This week we revisit Dr. Stanley Greenspan‘s Words*-Action-Affect (W-A-A) concept with Marilee Burgeson, who recently wrote an ICDL Newsflash on the topic. In Building Healthy Minds, Greenspan suggested combining our words or ideas with our affect (expression of feelings) and actions in our work with children in DIR/Floortime, which helps our children use ideas by us creating a situation where feelings or intentions need to be expressed. Although this is emphasized at the fifth developmental capacity in Greenspan’s model, its use is helpful in all interactions, as Marilee explains.

Marilee is a Developmental, Individual differences, Relationship-based (DIR) Speech and Language Pathologist in San Marcos, California, just north of San Diego. Her work has been focused in early intervention, and since retirement she is in private practice and consultation. She is a DIR Expert trainer with both the International Council on Development and Learning (ICDL) and Profectum and has been in the DIR world since the early 1990s. I hope you’ll enjoy her insights in today’s video and audio podcast!

A Way of Being, not a Strategy

When Marilee first heard Dr. Greenspan talk about Words-Action-Affect (W-A-A), it resonated with her instantly, she says. It’s a way to bring the child in and a way to highlight your own non-verbal affect cues that they can take in and understand. Over time as an SLP, she’s learned how important it is to get into that ‘W-A-A’ space by creating a safe space for the child where she is not seen as a threat. Hearing Dr. Porges speak about Polyvagal Theory confirmed this for her later on. She didn’t want to scare her clients with too much affect, language or quick movements.

Marilee focused on the way she was being because she mostly did home visits and had to meet the family where they were at. She would need to build that trust in the relationship with parents and follow their lead to see where they were at and go from there because that’s the parallel she wants to create for them to do with their child. Marilee has learned over the years how important it is to slow down and be really present because she not only wants the child to take her in, but she has to take in the family and the context of their relationships with each other as well. 

Slowing down also helps Marilee read the subtle cues that a child may be giving her that could be missed if we have our own agenda, are moving too quickly, using too much language, or questioning. You’ll miss what the child is really trying to communicate to you. This practice showed her the value of curiosity in finding out who each child is and how they are showing up. She wants to know who they are and support them to be that to their fullest extent, to be an ally and supporter. It really creates a great foundation in her work that makes it very valuable and rewarding.   

Marilee adds that it’s a non-verbal space, too, that she’s creating because she wants to the child to come to her and for them to know that she is there appreciating them and their ideas. It’s rewarding to have a child come to you and initiate and want to play, but this can take a long time, Marilee explains. It’s a lot longer of a path to this kind of relating than an ‘ABA’ stimulus-response kind of teaching in contrast. This is building a relationship that’s based on creating safety, which is also being attuning to regulation: that of hers, the family’s and the child’s, so they can be in a calm enough space to take each other in.

Creating that Safe Space

Marilee continues that it’s also so important to create that space because children on the autism spectrum have motor planning challenges, especially related to speech. Sequencing those sounds can be really challenging. It doesn’t mean they don’t have a lot of thoughts in their mind, but it’s harder for them to get them out, she explains. When you create the regulation and safe space, the child is more likely to try to make some sounds and say some words because they feel comfortable in doing so. There’s not a lot of pressure for them to say a word or say a sound, but sometimes in that space you can help them do that.

Marilee continues that it’s a dance between honouring the child and where they are at and encouraging them to try to make a sound. You might just do it once. The words, action and affect come curated to the child. That’s how we bring meaning in that brings language to life in the shared experience. That’s where the joy and affect come, because they’re both feeling it. If they are looking at the play dough and trying to open it and say “open” and Marilee opens it, they’re both so happy, for instance. It creates meaning and increases the likelihood that they’ll say it again. It doesn’t mean they’ll do it every time, but they are set up for success, Marilee asserts.

Action Words

You want to focus on the action words, Marilee explains, because they carry so much power and affect like, “squeeze“. Again, the child is more likely to say the word when they hear that affect which makes it more fun. It creates an opportunity for them to be successful. Also, when you add the sensory element, they are not only hearing the word ‘squeeze’, but they are feeling it, too. It helps them understand the concept of the words, as well, Marilee continues. It’s building more depth to the words, affect and action. You bring more to it depending on what the child is showing you. Sharing emotion and intention gets them to the place of initiation. In the context of the rhythm, they’re more able to do that.

Preverbal Signalling Precedes Speaking

We want the parents to have that with their children, too, Marilee states. It’s a very intimate space, and we want that depth of relating and closeness. They learn it in their primary relationships first. So talking goes on the back burner to relating because we want them to have a wonderful quality of life, including having relationships that they value, which is about relating. Children on the autism spectrum can miss a lot of flow because their bodies are filled with so much sensation that doesn’t allow them to tune in to us so consistently. We want them to be able to share, gaze and sustain a loving gaze–which is different than eye contact. It’s about the child taking you in. 

We’re always working towards talking, Marilee continues, but this foundation is the priority. We do this from the beginning. We are mimicking what mothers do with their babies when they’re preverbal. We take whatever the babies do as intentional and have a conversation about it with affect, and putting intention on it in a ‘sing-songy’ way to keep them with us and get a flow going to let them know we’re there with them. Even with kids who are already talkers, it’s the same, Marilee explains, because often they aren’t in tune with the rest. She will still wait, slow down and attune. Sometimes the verbal kids are so tuned in to the auditory channel, they miss the visual and affective pieces. It helps everyone regulate, be present and more effective, she offers.

Checking in with Families

When going into a home, Marilee also wants to bring very little with her in terms of props or toys. She goes with what’s there, and sees where they end up. It’s a set of skills to learn doing home visits. It allows the parents to take the ownership of what to do or where they’ll play. What Marilee has learned over the years is the importance of checking in with families and talking about celebrations and challenges. 

What was their favourite part? Hardest part? What do they want to think about for next time? What she thought might differ from what the parents thought, so it gives them a chance to talk about it, and talk about where they want to go for next time. These descriptions echoed for me Mili’s story about meeting the parent where they are at, and Joann’s story about learning to connect with the child from a couple podcasts ago. 

Communication-Action-Affect in Action

In my ICDL presentation last year, I showed the video of my son and I playing with the box of tissue. I modelled the action words, “flipped it over” when he kicked it and it flipped onto the floor of the passenger’s seat of the car. He had so much fun watching it flip and I used so much affect, that he remembered it due to our shared joy. The next time we played that game, he initiated that experience again with, “I want to flip it over!” Communication-Action-Affect in action! I also shared how he always remembers the words that have affect associated with them like when we were at homes to see the owners’ model trains and a guy exclaimed, “Oh! Come on!” angrily when his train derailed.

The ‘Onus’ is ‘On Us’

Recent advances in educating the public about autism, including Steven Silberman’s book, Neurotribes and Damian Milton’s Double Empathy paper, have shown us that communication is a two-way street. We need to be the ones to enter the autistic child’s world and meet them where they’re at. Relating is the pivotal foundation for communication. There’s a whole shared world of fun in following a child’s lead, Marilee says, like how I had fun with my son and a box of tissues. Instead of scolding him for kicking the box, I followed his lead and we made it into a joyful, fun game with a continuous flow of back-and-forth communication.

We learn what we care about, Marilee states, in her ICDL Newsflash about W-A-A: “Our desires activate our sensory system, emotional system, motor system and communication system and move us through development to achieve our goals. These signals connect comprehension to affect and create meaning within the context of shared experiences.“
We are drawing the child in by following their desires and through W-A-A we are anchoring their attention with ours. When we like something, we will be affectively invested in it and engage our whole system in it. It applies to relationships, too, Marilee continues. 

The Vehicle For Learning

Sometimes people want to take the main interest away from autistic kids because they think they should be doing other things instead of the same thing all the time, but this main interest is calm and organizing play for them and can turn into ideas. Going with their interests is so important starting at the sensory-motor level where it’s calming and organizing. It evolves and can create professions for them in their adult life. Their love of their thing is a vehicle to other things. 

I gave an example of how my son is currently in his ‘everything Mario Kart’ phase. At his day program, he refused to have suntan lotion sprayed on him. The teaching assistant said something about needing to put the spray on the Mario Kart cars so their paint is protected from the sun. My son instantly lay down and let them spray suntan lotion all over his body. The other day, he even asked for his paint protection before going outside to play! It amazed me how much his love of his main interest was a vehicle not for learning in this case, but for doing something necessary that would otherwise have been seen as a sensory challenge (not liking the feeling of the lotion on his body, for instance).

Marilee says we can’t always assume. We have to be curious and see where it takes us. It unlocks things that we can’t imagine. It’s important for parents to have that openness over the worry with their child as well. I added that it’s always a trial and error dance. The way the teaching assistant said it to my son as well must have made him relaxed enough that he wasn’t scared.

And in terms of getting that connection with a child, adding in a sensory component is often so crucial to getting that engagement, too, as Marilee said. In my kicking the box of tissue example, my son got to kick, had the visual experience of seeing the box flipping through the air and feeling that cause-and-effect. This is so different than being in a seatbelt at a table at age 2 being drilled with photo cards to label pictures like his first speech and language therapy sessions nine years ago!

We’re Wired to Relate

As the speech therapist, you have to be open to ups and downs, Marilee says. Sometimes things work, sometimes they don’t, and she helps to bring understanding to the family as well. You also have to be ok with a meltdown when it’s another person’s child in their home. We have to remember, she continues, that babies feel before they think! That’s how we tune in to babies. That’s how we know if it worked or if it didn’t. We can see the connection between emotion and sensation right there.

It’s similar to kids Marilee works with sometimes, she says. When we know babies can’t talk, we turn in to the non-verbal cues more intently. We need to do the same getting to know a child, especially when they’re distressed and not feeling safe. We need to wonder how we can help support them. We’re wired to be in relationships. Babies need their parents to survive. We’re wired to relate. This is what she aims to do in her sessions with clients.

Thank you to Marilee for sharing her insights and experiences with us around mobilizing with Communication-Action-Affect in Floortime. If you enjoyed and found it useful and helpful, please share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below. Let us know how your practice tip went if you try it out! Also, if you enjoy these posts and podcasts please consider becoming a Member of Affect Autism for as little as $5 US/month to help keep the podcast going. Much appreciation!

Until next week, here’s to affecting autism through playful interactions!