PHOTO CREDIT: Jason Leung
Mary Beth Stark joins us this episode from Atlanta where she has been a speech and language pathologist for over 40 years at Floortime Atlanta and is a DIRFloortime® Expert Training Leader. Our topic is about pre-social abilities as pre-communication which gets into reciprocity and the development of communication. This is an update of an older podcast episode we did at the end of 2019 and is replacing it with new insights.
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Early Floortime
Mary Beth says that she was lucky enough to be a Floortime therapist right out of graduate school about 45 years ago, so she never did regular pull-out therapy. She’s always been play-based and always worked with parents. In playing with kids and following the DIR® model–which is about joining with them and building a relationship and looking at their individual differences–she has always approached therapy that way.
In the 1970s, Mary Beth shares, Dr. Stanley Greenspan’s work wasn’t very well known and following the child’s lead was unheard of. She was in a public preschool where the goal was to get the children to say, “I want cookies. I want milk.” If they have the motor ability to do it, they’ll imitate you to get the cookies and milk, and that’s a wonderful thing…on paper.
What Mary Beth found, though, is that those kids weren’t really looking at her and weren’t really realizing that they were communicating. They knew that this was what they had to say to get a cookie, but didn’t understand the social interaction piece of it. She did notice, though, that she got a lot more social interaction without words when she ripped paper towel in front of a fan.
The kids were looking at her and smiling, and they were running off and getting the pieces of paper towel. That was more satisfying to her and to the children, and out of that was how they learned how to communicate–not with the words when you’re not ready to use words. It’s about the interaction before the words, Mary Beth stresses.
A Model for Social Thinking
Over time, Mary Beth has looked more in depth at how the ability to use words comes into play. Many speech-language pathologists still just want to teach words or give kids a device to use words, which works for some kids. However, others are only able to memorize and use the device for things they’ve been taught to use it for. That’s not communication, Mary Beth insists.
Communication is a skill, and a social, living, dynamic process that is all about these pre-social skills that set you up to use words, Mary Beth explains. Floortime is a model for social thinking which is a social cognitive skill. It’s the process of interpreting and understanding what the thoughts, feelings, intentions, and behaviours of other people are in a social context.
We start to realize what others are thinking and what our impact is on other people, and this is where the real power of communication is.
In her experience, Mary Beth has found that kids who don’t have a strong ability to socially think are the kids who will use language to get their needs and wants, and to regulate others, but not to talk about an idea, or what they did yesterday, or what makes them happy or sad, or what they really like–this is the real power of communication.
I asked Mary Beth what she meant by regulating others. She means they use words to tell other people what to do. If you offer them something, they’ll push you away if they don’t want it, which she refers to as regulating another’s behaviour. Autistic kids are not shy about letting you know if they don’t want something, I added.
But even with the kids who do that, Mary Beth adds, it’s important to let them that they are heard and say, “Ok! I’ll get out of the way!” Then about 10 seconds later, get in their way and again say, “Oh! I’m sorry. I thought you just meant that one time!” This sets up the interaction and that there’s another person there.
That holds a lot of weight when they realize there’s more to this. It helps them realize that yes, she’ll get me what I want, but maybe she won’t. And you always do this in a fun way, Mary Beth insists.
TIP
Sensorimotor, emotional, language, and cognitive development happens simultaneously in neurotypical children. But if your sensory system is not developed, it’s going to affect these other systems, so you need to look at each child’s sensory profile, Mary Beth says.
BONUS EPISODE
Members of Affect Autism and the DIR® Parent Network have access to the bonus episode with Mary Beth where she does a mini “coaching” session with me about working on communication with my son!
The Development of Social Thinking
The development of social thinking starts before babies are even born, Mary Beth explains. When they’re in utero, they can hear their mother’s or father’s voice and although they can’t hear the words, they can hear the tone, melody, or intensity. They hear speech and they can hear that there’s stress at the beginning of important things. If the mother sings, “Bah bah black sheep,” they hear the stressed phonemes and realize they better pay attention to that. They’re starting to realize what’s meaningful.
Social thinking is about knowing your impact on other people and their impact on you. In order to know that, you have to be a pattern detector and you have to have an idea of what your own and your parents’ patterns are. When they are born, babies are reading the patterns of others, Mary Beth continues.
Newborns have varying sensitivities, but they all read what is comfortable in their environment and what isn’t. They don’t focus on one thing singularly. They hear sounds with movement, and lots of things are going on. They take in all the information around them.
They can then file each part of that experience away to know what they like and don’t like. They may judge the slam of a door as something they don’t like, and simultaneously they startle. They have a sensory experience, they judge it, and have a motor pattern simultaneously, Mary Beth explains.
Functional Emotional Developmental Capacity (FEDC) 1: Self-Regulation and Interest in the World
Caregivers also have varying nervous systems and varying capacities to be parents. Some are ready for the new parenting experience, and some aren’t. Caregivers are all looking for connection, though. Newborns are looking for someone to take care of them and feed them–someone to connect with. Who is going to keep me safe? They’re both trying to figure out their patterns, Mary Beth shares.
After 8-12 weeks when a baby has a feeling in their stomach and cries, this person comes in and they get fed. What a wonderful thing, Mary Beth exclaims. When they have this feeling, they can start to expect that the caregiver will come. This is a part of social development. They have expectations and start to come together with the caregiver.
Functional Emotional Developmental Capacity (FEDC) 2: Engaging and Relating
When the baby’s nervous system has developed and they aren’t alarmed by new experiences as much, they are able to spend more time just looking at their caregivers and forming a relationship with them, looking at their face with an eye gaze, with the caregiver making noises that are appealing to them. This is the start of engaging, referred to in Floortime as “the gleam in the eye.“
In therapy, Mary Beth sees this in a child as the realization of, “Oh. She gets me.” We tend to not give as much importance as we should to this: connection. They are being cared for because somebody loves them and is interested in who they are. Someone understands them and listens to them. It becomes more and more important as they get older, Mary Beth states.
I pointed out how there is a learning curve when the caregiver sometimes gets you and sometimes doesn’t. Over time, trust builds as you see the caregiver’s efforts who is trying to understand you. Mary Beth says that you can notice when your caregiver doesn’t do what you expect and you cry, and the caregiver comes in to soothe you. The baby’s nervous system calms down again. It’s huge to be able to deal with unexpected things. The baby learns that they can have this big feeling, then get calm again, and move on. This is co-regulation.
Functional Emotional Developmental Capacity (FEDC) 3: Intentionality and Two-Way Communication
When we look at engagement and the baby gets the gleam in their eye, they still don’t have control of their bodies yet, Mary Beth points out. The parents are holding the baby so they can look in the parent’s face, supporting the social and sensory systems of the baby. They can watch when the parent smiles and moves their head.
The baby may look at the parent and the parent smiles, and if that’s too much, they look away, but they look again. After a few weeks, they’re doing more than just looking. They’re becoming part of the interaction. When the parent smiles, the baby smiles back. It might be imitation at first, but then it’s interaction.
Mary Beth continues. Usually it’s the parent who initiates and the baby responds. Then, as the nervous system develops, these back-and-forth interactions get longer and longer. There’s been a lot of research going on about what’s happening when the baby is looking at the parent’s face or when they’re batting their arm. The brain rhythms are synchronized during these interactions.
This back-and-forth helps with later social communication and interaction. When you’re in that with a baby, that dyadic interaction, you can call it reciprocity or spirt or connection. You can call it quantum entanglement. Dr. Stuart Shanker refers to it as the interbrain. It’s something to behold, Mary Beth asserts. It’s to be present in and enjoy it because the baby enjoys it, too.
Beginning reciprocity is all about what are called ostensive gestures at 3 to 6 months old. The only gesture talked about seems to be pointing, but these ostensive gestures are very important for later social and language development. They involve pitch, melody, vocal intensity, and eye contact. Babies catalogue what these mean. People tend to dismiss that because babies aren’t in this for a lot of time, but it sets them up for being able to look at a face and see the differences, and eventually read a room.
Functional Emotional Developmental Capacity (FEDC) 4: Complex Communication and Shared Problem-Solving
When you look at pragmatic language development and being able to “read a room,” Mary Beth explains, you know you have to be quiet in the library, but if you see everyone running, you’ll run, too. But there are some kids who learn the rule that you can’t run so they won’t know what to do.
This “reading of the room” begins in FEDC 4. If a child goes down a slide and bumps at the bottom, they immediately look at the parent to see their expression to see if they’re ok. This is a big part of being able to understand your own emotions.
You also see in your parents a wide range of emotions and you can attach the way a face might look to how you might feel, and vice versa, Mary Beth continues. When kids have a hard time with that, we tend to label their emotions for them, but we might get it wrong.
If they cry and we say, “You’re frustrated” but they are actually hungry, this can be very confusing. Mary Beth will instead say, “Boy it looks like you have a big feeling.” That sense of what you feel inside is the sense of interoception–knowing when they’re hungry or having to go to the bathroom. If you’re hungry and you’re being told you’re frustrated, that’s confusing.
In this two-way interaction, Mary Beth explains, kids start to learn the skills to use when it’s a three-way. It sets them up for the ability to deal with their own emotions and to notice that their parents have different emotions. It doesn’t happen when you start labelling emotions. It starts earlier than that, she says.
Therapeutic Considerations
Parents may wonder how to do this with their kids who might struggle with groups of kids where they have constrictions in those lower capacities that we need to strengthen.
Mary Beth sees three-year-olds in therapy. Are they regulating? Are they calm and attentive in their bodies? You can look calm and not be regulated. Are they interested? It’s important for them to have fun and think, “That lady gets me.”
When they are 3 months old, Mary Beth points out that nobody says, “Look at me.” It’s not about teaching a child. It’s about enjoying the child. If a child in therapy happens to look across the room at a ball, you grab the ball and ask if they want the ball. They’ll let you know if they don’t. They’re fabulous as they are. Do not do the practice of “withholding” until a child makes a noise! That’s not good development, Mary Beth stresses.
In working with kids who are nonverbal or are verbal but not really engaged, you want to get them connected, Mary Beth says. It’s about the affect and smiling. It’s about not talking, or talking and then pausing and smiling. It’s how you start that back-and-forth interaction.
If they want to talk about dinosaurs, you can’t think of anything better to talk about. Kids who tend to talk about one thing and don’t give anyone else a chance will begin to get reciprocal if you show interest in their topic of interest, Mary Beth emphasizes.
Understandable, caregivers want their kids to talk about other things, but they won’t talk about other things until they see the value in talking about things, in general, which is about joining them where they are.
Floortime Is Not Teaching
This is hard for some parents new to Floortime: that it’s not about teaching these skills when it’s not developing in the way you think it should. It’s hard to use your affect, join them where they’re at, respect their individual differences, follow their emotional intent, and use the relationship to build these circles of communication up so they will eventually be more robust with you to eventually engage with peers, even through other emotions. If they’re upset, can they co-regulate off of another person rather than have a meltdown?
Fixing Communication: Intention
When we talk about the beginning of reciprocity, a baby learns to initiate, respond, to wait, and to come back, which are huge skills in being able to interact. They’re learning these things in a very sheltered environment at first as they’re just with their caregivers. As their reciprocity gets more robust, they can identify when communication breaks down and can attempt to repair it.
For example, if you have a 15-month old who wants something from the pantry and you go the other way, they’ll pull you to the pantry. If you give them the wrong thing, they will pull your hand and point to the right thing. That’s an interaction. They knew they had to fix the communication.
Fostering Agency
It’s helpful when a child is really motivated to give them a “break down” so they’re motivated to fix it, otherwise they realize my Mom will help me or someone will ask if they need help so they’ll just wait–which is fine, but we want to instill in a child that they have agency and can do this. We want them to demonstrate how they’re thinking by using their bodies and moving with agency. This is a game-changer, Mary Beth insists.
When you’re younger and in your mom’s arms, you’re not learning that she’s doing something different. When you get to know yourself and you have another spurt in what your caregivers do, you notice that they move with their own intention, Mary Beth explains.
Once a child can sit up, point, and move with agency, then look back to see if you’re catching what they’re doing, you are seeing the communication as they are becoming a more active participant. By watching you, they start to realize that they can learn from this person. She isn’t just someone to just get me what I want, Mary Beth explains.
From Dyadic Interaction to Joint Interaction
At this point, Mary Beth continues, you have complex reciprocity where you know others think differently, that you have your own emotions and you can handle them as do others, you have plans, and others may have different plans. You’re doing social thinking. That’s when joint attention comes in. You still have you and your caregiver, but now there’s a third thing. You might be both looking out the window, for example, she suggests.
When you have joint attention with somebody you have what’s called “a frame of joint attention” where if you’re on the floor playing with blocks, you know you’re talking about blocks. You share that frame of joint attention, Mary Beth shares. When they’re in their mother’s arms, it’s the baby’s frame of attention, but when they have joint attention, they can be in that new frame of joint attention. If they then need a diaper change, they can see that the frame of joint attention has changed. This is the level of joint attention. You start to “read a room.”
Here, Mary Beth explains, words are not only to convey a message, but are to get somebody’s attention. You can see the difference between using communication to get somebody’s attention versus to get what they want. A child can get to joint attention. Mary Beth does this by not immediately “getting it” when they say something.
Of course, when they are starting to say words, you want to get what they want to encourage the words. But if you stay with this, what a child starts to understand is that everybody thinks like they think because when they say, “car,” they get a car. They don’t think that someone else might be thinking something else and that they have to get the person’s attention.
Mary Beth has all of her toys on shelves. A child may see a cow on the shelf and ask for it. But as soon as she gets off the floor, they start playing with something else. She will just sit down on the floor again and when they notice there’s no cow, they’ll ask again. Mary Beth will say, “Oh, I thought you didn’t want it because you didn’t watch me go get it.”
What that does is it starts to get them to realize is that this lady is helpful, but sometimes she doesn’t follow through. They learn they have to get her attention and be with her while it happens to make sure she follows through. That’s a big thing about pragmatic language–to know what you have to do. You learn that you have to get someone’s attention first. Simply teaching pragmatic vocabulary doesn’t instill in them that you have to have someone’s attention first, Mary Beth stresses.
Thank you to Mary Beth for taking the time to chat with us about this important topic. If you found this episode helpful and informative, please consider sharing it on social media. And, stay tuned for a follow-up episode we’ll do on the topic of “conversation” in the coming months!
Until next time, here’s to choosing play and experiencing joy every day!
