In this episode, we dive into the principle of following a child's lead in various therapeutic approaches such as DIR floor time, and Ayres sensory integration. Tracy , Cory and Michelle discuss the origins of this principle, share personal anecdotes, and provide clinical insights on effectively implementing this approach. They explore the importance of understanding a child's perceptual qualities and developmental needs to create meaningful and adaptive therapeutic interventions.
00:00 Introduction
00:54 Following the Child's Lead: Concept and Origins
02:16 Practical Examples and Clinical Stories
42:43 Theoretical Foundations and Historical Context
32:06 Application and Techniques
53:29 Summary and Reflections
From the Team: We followed the audience's need by choosing this topic, and it was really fun to talk it over together. We hope our insights help you better understand the principle of following a child's lead. If you have any more phrases or topics you'd like us to explore, please send them in. We love hearing from you and look forward to our next discussion.
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REFERENCES:
- MWE space, Dr Dan Siegel https://drdansiegel.com/book/intraconnected-mwe-me-we-as-the-integration-of-self-identity-and-belonging/
TRANSCRIPT
[00:00:00] Michelle: Hello everybody. We've been kind of chatting about, where to with our episodes because we are listening to what, our listeners are giving us feedback about. We're also involved in, clinics of our own and mentoring other staff.
[00:00:16] And, we are experiencing people kind of grappling with some of the underlying principles of the, um, treatment interventions that we provide. So we thought we'd start to explore some of these principles, and phrases that get thrown around a lot just to make sure that we have a really clear and precise understanding that what these terms mean.
[00:00:41] So we hope that's helpful. If you've got any phrases that you'd like us to, chew over, send it all in on the various mediums and platforms and let us know, uh, what you're eager to hear about. So what I was eager to discuss today is this concept or the principle of follow the child's lead, um, which we hear a lot in, in various approaches that we use, like DIR, floor time and, sensory
[00:01:10] integration from Ayres.
[00:01:12] Um, being the theorist that I am, I was like, where did this come from? Who, who invented this or put this phrase together and, you know, how's it come to be in OT? Um, and not just OT, I know speech use it and it's across various models that are multidisciplinary. So, you know, that was my little itch I wanted to scratch. That may or may not be helpful for other people, but I kind of wondered how did, how did this become a really common phrase that we use and what actually, is it, what is it and what is it not? And how do we make sure that we, are using these principles in a way that have some integrity and validity and that are helpful in either the assessment or intervention, um, phase
[00:01:58] As you know, we're all a bit eager to be precise and effective in our, assessments and our interventions. So here we go. Trying to be precise about this phrase, follow the child's lead.
[00:02:11] Cory Trace, how's this sync up for you? This idea of follow the child's lead.
[00:02:16] Tracy: So I, I was thinking about it as you were talking and, and thinking about the first time that, I ran into like a really sticky moment actually related to this idea of follow the child's lead. So it's kind of a funny story that I feel like I wanna share right now. I had this mentor
[00:02:36] Michelle: I'm gonna follow your lead Trace. Go for it.
[00:02:38] Tracy: so I had this mentor for a number of years when I was doing research and this person didn't fully understand the work that we do in occupational therapy, but did a lot of training around working with kids, especially kids that were quite complex.
[00:02:56] And this person said, OTs are always just following the child's lead and they're just following the child around the room, and you really shouldn't commit to that kind of theory or that kind of therapy because it really, it just does no good. Like why would you just follow the child all the way around the room? And I, I kind of chuckled and then I said, well, I, I don't exactly know, like the therapist you've been watching or whatever. And I can tell you that this is a very misunderstood and easily goes astray concept. So the idea is never to follow the child around. But the idea is that your mind is attuned to what the child is interested in, in their own development internally.
[00:03:44] So it's this very intersubjective understanding of following the child's lead. It is not a literal following the child's lead. And so, as I said that this person paused and said. I didn't, I, I just thought you were playing. I didn't know you were thinking about the mind and all of these things, so it was just a hilarious moment where I kind of felt like to the naive observer or to the novice interventionist.
[00:04:17] This is a very elusive concept,
[00:04:21] uh, and it's one that I think deepens almost every day you practice for the rest of your practice, is learning how to deeply attune to what is the child's system, their body, their mind, their curiosity, their actual developmental trajectory. What is it that it needs?
[00:04:47] And so I often change the phrase from follow the child's lead to follow the child's need because I want the clinician especially, and also parents and educators and others that we're helping to deepen our connection with kids as a conduit of helping them. But I want people to tune into that level and understand that if a child's body looks like it is moving a lot that isn't sensory seeking, that's telling you something.
[00:05:19] And if you tune into it, you'll get the right message and you'll know exactly what they need. And as you follow that lead that need you make progress so much faster and in more authentic, richer, deeper ways than if you contrive goals that are to try to accomplish a developmental checklist of some kind. So this idea of following the lead, it can feel slippery and elusive, and it can
[00:05:50] make it look as if you're just sort of meandering, but you're not. And, I really am so excited to talk about this more from a clinical perspective and think about the struggles we've each had in learning this principle and in and embracing it and in helping it to come to life in our sessions, but then what we learned from it.
[00:06:14] So anyway, I, I just remember feeling so confronted by this person and then kind of realizing. Wait a minute here, just back up a little bit 'cause you're not getting it. And as soon as I stepped into I get it. Wow. That was kind of cool to realize that there is, um, it is a principle, it's a foundation, you know, and so anyway, I don't know what that, that's a funny story in a funny, in a way that's just a sort of personal for me,
[00:06:49] in terms of deciding that this is worth owning, you know?
[00:06:54] Cory: it's very classic, um, of you, Tracy, in my mind, around making a abstract and not well understood principle clear in terms of refining the way that you actually define the term so that the person that you were talking to could understand the actual clinical skill that you were using in doing that as part of your intervention. What it, I mean, I, in terms of your question around where did the follow a child's lead term come from, Michelle, I have absolutely no idea. Um, I, I hear it a lot in a lot of different spaces, um, but I dunno where it came from. So maybe anybody, I don't, I don't know if you know either Tracy, but anybody, if you do know, or maybe it comes from many places, and that's one of those, one of those things that every different place it comes from thinks that it came from there and actually just came from many places kind of all around the same time.
[00:07:56] But I'm super keen to talk about it in reference to what we do just in treatment as well, because I can distinctly remember watching a video, and I wish I could remember the context in which I saw this video, but I can't. I just, I think the affective shock of the video is the only thing my brain has remained holding onto. But I, I know that I was watching this video in the context of, um, following a child's lead. And this, this is an old video, thankfully, and this person, I don't know what profession they were, I didn't hold onto that information, but they were a clinician of some form and they were talking to parents and they were, they were working with this child in this video, and she was like, you gotta follow the child's lead, which in this video meant she just had the parents and her copy everything that the child did, and the child was on top of an. Uh, an exercise ball. It wasn't a very big exercise ball, but literally on top of the exercise ball, grinding his pelvis into the exercise ball. So she had the parents and her get on top of an exercise ball and do the same movements and motions as the child. And I remember at the time, this was a number of years ago, being like, I don't think that's following a child's lead. I just remember being like so shocked that that was the thing that this person was suggesting that was following a child's lead. And I was like, that's not right. And I, but I, I didn't, I didn't have like, which to be like, um, explain that in any way. Like you could Tracy to your person and I didn't have the possibility even to talk to this person.
[00:09:50] I was just watching a video. But I just remember being absolutely gobsmacked that that was what was being suggested as following a Charles lead. 'cause in my mind I was like, you're literally just copying the child. There is no change in the behavior. So that to me is not like, that's not following their
[00:10:11] lead, that's copying them.
[00:10:13] And yes, I will copy children if it creates a change in the behavior that was a more adaptive, you know, like if it allowed for something to emerge for that child, if that was useful for me to copy what they were doing, and it allowed me to achieve more synchrony with the child in some way that then promoted connection or whatever.
[00:10:34] But if it, if I'm literally just following the child around and copying everything they do and nothing from that, then that, that's not following a child's need. That's just literally following them around, like you said, Tracy. And no wonder this other person was like, you're just following them around.
[00:10:52] You're not really, because, and I know early on. Uh, you know, in treatment sometimes you feel like, you're like, oh, I just feel like I'm chasing this child. I don't feel like I'm getting into something deeper here. And so, yeah, I think in those moments it, it's trying to step back and say, well, what is the need that maybe I'm missing in the way that this child is engaging in the world?
[00:11:19] You know, and how, how what I'm doing is maybe not meeting that and then I'm not able to sort of support the way that their developments are merging in a certain way. But I mean, I know Michelle, you've just like, sort of been diving into the DIR world a little bit more recently, so did you have any, I don't know, epiphanies around this space or what about you?
[00:11:43] Michelle: Wow. What I am, I'm doing two things that has it front of mind at the moment. I'm, um, working with some OTs that are kind of getting, the next level of, experience and embodiment about what this means. So I'm trying to really show videos and pause and go, well, that, you know, this is some decision making that underlies what's happening here.
[00:12:08] Um, I did, uh, I have been deep diving into, um, DIR and I guess what's it's making, what brought to the fore for me is that it's this kind of backwards and forwards in and out, um, experience for me where at times, I'll be watching a child. So I assessed a child last week and kind of how this played out was me trying to, observe the child and they were a bit jumpy around the room.
[00:12:40] They were having 30 seconds here with one activity, one toy, and then moving on. And so I did sit back and watch. They were really tentative to me and, the whole family was there. And so I thought it was a really nice way to let that child settle into the room when they had been, really no interested in me. There was no eye gaze at the start. And you know, they were walking skirting around from me. They're only really young, under two. Um, so I thought, I'm just really gonna sit back, answer mum and dad's questions. There was a sibling playing and I was watching, watching, watching to see all the, you know, the little things that they were doing, how they were picking up things, how they were moving away from their sibling when they were too loud, how they moved to, keep their head in upright all the time.
[00:13:29] So I guess that was part of the idea of I was watching and making some assessments about what was happening and trying to kind of clinical reason what, what was happening for that child that helped me understand what the gaps were, I guess, and what the need was. So then I did get involved when I thought they looked more positive and playful, that I was going in and trying to join them in play and have, you know, some shared attention. So it was a bit more parallel play and I was copying them at the start, you know, they were banging on a thing, so I was banging on a thing and seeing if, you know, they looked at me
[00:14:10] to, we all looked at the object. I was banging, so they knew that I was in their space or not. Then I tried to kind of turn, take and see if I can have their hammer, you know,
[00:14:19] then they moved away. So it was like, okay. So then it was back into my brain, like I was trying to be really present, that it was this process of watching, watching moving in, and intervening based on that, clinical reasoning that I'd done testing something out and then, you know, seeing what happened then.
[00:14:40] In this case a child moved away and so it was like right then I kind of came back and gave them space watched and saw what they were doing and thought, right. In my mind I was thinking, okay, I'm gonna come at it differently this time. And so I'd move in and, you know, try to engage with him in a different way.
[00:14:56] But for me it was, this just felt like, when I'm thinking about this concept, there was a real active and passive, um, components to it where I was more really watching and trying to make sense of, you know, what was happening for them. Clinical reason, make decisions about what I was gonna do, and then get really kind of more involved and active and then coming back, you know, and, and doing that again, testing it out, making a theory.
[00:15:24] Planning an action, um, doing it and then seeing how it would unfold and if it was positive, you know, you keep doing that again. It was like, right, I'll, I'll keep going, I'll keep going. That's working. That's working. It's more adaptive. They're more engaged with me now. They're more masterful in the object they're playing with, or, you know, playing in more complex ways.
[00:15:44] And then when it didn't, it was like, okay, I gotta come back. And, you know, in that session, in my mind, go, right, okay, plan B, what's happening now? So for me, it's both a process and it's just me in and outing. I don't, that is not a proper term.
[00:16:00] Tracy: no, it is a process. You're following the lead, but you're also kind of, so there, there's a few things that you're following within the lead,
[00:16:08] right? So first for all of the theories, and we can talk about this maybe in a, in another episode, is like a foundation. And, but that is that if, if the child is a bit more regulated and engageable or engaging in anything, what, whatever that happens to be following that lead is really different than if they're more disrupted or struggling or dysregulated. And following that lead is also really different. So one of the things that we have to situate in our clinical approach is, , really meeting the child and helping to hold the space regardless of sort of what that foundation is. But then we're always having in our mind and in our felt experience of, having that sense of the 'mwe' space, as do,
[00:16:57] as Dan Siegel calls it, right? Regardless of whether the child's more regulated or dysregulated, the level of, the US being with is a part of following the lead. So, even if the child is quite hesitant or remote or unfamiliar with us, we're gonna be very respectful and aware of, of their, their edges and boundaries and openness to us, or. Or worry about us or any of those things that may be going on for them. But what we're doing is we're looking for what is of interest in pulling them
[00:17:34] into any level of engagement, into any level of glimmer, of any level of, repetition, of a, of an action that was meaningful, whatever that happens to be. And what we are doing in our mind is suspending our clinical reasoning so we can just stay wholly present and be with, we might be watching and waiting and wondering as some of the DIR or language models might say we might be, offering an opportunity and then waiting to see what happens. We might be, joining them. And I, I wanna mention a little bit about this idea of copying, just to get us all thinking about that in the same way. So we all know that if we copy each other in a way that's not tuned in, it feels super yucky. Kind of creepy almost. So when we're talking about meeting the child and. Following their lead and being with them and joining them. And we might repeat actions that they're doing and it can look like we're repeating them or copying them. But when we do it in this follow the child's lead kind of way, we're super attuned to the fact that we're creating a shared mwe space that we're inters subjectively sharing a moment and an experience. And so it isn't that we're putting something on the child, we're not copying them in a way that feels like we're mimicking them or even, um, distal from them, because if you copy without that affective sharing, it feels really not great, to any of us. So there's this affective connection that underpins the following the lead that's really instrumental in this whole process.
[00:19:27] And I think we want to convey that to everyone listening, that it's really about in the space of connection, we're tuning into what the child is interested in, what their system is interested in, and we're building that through the being with them and participating with them. And that's really what we're trying to go after here.
[00:19:53] And it's, it can feel so subtle to use all those words that I just said to actually do that. Uh, but so it isn't ever just following their lead. It's, it's deeper than that.
[00:20:07] Cory: Yeah. And I think Michelle, what you were describing, I picked up the fact that you were following their affective
[00:20:13] Michelle: mm.
[00:20:14] Cory: particularly around safety and not safe. And, for whatever reason that created a sense of, I, you know, a withdrawal for that child. You then followed their lead around the affective cues and the way that they removed themselves from that instance to know, okay, that's not where things are at for you. And then I kind, I think you, like, it sounded like you then pull, pulled the appropriate responses, the therapist around, okay, I follow that lead and now I'm going to take in your need and create a new hypothesis around what other ways.
[00:21:00] Might we create a MWE space? And then you would in the assessment, go and test the new possibility for, or seeing any particular skill that you were looking for, for that, for that child, you know, so, 'cause he was little, you might have been looking at any sort of shared attention or sustained reciprocity.
[00:21:29] You could have been wondering about posturally, if I'm in his midline, if I reduce the praxis demand, does that change the way that he shows up and how he enjoys the interaction? We space, you weren't just picking up the hammer and banging it on object just in the hope that maybe he'd noticed. You, I'm guessing you can tell me if I'm wrong at any point, Michelle, but like if you were coming in and he's, he's, he's exploring a quality and affordance of something and he is banging a hammer on a particular object for whatever reason, he's en engaging in that. And so if I was in that situation, I would really step into my curiosity around. Like, I can see you are doing that and I'm interested in that too. I'm, Hmm, yeah. I'm gonna bang it in the same way. Like, what do you think? You know, it's like a really intentionally, I'm trying to step into the mind of the child and then wonder if that will catch interest to their nervous system. The fact that I'm interested in the experience that they're interested in. And then, you know, if I can pull that in, if that does create that, then I can be curious around the possibilities of that object with them. And then they might take on some of the things that I am wondering about as well in that space or. They might be like, no mate,
[00:23:02] Michelle: I
[00:23:02] Cory: I'm not ready to do what you are doing. I need to do what I'm doing. And
[00:23:06] so then it's again, okay, I gotta follow your, need in exploring this object in this particular way, rather than me wanting to expand the way that you are exploring the objects. So it, again, it's always, it's like a, for me it's always a wondering around what offering do I put out there that is taken up
[00:23:32] for them and what offering therapeutically. 'cause the offering I'm talking about is. Because I am a little bit greedy sometimes in terms of wanting change in how the child makes progress. I'm always wondering about what's that next slightly emerging
[00:23:52] skill? What's the next little thing that might becoming available for that child and how could I offer something in the interaction, in the activity, in the predictability, in the novelty, in the whichever toolbox I'm gonna pull from in the sensation I'm, I'm gonna be coming back to my STEPPSI probably there, and I'm then seeing if that is taken up by the child and that's me following their lead. So. If I put the offering out around the curiosity of, Hmm, I'm gonna bang it this way, you know, um, and they don't take that up, then I'm not going to be like, no, we bang it like this. You know, I'm not going to expect that they do it the way that I'm hoping they would do it, because that's the next step Developmentally, it's like, okay, that wasn't the way to achieve that particular unfolding or whatever.
[00:24:52] You know, it's either they're not ready for that, or that just wasn't the moment to see if that skill or capacity might emerge. So
[00:25:02] like you definitely weren't passive. I just, I know what you were trying to describe, but I was like, you're not passive,
[00:25:06] Michelle.
[00:25:06] You're very active through the whole process.
[00:25:08] Michelle: Yes, that's right. I, um, but I kind of was sitting there and I guess I get to, I think every time we have a new client, new family come in and observe us, you know, I have that idea, Tracy, that you know, what happened to you? It's like, well, you are here to assess him get on the mat, you know, get over there for me for the child. Um, I saw him doing a wide skirt, you know, moving away from me. So my choice then was not to get engaged. My choice was that he needs space and then I'm gonna try and signal safety through his co-regulators. So I'm gonna engage with his younger brother and his parents and have them engaging backwards and forth with me, and feeling safe and him observing that so that he's like, okay, my co-regulators, my people think she's all right. So I kind of went through his people
[00:26:02] to go, yep, she's okay. I actually think he was picking up those cues that the parents and child, was starting to send about. She's all right, she's all right.
[00:26:12] She's reliable and trustworthy, and she's gonna be all right. And then I went, you know, to try and engage with him, my first step was that engage affectively with him. And it happened to be that he was playing with a thing. So I, you know, it was around the thing. He moved away. So then my next thing was around, okay, maybe space is a thing for you, so I'm gonna try and engage with you across space and not get too close.
[00:26:39] And then I, you know, we'll try that again. But he'd moved on to another item, so whilst he had things going on, my wondering was how do you relate to people? How are you engaging with people? You know, firstly it was a space dimension I had to think about. And then it was all, my affective tools, my voice, did I use a voice?
[00:27:00] Did I not? My face, my hand motions, I tend to be bigger, affectively. So it was like, right. Turn yourself down, Michelle. But it, for me, it's just suspending the action while I kind of test things out and gather some information and then test something out.
[00:27:16] So I'll look more like I'm in action. Sometimes it, you know, when they're better regulated and have higher capacities, it's lot more fluid and you're in it and you're making those moment to moment decisions, like you said about what does a child need? Do they need to firm up that foundational level of, you know, regulation, engagement, connection, or do they need to firm up their praxis skills or, you know, whatever it is.
[00:27:40] But, um, yeah, when they've got lower capacities, then I'm a lot more watching and moving slower and backwards. And I, I do feel like I kind of need to take time.
[00:27:53] Tracy: Yeah.
[00:27:54] I, I also think that there's this beautiful thing that's happening for clinicians where, you're always, ever present with the child. Even when you give space and you're over talking with the sibling or the parent, you're intentionally kind of still anchoring yourself, uh, as an available source of information and regulation and curious things that might happen, maybe joyful exploration, but you're really gently following how does that child's a affective system respond to all of that.
[00:28:29] And I think we always keep that sense of, I want you to feel awesome and safe and regulated here. This is a really good place and I'm gonna be a source of that for you. And so we, we have to stay like really present and attuned to pick up on the little subtlest things that might indicate their own interest and wonder in the world. And sometimes that can be very fleeting for some of the kids that we work with for a variety of reasons. I think what happens is as soon as we. We meet that little person for their wholeness and what is their little nervous system telling us
[00:29:08] Michelle: Mm.
[00:29:08] Tracy: We, we do have this ability as clinicians to be fully present with that child and available but also we're with our clinical mind. And in our clinical mind, we're kind of nominating candidate. You know, opportunities like you mentioned Cory, with the STEPPSI like, here's the things I might be able to hook onto here to create a different experience for us together in this moment. But we're also kind of going through candidate wonderings around why is development so sticky and tricky for this kiddo. As we're watching, we pick up on the subtle cues of what the child needs related to what their nervous system needs in terms of, maybe they just need a little bit more information about the affordances of the bangables so that that can turn into a richer action.
[00:30:09] Or maybe they need a little bit more sound quality from the bangables because resonant vibration is really anchoring them in space or maybe they need, that synchrony of exchange to happen so that the social space starts to be more available to them. So in our minds, for a child at the developmental level you're at, we start to construct like mini hypotheses across these different developmental functions where we are wondering, Hmm, where's that just right opportunity for this child?
[00:30:49] And so in the Ayres framework, the follow the child's need is connected to the just Right challenge because you're helping to create that opening to adaptation through really tuning into where they're at and what's interesting and appealing to their little wholeness. And then what does that bring about for them. But if we don't have that idea that it could be social or it could be in the affordance space in sensory discrimination or praxis functions, or maybe it's really around how they're regulating themselves and finding themselves in this space, or maybe it's about how they're finding their body and their posture. So in this way, knowing a field of thinking like the spirit gives us in the spirit tool, it gives you a way to kind of dance through in your mind and wonder in a way that is informed. So your curiosity is both wholly present and simultaneously informed clinically.
[00:31:58] And those two things together are really what guide you in following, in, following the child's lead.
[00:32:06] Cory: I was smiling because you moved into the question I had, Tracy, which was, I wonder how Dr Ayres thought about following, like, how she intended that. You went right there and I was like, I didn't even have to, didn't even have to ask it.
[00:32:24] But it did make me wonder. About following a child's lead in regards to the affordance exploration component of treatment, because this is really hard. So what I mean by that is if a child is repetitively lining up, uh, some toys or repetitively, tapping or banging or shaking objects, and as a therapist you don't quite understand why that particular behavior is occurring, like for what function is that occurring, you feel sometimes like you're not sure how to support the child in the moment that you see those behaviors. So I know we've talked about, well not on the podcast, but I've, I've talked about with you, Tracy. The affordance of that, activity for a child. But I think it would be so, so helpful to talk about that here together because it's really confusing and it's taken me a long time to understand what on earth, I still don't fully, fully understand affordances, but I'm a lot further along that, that line now than I was and it has been incredibly helpful for my treatment. So, um, I wonder if we could chat about that
[00:33:57] Tracy: yeah, so I think it's a really important one to talk about in the space of following the child's lead because if you just copy the child and do that, rotely it, it's often super unproductive and can actually be almost kind of. Unkind at its worst.
[00:34:18] So how, how I'm putting that in parallel to this is that if, if you have a child who's doing any of these repetitive things that any of us might do, and truthfully, we all do repetitive behaviors for different reasons at different times. But if a child is a little bit sticky on it, they're repeating and then they're repeating again, and then they're repeating again. I think you, you do want to notice what it is that they're deriving from it. And sometimes we have to be willing to get it wrong. We will get it wrong sometimes when we nominate these hypotheses in our minds. And that's okay. Like to give ourselves space to sort it, because sometimes it's a little bit more complex than it might appear on the surface. But the other thing is that we know that the primary drivers of most of these early kinds of behaviors in kids is either to help themself feel organized and support their regulation, or it could be that the information is not connecting in a way that builds to the next block of information. And that would be more when we think about the affordance of an object as having properties that give rise to skillful interaction at whatever level that might be. And for a lot of kids who struggle with that aspect of more of a perception based issue is that the perceptual qualities in and of themselves are interesting, separate from the relationship that those perceptual parts have to the object itself. And so in our brains, we construct wholes and parts and deconstruct whole to part relationships all the time. But for a lot of kids, they don't do that easily or fluidly. So if you look at a vehicle and it has wheels, you think of it as it's representational thing, it's a car or it's a train. And that's has a representational nature to it. You've learned it through language, through deferred imitation, through memory and meaning that's been infused to you, uh, from people, from books, from the environment, from experience and all of that but it's representational. And a lot of our kids are operating at a level that's below representational thinking. And so when they, when you look at a car, you can't not see it as a car. Um, but a kiddo who doesn't have representational thinking, they may not see it as a car, they may see it as a flat thing that has round things on it. And the truth is that that's oddly curious that a flat thing can have round things attached to it. Like that's weird. Kind of. It's almost like, uh, gravity is like a property. If you have a thing in your hand and you let go of it, it should fall. And if it doesn't and it floats. You would look at it forever and uh, and you would never stop looking at it because it's defying a property and affordance that is expected. And so a flat thing with round things attached to it is a bit odd. Also, those round things happen to move, which is intriguing, and you might get stuck on the relationship between the flat and the round. You might get stuck on the fact that the wheels turn, you might get stuck on a shininess to one part versus the other part. So these perceptual qualities for kids who don't have representational thinking are loud for them. They really are interesting to them, and they're often repeating things in that space to try to make sense of them in a non-linguistic way and in a non-representational or symbolic thinking way. And so this is a, a space that a lot of our kids get stuck in, and
[00:38:34] in that we have to follow their lead.
[00:38:36] We can't say, well just jump up here to representational thinking with me and let's play trains. Because they're not thinking of it as a train. They're thinking of it as a weird flat thing with round things that move.
[00:38:52] Cory: Yeah, I can, I can talk about treatment for this as well to make this a bit more tangible he's only young and he's, um, he has a genetic, disorder is what his official diagnosis is.
[00:39:04] But he doesn't have language. So it's, it's, um, interesting I mean that helps in the way that you can't really go super representational, although we still try. Right? So like, he'll be interested in the wheels or the whatever, and you'll be talking about the bigger object that he's interacting with, not the thing that he's actually moving, so he is picking up the car and he is turning the wheels and straight away. They go to the representational object rather than, oh yeah, that moves.
[00:39:36] Which is the perceptual quality that he's exploring. And so I then had a chat, um, to his parents around he, there's something in this for him.
[00:39:47] So I was trying to follow his lead, but I was feeling a bit stuck. I was like, how do I help him, um, find more adaptive like capacity here in terms of his praxis? 'cause he did really doesn't know what to do with his toys. And his mom's like, he doesn't know how to play, you know? And so it's a goal, like, I'm trying to think how do I help him here because he's stuck on just, um, the spinning component of many of the toys that he has.
[00:40:17] I'd had a chat to Tracy about this, and I was like, okay, I feel like I might be able to offer some support here. And so I talked to the parents, said there's something in this that he's interested in and trying to figure out, and I kind of tried to help them come back to the fact that these things move and spin and let's give him lots of ways to move and spin things. Like let's find all the toys in the house that move and spin and let's, um, explore this with him and, I was like, he needs to sort of figure this out as a thing so that it can become the next thing. It's until he figures out that these things move and spin, he can't then move to, oh, I could push it, which is a new action and it could roll, which is a different affordance, but it's kind of based on that spinning quality.
[00:41:06] So, um, then they did that and then recently, like he started pushing and rolling the ball to us. And so that was really exciting because it was sort of the first time I really knew what to do with that, kind of as a, like, as an a, I guess a developmental thing that sometimes happens and being able to follow his lead appropriately rather than what I had probably previously done, which was again, try to go to the representational whole object, um, with the child and see if I can get them to join me in that when what their need and lead
[00:41:43] that I should have followed was the fact that they were perceptually trying to figure out a quality of an object. Now I don't always get at that neat and tidy in terms of what perceptual quality are they trying to explore, because sometimes you don't, can't always figure out what is it that they're actually trying to figure out in the activity that they're doing.
[00:42:02] So, but that was so helpful.
[00:42:04] Michelle: I just jump in? Because in that decision making, we've all had similar cases, I guess, where, um, they may know that the, the new affordance is that becomes a thing that moves on the ground and they moves on the ground in different ways. So then they start, you know, pushing the things, um, on those spinning things, pushing a IE pushing a car or vehicles, um, in multiple ways.
[00:42:29] But they may still at certain times, pick up the, the object and start rotating those spinning things again.
[00:42:37] For me, that then shows that, do you know what, in part, this wasn't a affordance issue, but in part it's also a thing that they're curious about that might be self-soothing, that that. Perception of, you know, their eyes following the spinning thing or their fingers tapping repetitively.
[00:42:55] The wheel might have some quality there that is regulating for them.
[00:43:00] And then you know, it's got two functions for them. It might have, you know, who, what started first, who knows that it became a visual thing of interest or a, or a tactile thing of interest that evolved into, oh, that thing can move to a car.
[00:43:15] But when they keep coming back to that perceptual thing, then you know, you, you've answered another question. Then it's like, oh, it's got two functions for you. And once you, you know, you've had the first one of them answered, the affordance component, it still meets your need as being of interest, curiosity that might be self-regulating.
[00:43:35] Cory: a hundred percent. I did have one thing though, I wanted you to unpack with me, Tracy, which was in the back of my mind. So I've, I've have one component is I'm, I'm thinking about his need around the perceptual quality of spinning objects, and I'm wondering in treatment, how I can help satiate that or enhance that so that he can actually figure that out. And then the other piece that you had talked about was. Because it was transferring across many things. So the fluttering of leaves, um, spinning of objects, um, like any particular flickering or movement. So the second piece in my mind was the sensory integration element of, um, the visual vestibular kind of, I guess, integration around the particular perception.
[00:44:26] So I wanted you to help sort of unpack that, Tracy, 'cause I wouldn't not do it as articulately as you, it's probably not a word, but I think you'll be more helpful to, to articulate that. I'll know.
[00:44:38] Tracy: Yeah, so it's another level of kind of the foundation, if you will, of affordance is perception and the foundation of perception is sensory discrimination. And one of the important, sensory discrimination functions that comes online in the first, really solidifies in the first year of life is this, visual vestibular function where if my body's moving and something out there is moving I sort of know that I'm still, and the thing is moving or the thing is still, and I'm the thing moving. So you get this differentiation, where there's this stability field that comes from the vestibular ocular reflex integrating. And as that really comes together, it starts the foundation of our sense of self and our sense of self, and other, and our
[00:45:31] sense of self in the environment.
[00:45:33] And so the, it's based in the vestibular function it actually a very specific vestibular discrimination function.
[00:45:42] So we have a lot of kids where as, the next layer of development gets a little complex for them, whatever that is, maybe it's upright and reaching out into space, eyes, reaching from midline out into lateral space can sometimes challenge that. And what'll happen is anything that catches your eye or anything that actually moves in the periphery can start to become a little bit, disintegrative, if you will. So we all have to go through this process and really you feel it at different times. Like even recently I had a little virus that hung around for a bit and I had a cold and I had some pressure in my, head. And I noticed when I was driving that I was having a lot more of that kind of like, wait, am I, did I stop? Or is the car next to me moving? You know, that little vertigo kind of vestibular function. And it was really just from the pressure in my head, but I had to pay really careful attention when I stopped the car, like.
[00:46:45] I am stopped. I had to like take a breath and land that for a moment. So imagine if you're developing and you walk by a thing like a revolving door, you, you really cannot tell what's happening. If you walk by a fence that has many slats and the light changes as you go by it, it will catch you and you will have to walk by it 50 times or 5,000 times to sort what is that?
[00:47:16] And if we restrict kids from having the experience of sorting it, then what happens is that that then becomes dysregulating. It's like, wait a second. This is a basic thing. That person was holding a ball and they opened their hand and it didn't drop. I am curious about that gravity. Should function. So if I walk by the light and it catches my eye and I can't sort, where's the light coming from? Is it the light? Is it the fence? Is it me? Is it that? What is it? That curiosity is like a precursor to understanding language, to understanding representational thinking, to understanding how the world works and the child's curiosity around that needs to be supported. We have to help them to be like, yeah, what is that? And I'm gonna, you know, make the shadow change and be like, wow, what's happening here? And I'm gonna follow the child's lead and follow their need in that moment and help them to fill that knowledge bucket that's coming from not cognitive knowledge, it's experiential, sensory, motor based, embodied experience of curious understanding of how all these properties work. So affordances are properties, and for a lot of our kids, they just have a need to understand those basic affordances. What's shiny, what's not shiny? What's pickable, what's not pickable, what's squishable, what's not, what's movable, what's not, what's pushable, what's not, what's, you know, what can my hand do versus my fingers do?
[00:49:01] All of those properties of my body affordance are interacting with the qualities of the objects out in the world. And those objects that move in particular, are deeply fascinating and and hard to understand until you get enough of a schema about them.
[00:49:20] Cory: Mm. Yeah. Amazing. I wanted to be able to do both of those things for him in following the clues that he was giving me around the needs that he might have and following his lead. So I was trying to help his parents recognize let's come back to the perceptual qualities of these things.
[00:49:37] Let's in kind of enhance that for him, let's allow him many opportunities to just look and experience and do that. But also I was working on his vestibular discrimination, body awareness functions as well in my sessions because I want him to figure out where am I and where is the environment, and help him sort of discern that in a way that's useful to him, especially in relation to the way that he's trying to reference across space.
[00:50:09] And the way that he uses his eyes and anytime something moves too close to him in, in any sort of. Speed. It doesn't even have to be fast. It gives him a shock 'cause he's not able to track the objects of space coming towards him. So all of these things are like, okay, let me also work on that as a clinician because that is really where my job is.
[00:50:30] Like I really need to help you with this. This is where my training is really useful to you mom and dad, because that's not something everybody learns. And that really, I would do him a disservice if I didn't observe that and try to address that in my clinical sessions. Um, so, you know, the parents can easily, I can help them with unpacking the perceptual qualities and the affordances that maybe he's interested in exploring, and then they can run with that.
[00:50:57] But sometimes the vestibular piece in targeting that is trickier. Um, especially when you have individual differences in parents that can't spin or you for whatever reason, you know, you don't wanna, um, throw them into the deep end around, uh, experiences that may not be very enjoyable to the nervous system.
[00:51:16] But, so I, you know, I was doing that piece and sort of just holding him against me, spinning with him stopping and then orienting and catching and saying, yeah, we were spinning. And then just bopping him against my leg with a bit of rhythm to get probed through the spine, basically, to try and be like, here you are, you know, we're back again.
[00:51:38] Now let's give a little more input into different receptor. Let's come back re-organize around the midline. Let's go again. So that's kind of the two parts that I was thinking about in my treatment for him. But I'm curious as well, Michelle, about your little kid, I mean, your only assessment last week, but yeah, just any other thoughts you might have had around treatment for him or what might be going on in that space and following his lead and,
[00:52:05] Michelle: Yeah. , I guess I don't necessarily wanna deep dive into the particular child, but just this concept of follow the child's, need. Is just one that starts from the moment they walk in the door or you're gathering information from the family and you're starting this process of, getting to know them to really intimately know what's happening for you across all your domains and how does it come together and for the purpose of me, you know, really understanding you and then being able to share that with all the people around you so you feel, felt and seen wherever you go.
[00:52:46] And that, you know, that's our want that everybody kinda feels, felt. Um, and then, the next level for me is, you know, I'm as greedy is the best of them is what's coming up first? What's interrupting you the most? That really constant, watching and making a hypothesis about what's happening for the child. Working out where will I go in, where does it feel right? We use the spirit model to help us, really make a very detailed map about the child's individual differences. And then, based on my individual differences and preferences, we'll really work out where am I gonna go first?
[00:53:23] um, yeah, I guess it's the underlying principle of what we are doing in the moment.
[00:53:28] Cory: Following the need.
[00:53:29] Tracy: Yeah, so we were following the, the audience's need by doing a topic like this, and it was really fun to talk this over with you. I did wanna say from the very start of this episode, we said, where did that come from? And Cory, you mentioned that, you know, it came from so many places. I honestly
[00:53:46] don't really know, but I do know you read it in the Hannon literature for speech and language therapists. Um, I've heard it forever in the early childhood literature, just generally. So in most early childhood educational philosophies, it's often embedded there. Certainly air sensory integration has a particular bent on following the child's lead and the DIR floor time approach. And Dr. Greenspan, you know, would often talk about it, I think even more than Dr. Wieder would talk about it. It's also kind of centric to those early infant mental health days that Dr. Greenspan was trained in with, the Braselton group and different folks like that that were talking about it. But then I was, and I really don't know where it comes from, but I did see that it also, Maria Montessori who predates all of those people, it was actually a principle in that educational model that she developed. And I always remember, you know, that she developed that approach for really targeted, working with kids that had special needs and especially intellectual disability.
[00:54:53] So there's a wisdom to it that probably goes way back before that. And I, I don't know the whole history of it, but I find it interesting that we find it in all the disciplines there, is a, a wisdom to it
[00:55:06] You can come to trust and rely on, but it, it is informed and that's been fun to kind of hash out with you guys
[00:55:14] Michelle: mm mm. Awesome.
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