configured the Safe and Sound Protocol to be remote. A provider can now assign a code for a smart phone to complete the protocol at home and the provider can track compliance. You can also complete it over video conference so the provider can get video confirmation of the implementation of the treatment.
Polyvagal Theory and the Pandemic
Life during the pandemic is threat to us, Dr. Porges says in a recent publication and in a recent podcast with Virginia Spielmann of the S.T.A.R. Institute. Typically as humans, we mitigate threat through social interaction, but now social interaction is also a threat. However, this pandemic is occurring during a unique time in history, Dr. Porges says–during the time of the internet. We can use video conferencing in a different way. Instead of using it for education or entertainment like we have historically, we can use it to convey affect with each other.
We have to build some neural exercises into our conferences, he says. We want to look at people and get direct interaction, so it’s a paradoxical challenge. Even if we can’t have true face-to-face interaction, it’s certainly a lot better than nothing. We may not be able to do this with our kids, who might not tolerate online meetings, but we can use the process of deep breathing to help our children. Singing, playing a wind instrument like a recorder, or just getting the child to exhale slowly is calming. We can blow bubbles or blow in the straw making bubbles in a cup of water.
These are neural exercises of state regulation. People think about the Occupational Therapy model, Dr. Porges says, and swinging, or vestibular stimulation is important, but breathing is a fast path to calming the physiological state which is very important. When you exhale slowly, you are performing a profound neurophysiological manipulation. You’re optimizing the vagal motor influence on your autonomic nervous system, which is calming yourself down.
With our kids, we have to think about how we talk, the number of words we use in our phrases before we take a breath, and if we extend the duration of our phrases we convey calmness, Dr. Porges says. It’s so important to get back to that state for our kids because then, many of the emerging properties that result will be the ones you want: social behaviour, interaction, and regulation.
See many articles and interviews with Dr. Porges here and at the bottom of that page, sign up for the Saturday newsletter from Unyte to get new research on neuroscience, conference and event information, new articles and podcasts with Dr. Stephen Porges and Unyte-iLs product news.
See and read about one clinician’s use of the Safe and Sound Protocol in the U.K. here
A big, huge thanks to Dr. Stephen Porges for taking the time to podcast and share this wealth of knowledge with us. I can’t wait to share with him how our son benefits from the Safe and Sound Protocol. If you have any thoughts, stories, or questions, please feel free to add them to the Comments section below. And if you enjoyed this post and learned something, please consider sharing it on Facebook or Twitter via the links below.
Until next time, here’s to affecting autism through playful interactions!