Returning guests, Clinical Psychologist Kathy Platzman of Floortime Atlanta and Infant Mental Health Specialist Colette Ryan, both DIR/Floortime Expert trainers, join me today to discuss constrictions in development, in the context of the Developmental, Individual differences, Relationship-based (DIR) model. Our children can have higher developmental capacities emerging while being constricted in the lower capacities, depending on the environment or other factors. We discuss why this is normal, go through some examples, and discuss how we support our children around these constrictions to promote their developmental progress.

Constrictions in Developmental Capacities

by Affect Autism

Functional Emotional Development

The Functional Emotional Developmental Capacities are the stages of development outlined in the DIR Model that describe ages that neurotypical children tend to master social-emotional developmental milestones. For children on the spectrum, the developmental trajectory can look very different. Each child’s progress is unique, but the framework is the same. We talk about where children are developmentally, how their Development is impacted by their Individual differences, including their sensory processing profile, and by their Relationship with primary caregivers. We haven’t so much focused on the idea of constrictions on this site yet.

While these capacities unfold, Dr. Platzman states, and we check them off on a list–meaning that they’re strong, robust, and dependable there, it doesn’t mean that they’re always there. Take the first capacity to stay calm, focused, alert in attention, behaviour and mood while staying vaguely connected to others no matter what is foundational but disappears for everybody when under duress. You lose your ability to stay calm, focused and alert while taking in information when under stress, Kathy explains. With children who are struggling to master their developmental capacities, it’s almost like a blinking light. The capacity will be strong for a time, then weak.

In Floortime, we’ll look closely at the why behind a child’s capacities being strong or weak in a given time span. It’s usually the first two foundational capacities that will abandon us under stress, Kathy explains. When the first two capacities are strong, magic starts to happen developmentally, she continues. But when you see the first capacity weaken, you’ll see attention wander, impulsivity, souring mood, and when you see the second capacity of engagement weaken, you’ll see a cut off of the child being engaged with you, and sometimes the practitioner loses engagement.

Constrictions in the Developmental Capacities

Colette thinks about constrictions in two ways. First, in the DIR Home Program, when talking about developmental capacities with parents she talks about ‘swiss cheese’. A child might show strength in imaginary play at the fifth capacity, but have some holes earlier in the development where they might not show engagement. It’s about determining where in the capacities the child is not firm and solid in their development. The other way she thinks about constrictions is in teaching DIR 201 and 202 Floortime certification courses where she’ll ask students to think about a child’s mastery in each capacity as mastered, constricted, emerging, emerging with support, rarely present, or not present at all.

In these case studies, a child might have some strength in a capacity, but a something is getting in the way of it being mastered. What do we need to do to support the constrictions? What are the supports and scaffolding that we need to supply to help that capacity get stronger and firmer? It can often have to do with the use of affect. We might have to tune in to their sensory system, for example. I gave the example of my son who has had constrictions at the first two capacities throughout his development. He might lose engagement if he is not interested or if something is too difficult due to motor planning challenges, for instance.

Thinking about Constrictions

There can be many reasons for constrictions in the developmental capacities. Reasons can include environmental factors such as noises or lighting, or being in a new place. They can include individual differences like motor planning, or can include relationships if a child is with someone unfamiliar, or if a familiar person is acting differently. Kathy says that they’ll first look at sensorimotor differences first which usually means that some sensory input is too much, or the demand for sequencing and motor output is too difficult. Children might need different levels of support at different times for different reasons, she explains. 

The ‘D’ is what we’re looking at and the ‘I’ is why something might be strong, weak, or different, Kathy continues. She gives the example that if she doesn’t get a good night’s sleep, or hasn’t eaten correctly, or just spent an hour in traffic, her sensorimotor system might be stressed and her developmental capacities might not be that strong. Colette adds that the ‘R’ is that some relationships have an adult who is really attuned to the child while other relationships might not have that attunement. Dr. Greenspan would talk about seeing the child in their best light by going to the home for assessments where the child is most comfortable rather than in a strange office with strangers under a time constraint.

I gave an example of a recent experience I had, in the last week, with my son going to see the new Paw Patrol movie at the cinema. He was very overwhelmed when we arrived and yelled, terrified, that he wanted to leave and go back to the car. I knew he really wanted to see the movie and as Kathy has said many times, I have “pennies in the bank” with him–that is, he trusts me, so I held him in the entrance hallway and I described how I co-regulated with him for 30 minutes until he willingly went to his seat and thoroughly enjoyed the movie. He has been talking non stop about it ever since and wants to go see it again.

Constrictions can surprise us

That incident with my son really made me reflect on how we know him so well and have made his life very comfortable and predictable, but when it’s not, these constrictions come out. It reminded me of Colette’s podcast with me about meaning making. Something about that movie experience was not what he expected and he didn’t have meaning yet for what that movie outing would be like. I wasn’t expecting it and it surprised me, but I was able to calmly hold him, reassure him, and talk about what was happening and what was going on, on the movie screen, until he felt calm and regulated enough and wanted to go to the seats and finish watching the movie.

Kathy pointed out that Dr. Greenspan would say how we need to provide firm boundaries in a warm and loving way for our children. We try hard to get symbolic representation so the child can begin to think about these things symbolically rather than having to experience them.

Floortime practitioners can work developmentally on lower and higher capacities at the same time as they get to be familiar with the child’s individual profile and where their constrictions exist and why. And Colette adds that knowing what your child’s constrictions are is such a gift to the child. When we know what is difficult for them, we can be prepared to support them.

A Floortime approach allows for a luxurious amount of time for meaning making.

Kathy Platzman, Clinical Psychologist

It’s a constant wondering of where is that individual in that particular moment, on that particular day.

Colette Ryan, Infant Mental Health Specialist

Dr. Platzman points out that my son’s idea of a cinema is now broadened because we could be patient and let him experience the new aspects of the cinema that he hadn’t expected, just like an apple might be green or yellow. The more experiences we have with different things, the less restricted our ideas about them are, Colette adds.

I shared how a friend of mine told me about a scene in Temple Grandin, the TV movie, where she went to her grocery store but the doors had changed to automatic doors. She stood there dysregulated and just watched them open and close over and over until she was able to go inside. As an adult, she was able to self-regulate until she was ready, whereas my son wasn’t yet ready to do that and needed my support.

It happens to all of us

Kathy reminds practitioners she trains that we are not all put together ourselves and can be dysregulated as much as the people we are supporting. She gave a hilarious example of having house guests whom she invited to make themselves coffee in the morning if they were up first, but they used her favourite cup and then chipped it! She was gracious and polite, but it dysregulated her the whole day and still bugs her to think about it. Colette points out that as Floortimers, we can say to her, “That must have been so hard” rather than, “Get over it.” We can join someone in how they felt rather than telling them that they should have felt differently.

How much support is too much?

I reflected on the difficulty for some parents to respect a child’s constrictions depending on their cultural or other expectations where one might have thought that if they paid money for the movie tickets, and the child wanted to go, that the child should go sit down and watch the movie, or they might have complied when the child didn’t want to be there, and have gone home and missed the movie. It’s hard for some parents to attune and really stay in the moment with their child. Then on the other hand, if you provide too much support and don’t let the child learn how to be independent, that is not ideal either.

One of the gifts of Floortime is that about 2/3 of what we do is mistakes, so we get really comfortable with over-shooting, under-shooting, but you have nothing to do but try, and it is always a good thing to reach to see if this kid is capable of something…A lot of this takes courage.

Kathy Platzman, Clinical Psychologist

For some parents, Colette adds, the doing for instead of doing with is a way of avoiding difficulties. In this case, Colette says it’s important to support parents to help their child take small steps towards independence, rather than just doing everything to avoid a meltdown. Kathy adds that sometimes we don’t have to do anything but just stay in the moment.

Factors affecting Constrictions

What are constrictions at one point in time might not be later in time. Those motor planning constrictions that my son had a few years ago have lessened. That is, he is able to sequence and plan a lot more actions than he used to be able to. I gave the example of neurodevelopmental reflexes that integrate over time. But even in the present, constrictions can vary.

Kathy does a scan starting with questions about general health, wondering if the child is in any pain, feels lousy, tired, or hungry. Colette suggested the acronym HOST (Hungry Overstimulated Sensory Tired) and Kathy suggested HALT (Hungry Angry Lonely Tired). All of these things can get in the way and cause constrictions. Kathy adds that children are used to living with the condition of their body and may not communicate when they are not feeling 100%.

New relationships, new environments, new lighting, a new way of sitting as kids go back to school, and the like can also cause constrictions. I gave the example of my son’s sour behaviour before a bowel movement that we don’t understand until he has a bowel movement. He was unable to communicate that he was uncomfortable. Now he is able to tell us when he feels a bowel movement coming on. So there are these physical pieces that include environmental and health factors, which includes interoception (i.e., what is someone feeling inside and do they know what they’re feeling).

Dr. Platzman explained that the journey of information in your body to information out of your body has three legs: Input through your sensory systems: registration, modulation, integration (are you getting the information that’s going in), then the information goes to your brain and you process that information. You may have a learning disability or a visual, auditory, or kinesthetic processing challenge. The nervous system shuffles the information and gets it to your brain and sequenced output is through your motor system. You could have constrictions in any of these three legs.

Colette adds that, as Floortimers, we have the gift of time where we can wait for a response while the individual takes the time to process. 

For many of us, our processing is like a four-lane highway, but some of our kids have processing like a country road, she explains.

That processing time to pull it together and get it out of your body. We wonder about that all the time as Floortimers.

Kathy Platzman, Clinical Psychologist

Kathy gave a great example of a client who would say, “Goodnight, I love you” to her child at bedtime and then leave the room with no response. One day she had to return to the bedroom because she forgot the laundry basket and she heard her child say, “Goodnight. I love you.” She reflected that she probably missed that response every previous night!

Other constrictions from mental health include family income, resources, and other demographics. If you have to come home in a traffic jam, you won’t be the most developmentally supportive parent when you walk though the door, Kathy suggests. But the joy of working with parents is that they know their children more than anyone else, she offers. 

Colette says that this is where cue reading and sending is so important. We know our children’s cues that indicate they are about to get dysregulated so we can take that foot off the gas. Kathy also points out that in my cinema example with my son, life provided the challenge rather than me challenging him, and I knew to co-regulate and support him. 

Challenging and Providing Support

In free play Floortime sessions at home where there are no distractions, you can often see peak developmental capacities and then you can challenge and expand within this very fun environment, with ‘pennies in the bank’ (i.e., within a warm, safe, and trusting relationship). Colette says that this is where cue reading and sending is so important. We know our children’s cues that indicate they are about to get dysregulated so we can take that foot off the gas.

Kathy points out that in my cinema example with my son, it was life that provided the challenge rather than me challenging him, which is a bit different, and I knew to co-regulate and support him. I pointed out that we never even got to the topic of following a child’s lead, which can also help support constrictions and allow us to challenge because we are supporting a child’s interest that brings them joy, which allows them to show their developmental capacities.

This week's PRACTICE TIP:

This week think about some situations that surprised you with your child and how you can prepare yourself for the next time you might feel unprepared for when the constrictions show up.

For example: Imagine what you will do to support your child if next time they show up at an activity they are used to and enjoy, something is different and causes them to be dysregulated. What back-up plan will you have? How will you co-regulate and stay in the moment rather than rush away to avoid a meltdown?

Thank you to Colette and Kathy for sharing their insights on this complex topic. If you enjoyed and found it useful and helpful, please do share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below. Also stay tuned for the next three-part series of podcasts featuring three different departments at Professional Child Development Associates (PCDA) in Pasadena, California, a DIR/Floortime multi-disciplinary clinic, that showcases the power that DIR/Floortime can bring to a service model for autism and developmental disabilities.

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

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