Monday, November 8, 2010

The Dance of Parent and Child

The Cradle of Thought-  Chapter two

“First there is initiation on the parents part, then a phase of mutual orientation when the infant is neutral or bright faced in expression and as the mother shifts to smooth vocalizations. Then a greeting where the baby smiles and moves limbs and the mom becomes more animated. Next is play dialogue when the mother talks in brief bursts with pauses and then the baby vocalizes, then the mother responses with changes in facial expression or further talk etc then the infant looks away, neutral or sober the engagement has been broken until next time.”

There is nothing sweeter than a baby….it is funny to watch *grown ups* with serious faces approach a baby and all the sudden they are smiling and making goofy faces! An important thing in that interaction that I took for granted is the co regulation as described above! You don’t think about those intuitive processes if development is following a typical path! Once my 2nd son and then my 3rd son were diagnosed with Autism, I knew all too well not to take anything about development for granted!! Those co regulatory actions would bring me to tears ( as my kids on the spectrum started to *get it*)

The following study was done in the 70’s and is so relevant to our kids! This is the starting point to where most of our children on the spectrum fall off the typical path of development. We must start there again, in a more deliberate, step by step process. Please read about the study HERE

You can’t help but see the importance of *feedback* in an interaction. So of course it makes sense that Hobson starts at this co regulation. This skill is present in infants and is the basis of their social foundations ( like perspective taking)! Makes even more sense that any Autism treatment should start at the beginning!! Restoring a child’s trajectory path would involve actually knowing what the original path was….when you want to restore something you want to take it back to the original. I wanted my children to be defined by who they are…not by their Diagnosis! Some incredible Ah ha moments happened on the way! One important revelation was until recently ( the last 10 years) the research done with children never transferred to how to best help our children on the spectrum. It was mostly based on behavioral techniques that work in the animal kingdom and even with us ( yeah…like…. what you YOU do for a Klondike bar ?) But the difference is, WE have the social understanding and our kids on the spectrum do not. This is why behavioral techniques are simply compensations to the bigger issue at hand! Updated studies looking at development and understanding that behaviors are just a manifest of what was lacking in development. Here is one study concerning a child’s that takes a look at development…

If we are going to be diagnosing children earlier on the spectrum , this notion of giving them skills without understanding the cognitive function of the skills is just building on an incomplete foundation. Obviously the earlier we can Diagnose a child, the more it makes sense to look at their developmental trajectory.

On pages 35 and 36 of the Cradle of thought ( continuing on co Regulation)- Never is the one partner causing the other to do something. One musician does not cause the other to play a note. In the same manner neither the mother nor the infant causes the other to greet or to attend. They are mutually engaged and both participants modify their actions in accord to the feedback they receive from their partner ( intersubjectivity).

My own children used to think of me for an instrumental purpose. They wanted their needs met. They are hungry or thirsty. Everything is about them ( ever want to say to someone, its all about you huh!) well with Autism, their neurology really makes that statement true. ..Dont get me wrong, they were affectionate then, but they could never really share with me their thoughts…I always wanted to know what was going on in their head!! My Perspective or Emotion do not resonate with meaning for them!. The * Personal engagement* and their ability to take on my perspective as well as understand theirs, was crippled in our interactions!!

In Michelle Garcia Winners’ book, Thinking about you, Thinking about me, she talks about what Social skills are. “If we understand that social skills involve social adaptability and the related social interpretation of others’ thoughts and desires, we realize how essential these skills are for not only interactions, but for situations such as quietly sharing space in a classroom or when working on a job”..She continues to say that “Our students ( children with ASD) tend to believe that the interaction is taking place for their own personal enjoyment and not for the mutual enjoyment of the group….they fail to realize they are always sending some form of communication when they are in close proximity to others.”

She makes note in her book “ Dr Gutstein, author of Autism Aspergers Solving the Relationship Puzzle, does an excellent job recognizing the basic attributes that serve as precursors for social relationships.”

Kudos to Ms. Winner for being a professional who *gets* that our children’s success is more than academic knowledge. Their success depends on their ability to be effective communicators, critical thinkers, and their dynamic ability to relate to others in this social world!

For that dynamic ability-Think about our own relationships…our interactions are a bunch of *misalignments* that need to be repaired as we conversate. Talking over someone else…that thought process. We are trying to regulate our feelings and emotions. Our relationships are built on understanding this back and forth interaction and the *why* of it. Our children are no different. Our children with ASD don’t have this piece. What then happens as with human nature is we start to overcompensate for this social deficit. I know I did…for YEARS! Bombarding my children with questions….trying to get them to learn as many skills as possible thinking that somehow that will transfer.

When my son was 8 it was apparent nothing was going to transfer and while he was *academic*smart, and could do just about any skill, he absolutely lacked the co regulation of relationships. This in turn made it difficult for him to understanding friendships, and most things about the social world.

So much of “The Cradle of thought” truly helped me to have a glimpse of the struggles that my children faced with that regulation repair!

On pages 38-39-two and three month olds were put in front of the television The screen shows the infants mother on screen looking towards the infant. The mother was facing the camera sitting in another room and she could also see the baby. Mother and baby were able to engage with each other in a very fluent manner. Then a disruption was introduced...there was a 30 second delay between events and THE two ends of the video cameras. When the baby watched the video camera she could see her mother responding to her actions 30 seconds before. This meant that the mother’s actions were not in tune with what the infant was currently expressing. This effect caused infant distress. It is not that the infant felt unattended, as the mother was attending.. but that the interactions were not intune

Reflecting on this, wow, lack of co regulation is huge with typical children! We, as parents do it so intuitively ( respond to our children) when a response is off and not in tune, like with Autism, it is a scary domino effect to the regulation.

Infants are highly tuned into people from the start. They have an active social life. It is unusual for people to be unengaged..even those who are shy. People who are shy are still thinking about the other person, etc

On pages 50 and 51, Hobson talks about the *inter* personal engagement effects…a study with different children with ASD He did his best to be relaxed and engaging to both children on the spectrum but saw through video that he was less outgoing and more hesitant with the children who did not interact.

This is so true to be our human nature….if I am talking and someone appears disinterested, the thoughts in my mind are like, alrighty, they aren’t listening and don’t care! C yaaaaa…

He ends the chapter with explaining that we all have the basic human response to express our feelings to one another… a response that is more basic in thought. If someone lacks the basic direct access to the mental life of others, how would someone arrive at an understanding that people have minds? How would their thinking be affected? There are forms of interpersonal engagement that happens before thought…Could it be that such engagement also provides the basis for thought. I say, absolutely! Every child can reach this engagement if given the *map* of their own developmental misstep…

I know for our family, Once my children mastered this engagement, their social understanding was able to be built upon a solid foundation of development…which returned them to that track…and more importantly, to me!!

I will never look at typical development as *simple* again!

How about you?


Monday, September 27, 2010

The Cradle of Thought- Chapter One

In the preface of the Cradle of though, Peter Hobson asks, when we watch a baby interacting with their caregiver, are we merely watching her body, or do we see her mental state? What is she experiencing?

What I enjoyed about this book was how Hobson bridges the mental life of babies with exploring the origins of thought and how this typical development is affected in our children with Autism.

If we look at the mental life of babies, we don’t see language. We do see communication in the form of social engagement that clearly is effective in communicating with words. This social engagement links us together, sharing one another’s perspective.

From page two, I quote “ Social engagement is what provides the foundations for language. Not only does it serve as a motive for language to appear in the first place, But in the structure of what is exchanged between one person and another…

We know all to well that children on the spectrum have a hard time communicating ( even if they are talking) So in essence, Autism shows us what happens when this Social engagement is developmentally missing. And this is the topic of the Cradle of thought.

I just want to say, this book was copyrighted in 2002. The founder of RDI ® took the information from this book, and others, to bridge the understanding of that breaking point that caused our children’s neurology to be affected. The *theory* was then researched for a functional solution to help our children. By making the core of the foundation of RDI about Social engagement and thinking ( not skills, or behaviors) we are in essence *remediating* the Autism itself and not just the behavior created Because of the Autism. I can mention here also that Mr Hobson is involved with numerous research studies for RDI and its effectiveness to get to the core of the deficit in Social engagement.

As we go through the chapters in this book, we will be exploring perspective. The ability to give our own and to share with another person. We are going to talk about Flexibility and imagination. Our *socialness* has a huge impact on cognitive development of the neurodevelopmental system. By the time our children are Dx, they have been struggling with this development! They are struggling with understanding Perspective!

On page 10 of Chapter one Mr. Hobson touches on mother and child. What I took from his words were the lack of meeting of hearts and mind that we, as mothers depend on. We need the back and forth communication. I remember with my own children being so excited for that first smile, that togetherness without saying a word. Waiting for that connectiveness or losing it with regressive Autism ( I have experienced both) was just crushing!! And not just once, but twice. The heartache was just unmeasurable when I think back!

He continues in his  review, methods of clinical descriptions and touches on the ''compartimentalized brain'' theory. Where treatments have been tailored to specific regions of the brain- Not we'll work on language, now we'll work on social... They can't be separated, and as Hobson explains, it may cause more difficulty neurologically in terms of integration.

To restore a child’s developmental path we are not changing the child, we are restoring their developmental path. This is an important note because social engagement and thinking is a dynamic process which compliments each individual child’s personality. Restoring their pathway lets them be who they are without the additional struggle to understand the social world.

The connection within our own mind and how we perceive one another by thought and action is our “Social Engagement” When we look at how to help our own children, We need to grasp what typical look like within developing Social engagement to be effective in both short and long term goals.

Hobson ends the chapter with this quote-

And so we know our ultimate aim: to understand how nature dovetails the human infant’s innate capacity for social engagement with what a caregiver provides, and thereby creates an interpersonal cradle for the growth of symbolic thinking. P. 28

And so here we start..Understanding what goes right and then focusing on that to know how to help our kids with Autism!


Upcoming- Join me for the next blog on Chapter two- Before thought.

Sunday, July 11, 2010

The Principle of Perspective part two

Joining me for this post is Dr Bob Sears. In addition to being a husband, father, and an incredible pediatrician, He is the Author of “The Autism Book” and the Director of TACA’s Medical Advisory Board. He is also on Facebook. :)

Hi Dr Bob, Thanks so much for joining me for the beginning of this series! I am very thankful for your book and how you present the Bio-medical information for our families…and for the fact that we can then take the information in the book to our own doctors! With that, I am curious on what made you decide to get more involved with *Autism* within your practice?

Dr Bob- Ten years ago a parent brought her daughter into my office and asked me to help her with some treatments for her child with autism. Her ideas sounded “crazy” to me at the time, but I’m open minded and like to help. So I started investigating what she wanted to do for her child and it made sense. I trained with some open pediatricians who were already treating autism, and the rest is history.

KD- On page 61, you wrote “I believe that parents should not wait around for the mainstream scientific world to tell them what to do for their child. Yes Science will give them the answer someday, but that day will come too late for those reading this” I love this statement Dr Bob, because it shows how there is a bridge that needs to happen between evidence based medicine and validating what parents and physicians see with their children and patients. Can you briefly talk about Leaky Gut and Vitamin, Mineral, and nutritional deficiency?

Dr Bob- Leaky gut occurs because the intestinal lining is so irritated by inflammation from allergies and bacterial/yeast overgrowth that it acts like a net with holes in it. The net is normally only supposed to let digested food into the body. Instead, larger particles of undigested food (which are more allergenic) and toxins (that normally should pass out in the stools) are absorbed into the body. Vitamin and mineral absorption is poor and the child can because deficient in various nutrients.

KD- Great, and I know you go into detail about Leaky gut in your book. I also wanted to ask questions about the first five supplements to start as you mention in your book.

Dr Bob- The five primary supplements that help replace what most kids with autism are deficient in (or that are designed to help improve the neurologic and metabolic deficits that exist in most kids with autism) are digestive enzymes (to help calm down the leaky gut), taurine (an essential amino acid needed for a variety of metabolic functions), omega-3 oils (which help with inflammation, gut function, and neurologic function), multivitamins/minerals (to replenish deficiencies), and probiotics (to help make the gut a healthier environment).

KD- I can really relate to your recommendations. Enzymes and Probiotics made a huge difference in my younger sons body chemistry! My younger son who is now 9, was also Diagnosed with Low muscle tone like so many of our kids. Can you review some of what is in your book concerning this?

Dr Bob– Many kids with autism have low muscle tone. This is hypothesized to be due, in part, to dysfunctional mitochondria (the “batteries” in each cell that generate the energy molecules each cell needs to function). Less cellular energy results in lower muscular function. Taking various supplements that help improve mitochondrial function may help with muscle tone and coordination. Supplements include various B vitamins, Co-Q 10, and L-acetyl-Carnitine.

KD-I do know many families struggle with ADHD too. What are your recommendations for supplements that improve cognitive abilities and attention.

Dr Bob – Antioxidants are the basic approach here. I like pycnogenol and quercetin, two plant-based compounds that are very potent anti-oxidants. These help improve the function of various brain chemicals that are needed for attention and focus.

Methyl B12 (most effective when given as shots) along with glycine (an amino acid) and folinic acid (the active form of folic acid) can also help.

KD- Thank you again for giving us a preview of the Bio-medical information in your new book. “The Autism Book”. You have a heart of Gold when it comes to helping families! I can only hope that more mainstream doctors are able to be open minded and listen to the research…and include the parents as part of the team like you do! You strike a balance of mainstream medicine and a natural approach for all children!

Speaking of balance, I was also able to listen to the Autism One conference on Ustream last month. I loved the different speakers and their perspectives. One quote that I loved was from Dr Kartzinel “We don’t treat Autism, we treat the underlying medication conditions associated with Autism”

Here is another doctor who *gets it.* With our children, there was a tipping point in their neurology that halted development. With each child, that point is unique.

We cannot just address the behaviors that our kids exhibit, we need to start building the foundations of that which was halted…typical development. Like a one -two punch. Another quote from Dr Kartzinel at the Autism one conference is “Nothing is a cure all, we need to build a foundation”

Just as important to our children’s biochemistry is our children’s developmental function. That foundation will be talked about in detail as we continue. We, as parents, want our kids to have a foundations for theory of mind! We want our kids bodies healed, and their minds!

RDI is a program that restores a child’s natural development path before Autism affected their neurology. Just as Bio medical treatments are effective for the underlying medication conditions associated with Autism, RDI is effective in treating the developmental core deficits that were halted in Autism. The goal of RDI is to go back to the precise point where the child stopped developing typically and systemically allow the opportunities for a second chance at these developmental milestones. RDI uses the model of typical development with the parent or caregiver guiding the child with intruistic motivation to improve self awareness, co regulation and experience sharing so they are no longer obstacles to the child. These theory of mind functions are extremely difficult for children on the spectrum. RDI has simply taken the research on the development of typical children and applied that research to help our children revisit what they could not get the first time because of Autism.

I know you mention RDI in your book Dr Bob. How did you first hear about Relationship Development Intervention?

Dr Bob- I originally heard about it from other pediatricians involved in treating autism as an adjunctive therapy for children with autism to help them improve their social abilities. I have since learned that it is much more than that.

KD- What do you generally tell your patients regarding RDI?

Dr Bob- I have started to recommend it more and more as a primary developmental therapy (just as OT is a primary therapy) for my patients with autism.

KD- That is great! This is so important because we want our kids to understand what we understand… the very core of what makes us *care* about why we act the way we do. We want to fill in those developmental milestones which will prevent gaps and regression as our children get older. Relationship Development Intervention is the remediation program that accomplishes this goal by allowing our children with Autism to have a second chance to make those discoveries they missed the first time. This gets them back on the track of typical development, where their continued growth then flows naturally. Biomedical intervention can be needed to treat the underlying causes of the initial tipping point. Simultaneously, RDI ® follows the cognitive developmental sequence from the effects of the halted functioning, and builds a strong neurological foundation.

This foundation, the ability to “think” will be our first chapter in “the Cradle of though”
Once again, thank you so much Dr Bob Sears. You are invaluable to all of us in the Autism Community!
For all who are reading- Please feel free to ask any questions during this series as we explore *thinking.*

Friday, July 2, 2010

The Principle of Perspective Part One

Thought, desire and feelings. How do they integrate? I never dreamed this would be something I would give a second thought too. My world changed after my son was Dx with Autism. Like many, I was told my children ( I have two with ASD) would never lead a normal life, and need to be placed in an institution, This was my first sense that convention wisdom when it came to Autism had a long way to go in understanding what Autism * is*. I also discovered that while mainstream medicine needed an update, there were many cutting edge developmental scientists and Doctors that were leading the way to greater understanding. I am finally at a point where I see that we are ALL trying to unravel Autism and how to effectively help children live a quality of life that they want!

This is what is leading me to concentrate the next month or so in reviewing the Book * The Cradle of thought* by Peter Hobson. I read this book a few years ago, and I found this book helped me to understand what I needed to focus on with my children, as this book is one of the dozen that Dr Steven Gutstein used to help all children on the spectrum through Relationship Development Intervention ® .

Fast forward a few years later, both my children are doing fabulous and they have effectively returned to their own developmental tracks in development. My youngest is not with his peers yet, but he will be…. And they both are able to share perspective and understand social cues ( theory of mind)

Back to thought, desire and feelings. These are the foundations to subjective perspective in infancy. In turn, this subjective perspective matures into taking on another’s perspective.

Taken from a book by Peter Walsh PhD- “No, and ways parents can say it”

A fascinating experiment helped map this change. A group of toddlers at fourteen months and then eighteen months were presented with raw broccoli and Goldfish crackers and then asked to share. As the author Malcolm Gladwell explained in a January 10, 2000 article in The NewYorker:

Some years ago, the Berkeley psychology professor Alison Gopnik and one of her students, Betty Repacholi, conducted an experiment with fourteen-month-old toddlers. Repacholi showed the babies two bowls of food, one filled with Gold¬fish crackers and one filled with raw broccoli. All the babies, naturally, preferred the crackers. Repacholi then tasted the two foods, saying "yuck" and making a disgusted face at one and saying "yum" and making a delighted face at the other. Then she pushed both bowls toward the babies, stretched out her hand, and said, "Could you give me some?"

When she liked the crackers, the babies gave her crack¬ers. No surprise there. But when Repacholi liked the broccoli and hated the crackers, the babies were presented with a diffi¬cult philosophical issue—that different people may have dif¬ferent, even conflicting, desires. The fourteen-month-olds couldn't grasp that. They thought that if they liked crackers everyone liked crackers, and so they gave Repacholi the crackers, despite her expressed preferences. Four months later, the babies had, by and large, figured this principle out, and when Repacholi made a face at the crackers they knew enough to give her the broccoli.

Toddlers are not doing things parents don't want them to do JUST to be contrary. They are exploring this newly discovered difference between themselves and others.

Now that we see when theory of mind starts to emerge….we can look at Autism, and that lack of emergence, and ask… What happened? What was the cause of how the brain was deprived from this typical growth of thinking?

We know genetics could play a role. We know that our environment and the toxins a child is exposed to could play a role. We also know that it could be a combination of both and that each child’s tipping point that lead to the brain deprivation in development is unique. We know that there is regressive Autism and Infantile Autism. We will be exploring all these possibilities, going over Peter Hobson’s “The cradle of thought” and talking about effective interventions and why they are effective. I hope that you find this series in my blog helpful.

Since I am not a medical Doctor, Dr. Bob Sears will join me in part two to discuss some Bio-medical information regarding Autism.


Monday, May 31, 2010


my utube channel-
ok now that one more thing is done I can finish working on my next blog which will be featuring a special guest :)  Hoping to have it up within the next few days!


Tuesday, May 4, 2010

New website and idea for post

Hey Everyone!  I finally made an official website  click here .  I will be working on that in the coming weeks.  In addition to that, I am planning to start a series of posts based on the book by Peter Hobson "The cradle of thought".   Hobson and his wife are involved in research studies for RDI and his book is foundational to why Dr G knew our kids could attain theory of mind.

I hope to start those in the next two weeks!


Tuesday, March 9, 2010

Our children's future!

Here is a recent study concerning outcomes for Quality of life for our young adults on the spectrum aging out of the educational system-

quality of life into adulthood

This is obviously not good news.  That said, I do believe we have made strides in how we,  as a society, view Autism and how we treat the deficits of Autism.  While there are still treatments that focus on behaviors and getting a child to perform static skills,  studies like these show that the long term benefits to teaching skills in hopes of generalization to thinking is very limited.  We now know that children with Autism can obtain theory of mind in a developmental fashion just like their Neuro typical peers.  Theory of mind/mindfulness however cannot be taught as a set of discreet skills to master.  A child's developmental gaps must be remediated and the neurology of the brain will  begin to repair itself.  Developmental/Cognitive programs like RDI(R) Relationship Development Intervention, provides a child a do over in development.   On page 15 of "The RDI Book"  Dr Gutstein states that Dynamic Intelligence ( Theory of mind) and Neural integration have a circular relationship with one another.  Dynamic Intelligence is a product of a neurally integrated brain.  Neurally integrated brains development through dynamic problems that challenge the brains current neural architecture.  The observable product of dynamic neural development us Dynamic intelligence."

Static vs Dynamic intelligence chart

Keeping in mind when we refer to IQ,  we are looking at static skills.  Someone with a 4.0 grade average from Princeton or YALE is not guaranteed a quality of life ( good job, marriage/relationships, etc) simply on their IQ.  The determining factors take into consideration ones ability to have the mindfulness of all those dynamic functions mentioned on the chart.  Life is not the sum of knowledge and IQ,  but of experience and being able to share experience and perspective.  This is NO different for a child on the spectrum.  They may have some obstacles in their neurology for this to come naturally,  but that is certainly no reason to concentrate on static abilities only with the thought that they are not needed,  or that they *can't* do it. 

When I look at my own children,  of course I want them to do well with static skills.  Those tend to come naturally for I definitely can't memorize like my boys can!  However,  I know I needed to look further then *school* and sitting in a classroom learning skills.  Beyond school is an entire world that does not play by the *rules* and is constantly changing.  How would I prepare them for that?  How can I make sure they don't fall into the statistics of functioning as a child with ASD,  getting by, only to have the demands of adult life too much for them to handle.  As the study shows, we need to do better!  We can't sit by and hope that they will develop dynamic thinking by teaching our children static skills.  We know that brain neurology does not work that way. The ability to solve problems, prioritize demands, have meaningful relationships and achieve long terms goals is acheived by the foundations of developmental neurology which are in place in a typical functioning child.  We can have the same for the child with ASD as we go back to  their * breaking point* in neurology and fill in those gaps.  That is building a mind on a strong foundation.  Our kids deserve that second chance!!

Tuesday, March 2, 2010

Level 5

The fifth level of intersubjectivity is in regards to after 36 months in a typical child, and after stage 3 in the RDI objectives. This level represents My mind - past, present and future to Your mind ( child) past, present and future. Both minds are able to collaborate their experiences with one another. Included are the abilities of reminscing and reflection!  This level is a level where of course there is always room for improvement. As adults we want to be able to balance our plans with a partners plans, and collaborate with one another instead of one person trying to control the entire interaction.  Also included in this stage is being able to look at a situation that another is going through and put yourself into their perspective ( or to think of the different possible perspectives then just what meets the eye)  Speaking of that,  take a  look here , here and here  to take a comical look on what happens when we lack being able to apply the intersubjective relationship to a situation!

 As far as what I see in my child with ASD, they both are able to share about the past experiences, the present and collaberate on the future. For a child, a good clue that they are could be in this stage is they are able to just come up to you, and say something like Mom, remember when * fill in the blank* and it is an experience or an interaction that you both can reflect and share on. One thing that could be a clue that a child with ASD may not have all the levels in place is that the conversation is very rote. The Parent is asking all the questions* how was your day, what did you do? etc* and the child is just responding. The parent is doing the work in the conversation to keep it going. Without that work, the conversation would fizzle pretty quickly.
 RDI addresses the different elements of the intersubjective relationship in Guiding the child and working on those first foundational skills. This work ensures there are no gaps when these elements are  remediated. An example of gaps would include having to prompt a child for the interaction. If a prompt is needed to have a child *look* at the parent, then that child is not developing the intersubjective element. Without gaze, a child cannot take on the caregivers perspective. You can see how, with RDI, getting to the root of the intersubjective relationship goes much deeper then just getting a child to be social or learning skills only. In RDI, we believe we must start at the beginning. Starting anywhere else is insufficient in order to progress through the natural developmental stages.

My goal as a Mom was to restore these developmental milestones for my children with ASD.  As an RDI consultant my goal is to help other parents restore this relationship within their child .

Intersubjectivity - levels 3 and 4

The third level of Intersubjectivity are for the ages from 15-24 months.
Inter is My actions/My intention and subjectivity is Your actions/your intentions ( child). This demonstrates the expectations of knowing the partners next actions without him or her telling you. Since my younger son on the spectrum is in stage 4 of RDI, he has this level of intersubjectivity mastered since this is a milestone for a 2 year old. An example of this includes one morning when  I was cleaning up, I had a bunch of wrappers and papers in my hand to throw away. My son and daughter were dancing in the living room and a wrapper must of flown out of my hand back onto the floor. I glanced back with the intention on coming back to that once I threw everything away. What happened next was my son picked up the wrapper and ran to the kitchen ( I was heading back from the trash when we met up) he walked around me and threw the wrapper away. He then went back to his fun time with his sister. He was able to take my intention of throwing the items away, and without me saying a word, he picked up that I dropped the item and he was able to carry out my intention of throwing the item away. This was all without saying a word to him, which is very important when assessing if your child has this level mastered.  I of course said, "thanks Jes!" I sort of chuckle with this level because I think that children at this age ( or children with ASD at this level) happily interact with you and feel very competent when they can help. This level gets alittle clouded once the teenage years come into play since then I am sure my teen would simply say ( well I figured you were coming back to get it)~grin~ So the thought is there :) There are many more examples of this level. I know for my Neurotypical daughter she would play and be able to know the next step in the interaction because of my previous intentions and actions.

Then we come to the fourth level. This level continues at ages 24-36 months. At this level, partners are balancing reference points. it goes from level three where the child knows intentions, to level four where the child trusts the parent and knows intentions, but is also developing that awareness of balance in blending the parents perspective within their own perspective. This level is the higher functioning of curiosity. They certainly dont call it the terrible twos for nothing! Sometimes I will hear that the terrible twos go well into the threes! :) It just depends on how long it takes for the child to balance that external and internal reference points to be able to blend perspectives. What this would look like is a child would take your perspective ( if you were to hand them an item and say *Yuck*) they would more then likely say yuck too...take on your perspective. Where you would see the development of this fourth level is if they then take another look at the item and want to also make their own conclusion. For example, the Child thinks...Mom says yuck, must be yuck. Wait, I don't know, let me look at it again.  The child would then revisit the item to try and work out *their* feeling compared to Mom's feeling.   Before this level, the neurotypical child ( and the child who is around stage 3 in RDI objectives),  took your perspective pretty much without question.

Friday, February 26, 2010

intersubjectivity deficits within ASD

 The lack of development within the Intersubjective relationship for a child with ASD is one of the most documented deficits within the research of Autism. Developmental psychologists like Alan Sroufe, Alan Fogel, Barbara Rogoff, Peter Hobson, and Daniel Siegel, all have written books concerning this topic, along with joint attention, theory of mind, and Guided Participation. The research from these psychologists was the starting point when creating RDI. Peter Hobson, the author of "the Cradle of thought" is a Professor of Developmental Psychopathology at University College London and is currently involved in a study for RDI methods for the association between social and cognitive development across these areas in children with autism receiving treatment.
The following two links show research regarding the IR.

The next research paper describes the deficits of children with ASD and is exactly the focus of the Relationship Development Intervention program.

So along with theory I wanted to give you a few links from RDI moms incorporating this information into the lives of their children on the spectrum and families. Their discoveries this week as we continue this process of truly understanding the intersubjective relationship ( and how to remediate this deficit) is truly inspiring to me in addition to my own children and their progress!

Tammy   tells us how a trip to the post office was very enlightening as she was able to people watch different levels of intersubjectivity in action.

Jennifer  tells how she used some RDI strategies within the IR helped calm her daughter

JB lets us see the cutest little boy in action demonstrating some typical development within the IR. I also wanted to point out in this blog, Mom reminded us that Intersubjectivity is Not the same as a child simply looking, or even referencing.

Penny  talks about when she first realized the concept of Theory of mind.

Wednesday, February 24, 2010

The breakdown of Guided Participation

Guided Participation. What is it and why does RDI focus on the guided participation relationship as a means to restore a child back to their developmental track?

20 + years of research by experts in fields of mental health, development and environment coined the term Guided participation to represent how all societies use this method to guide their young. For a neuro-typical child, the parent immediately forms the connection and the child gives feedback according to that relationship. As early as 6 weeks, there is a role as guide for the parent and an apprentice for the child to learn from the actions of the parent. That baby is learning to be an active participant in their relationship with their caregiver. The parent does most of the work in the beginning and gradually by 1 years old, as the child is further developing theory of mind, both caregiver and child have an equal role and responsibility that consists of a natural flow of give and take feedback.
But what happens when there is a breaking point in that developmental milestone? What happens when a child cannot provide that meaningful feedback to the parent? Quoting page 129 from “the RDI book” from Dr Steven Gutstein- he says “Autism is not dx by the presence of any specific behavioral problems. What is distinctive is not the commission of specific things that the child does but rather the omission, when the child does not do, or is unaware of.”

For my own children on the spectrum, I clearly remember with each of them where I was not receiving that feedback. With my older son, of course knowing nothing about Autism, I did not recognize this until he was almost 3 years old. For my younger son, I knew there was a lack of feedback before he turned 1. Not knowing about relationship development intervention at this point, I desperately looked for ways to get him connected to me. This typically involved a lot of prompting and therapy to try and get my children to look at me, etc. What I tended to do with the lack of feedback, is do all the work in the interaction. Or I would just assume my child was not interested and this resulted in non therapy hours letting my child go off and stim or watch TV. I felt pretty incapable of successfully bringing my children into my world without me doing all the work.

10 years ago Autism awareness looked differently then it does today. This lack of feedback from my son, well, honestly, many people told me I was spoiling him, etc. This caused a lot of guilt for me…a lot of self doubt. I loved being with people but I was getting to the point where I did not want to be around people because as a parent of a child with Autism, I am sure you can relate to what others say who do not live in our shoes. And to that fact, I say that my children have taught me more then I could of ever taught them!
When I learned about RDI, I was floored when the programs description as I researched it explained to me about this breaking point in development. Someone was actually able to scientifically explain to me what I was *feeling* in my relationship with my children on the spectrum. I felt validated! That does not happen often when you are navigating through this journey. Since that point, RDI has proven time and time again to empower me in my jouney with my children.
So I thought I would empower you, the reader, Just in case you are having one of those days…that you need a pep talk! :)
There are different reasons for the neurological breakdown that results in Autism. There is regressive Autism and infantile Autism. I happen to have one of each… Lucky me ~grin~. Genetics can play a role, and triggers from the environment play a role. I believe that there is a genetic disposition and something in the environment triggers that vulnerability within the connections of the brain. One of my children benefits from some biomedical support because he also has gut issues that needed to be addressed to maximize his remediation. No matter what the origins, the end result is Autism. This tipping point, as Dr Gutstein Explains in his book, disrupts the child’s ability to develop the pre- requisites for the basic Guided Participation relationship that neurotypical children exhibit as they are able to continue on their path of development.
So what does this mean for us, as parents, who may feel incompetent when dealing with this breakdown. It means Autism is NOT our fault!!! Personally, for me, it set me up for a vicious cycle of compensation where I was doing all the work in my relationship with my child. I grew tired of the lack of feedback. I kept thinking I was doing something wrong! Think about in any social situation, when you are talking to someone and they are looking around. It is clear to you that their mind is elsewhere. They are not paying attention. They are not giving you the same feedback you are giving them. What do you do? For me, I either stopped interacting or yelled at them for not paying attention. :) When your own child does this to you, it digs down into your innermost *mommy* feelings of failure.
As a consultant, I address this with parents within one of the objectives within RDI. On page 131 of the RDI book, Gutstein reminds us, as parents that it is very difficult to compensate for the vulnerabilities with our children to get them to the point of remediation. He goes on to say that in his experience, the majority family members with an ASD child are among the most capable parents and grandparents, yet because of this breakdown, they struggle to carry over this expertise with their child with ASD.
For me, I felt like it was because I was told I had to teach my ASD child differently than a neurotypical child. I struggled with this for years until I found RDI. Restoring the natural process of development in my ASD child made sense to me…to follow the developmental path to fill in gaps of development in a more slow deliberate manner as a second chance for them.
Having the complete developmental curriculum at my fingertips in the operating system within RDI has empowered my family to know that my children will achieve a quality of life…all my children, ASD or Neurotypical. They are both back on their own developmental track.
Restoring our child’s developmental path is not impossible. You, as parents, have the capabilities to do this. Your child’s Autism, and their continued struggles, are not something that you did, or did not do. The breakdown OF the GPR is the cause. I salute each and every one of you as we go through this journey together!
So promise me that you will feel empowered when you look at your child. I am sure of their potential!

Saturday, February 20, 2010


What is intersubjectivity?
I was pulling into Taco bell a few days ago for my son…he so desperately wanted a taco and I had a coupon, so there ya go! :) I slowed down, had my blinker on, but could not turn in because someone at that exact moment was walking in the driveway. It was only a moment that I had to wait for this person to cross, meanwhile the car behind me beeped at me. ….so I calmly said to my kids, now there is a good example of that person lacking intersubjectivity. My 6 year old said, Inter what? My teens just rolled their eyes.
So what is it…and why is RDI focused on restoring intersubjectivity through the process of Guided participation? Oh Guided participation is just a fancy way ( and the term that developmental scientists use to acknowledge how typical children learn- check out the book, Apprenticeship in thinking by Barbara Rogoff.) to say the process of a guide in a relationship, and we believe, in RDI, that children with Autism deserve a second chance at typical development through this guiding process. Therapies that are skill based work on teaching skills to children with little regard to what these kids are missing in the developmental track. They believe they can bypass development. What happens is the child will make progress that 1st year of skills, but those skills are instrumental in nature. Sure it is great that they can now sit still, and ask for juice...but the same progress can be made developmentally, while working on filling in the social and relationship gaps. That is not possible in a skill based program. What I have seen time in time again and even with my own children, is that then we have to go back and undo the uneven learning posed by skill training to get to the root of Autisms issues…understanding the *dance* of relationships.
Back to Intersubjectivity…the scene at taco bell. Ok, it is a bit of a dramatization…but at the same point I wanted a simple illustration. That person behind me, could not take my perspective. It was about HIM….not about US being on the road. He could not SEE why I took the action to stop instead of get out of his way. It was, at that moment, all about his needs. We obviously all have moments like these…so what I am referring to with lack of intersubjectivity with Autism is not as simplistic. We all have the foundations in place to be able to take on someone else perspective. Children with Autism do not.
The importance of understanding the Intersubjective relationship in regards to Autism is crucial. It is the basis for how we development mental engagement. Subjectivity is our appraisal, thoughts, feelings, memories, perceptions, etc of something, and Inter is that bridge between people. On this blog ( at an earlier post) I talked about the study showing that 18 month olds understand that others may not have the same feelings as they do about a subject. We already know that children with ASD struggle with relationships and perspectives. So where do we go back too?
There are five stages of the IR.
Children between the age of 3- 9 months have established primary intersubjectivity. They know that your actions and their actions go together. They take an action to your action. Think Peek a boo. The child is engaged with you and stays with you and the interaction. Both parent and child have a role in peek a boo…and a typical child will stay with his role.
Secondary Intersubjectivity is from 9-15 months. The child starts to be able to read reactions from not only how they feel but how you feel? They care about your reaction. I am reminded of a child who is learning to walk and falls….and looks at you for your Shared reaction….because that trust is there and they can accept your reaction to how they feel! If you react minimally and calmly, they typically will not cry. If you jump up and exclaim, Oh my are you ok?…They could share your perspective and start to cry. They are not hurt, but they are able to grab your reaction within the intersubjective relationship.

Typically with Autism either the primary or secondary IR has been affected. Because of Autism, the childs development has stalled in this area. RDI will go back to this stage in development and start to remediate the deficits that contributed to this not fully developing. Only then does the child have a strong foundation to continue on their developmental track. An example of how RDI works on Intersubjectivity at the 3-9 month old level ( since we certainly cannot play peekaboo with an older child) is through a process of co regulation. This co regulation can be fostered in any interaction that is done with the child. For example, simply by brushing your teeth with your child in a co regulated manner ( no commands, but slowly helping your child to focus on both you and he brushing teeth together), we can slowly help your child to understand that other people have a perspective, and a role in an interaction.

Stay tuned for the last three stages in the IR!
If you have any questions or comments, please post here or email me privately at .

Friday, February 12, 2010

Theory of Mind

Taken from the book- "No, and why parents need to say it"

Some years ago, the Berkeley psychology professor Alison Gopnik and one of her students, Betty Repacholi, conducted an experiment with fourteen-month-old toddlers. Repacholi showed the babies two bowls of food, one filled with Gold¬fish crackers and one filled with raw broccoli. All the babies, naturally, preferred the crackers. Repacholi then tasted the two foods, saying "yuck" and making a disgusted face at one and saying "yum" and making a delighted face at the other. Then she pushed both bowls toward the babies, stretched out her hand, and said, "Could you give me some?"
When she liked the crackers, the babies gave her crack¬ers. No surprise there. But when Repacholi liked the broccoli and hated the crackers, the babies were presented with a diffi¬cult philosophical issue—that different people may have dif¬ferent, even conflicting, desires. The fourteen-month-olds couldn't grasp that. They thought that if they liked crackers everyone liked crackers, and so they gave Repacholi the crackers, despite her expressed preferences. Four months later, the babies had, by and large, figured this principle out, and when Repacholi made a face at the crackers they knew enough to give her the broccoli

This above study shows a very important example of when a children developmentally understands some foundations of Theory of mind.

For our children with Autism, many have not been able to seperate that others feel differently then they do and put that into practice when they are interacting. RDI (R) addresses this in their program as it guides the parents and child through the developmental stages beginning exactly where your child left off on his developmental track.

What has been your experience with your child and this very important developmental milestone?


I have created this blog to talk about remediation and how remediation is possible with Autism spectrum disorders!!

The definition of remediation-
The act or process of correcting a deficient so that it no longer is an obstacle.

Autism is a cognitive developmental disorder. By correcting where the developmental path went astray in the brain, we can remediate the effects of Autism on that individual. This is done by a do over, giving the child or adult a second chance at development. The only program to date that does this in a step by step fashion ( breaking down each developmental step in typical children) is a program called RDI.

I am a Mom of 2 children on the spectrum, 2 neurotypical children, and I am an RDI (R) consultant in training.

I hope that you will find this blog helpful in your journey with Autism! My goal in becoming an RDI consultant is to help other family achieve the success that my own family has....and I am thrilled to be able to have that opportunity.

Here is my website!

and Yahoo group

Visit me on Facebook!/group.php?gid=84889719037&ref=ts

I would love for you to post questions if you are new to RDI!!