Reality Check

As part of my general reading and self-education about the autism spectrum, last week I decided to read a bit about the RDI (Relationship Development Intervention) approach, which a friend described to me some time ago (she is using it with her 6-year old daughter ) So, on Friday I got the standard RDI activity book for young children out from the library. It offers structured, parent-led activities to help foster attention and co-regulation (central DIR goals), and as I skimmed it I thought of borrowing some of its strategies for complementing both the child-centered, unstructured Floortime sessions and the structured, ABA social skills group Uma is doing. I decided to consult Tal about this at our next session on Tuesday and to experiment with one or two RDI strategies in the meantime.

Amongst the Stage 1, Level 1 “novice” activities I read about was one that involved picking soft objects out of a box and passing them back and forth quickly to the child (with a possible variation involving retiring and introducing new objects into the cycle of exchanges); this is supposed to help work on referencing facial expressions and cooperating joyfully on a fast-paced activity that involves shared attention. I decided to experiment with it, since I know that Uma has made progress on shared attention and referencing but has a long way to go. So upon taking over from Anastasia at 4pm, I grabbed a box in which various toys were already jumbled together, sat down on the rug with Uma and said “Let’s play a new game!”  (Admittedly this was not a very well thought out approach, but the point of this note is less the outcome of the activity than the reflections it triggered.)

I was totally unsuccessful in directing Uma’s attention to me or to the activity. She was already engaged in assembling her figurines for her “pretend playgroup” game, and she steadfastly refused my invitation to play a new game. So I switched gears mentally, thinking that after 20 minutes or so of playing Uma’s game in Floortime mode, I would try to reintroduce the activity. I never got around to doing that, but, since the RDI activity instructions were fresh in my mind (they focus on various developmental objectives, which mirror many Floortime goals), I found myself  watching Uma closely for shared attention, referencing of my nonverbal communication (facial expressions, gestures), etc. I realized that I was seeing none (or very little) of these things.

This touched off a fast and furious chain of gloomy reflections upon the severity of Uma’s condition as well as a reality check of sorts on how our afternoons together (including our Floortime sessions) are going. I had been thinking that we were making progress, but have I just been fooling myself? It seemed to me that over the course of twenty minutes of play (was it even that?),  I had been totally ineffective in intervening and shifting Uma’s rather rigid and disjointed agenda. At one point she announced, “Goldilocks and her sister will go to the doctor and Goldilocks will check the doctor, and then they will go to the swimming pool, etc.” I tried to point out that the doctor should check Goldilocks (not the other way round), and was ignored. Then I tried to get Uma’s attention by joining in the game, but the only acknowledgment of my presence I got was verbal (Uma said “yes,” or “no,” but she never looked at me.) If there is a verbal exchange without shared attention is that even a circle of communication? Then I tried to directing her to an activity I though would be regulating (playing “row, row” with our feet or jumping). First she ignored me, then, after playing on her own for a while (during which, I have to admit, a mentally checked out for several minutes), she suggested "row, row" as if it were her own idea. She was extremely controlling as she went about it, however.

All in all, my RDI flirtation or thought experiment made me see my Floortime practice in a new light.  In this session, it seems to me now, Uma and I were both prisoners of her rigid agenda and we were not able to work on any developmental objectives during this session. I realize that Uma is capable of shared attention and referencing at other times, but the fact that I was not able to elicit or direct it at all in this situation makes me wonder how “available” this skill is to her or anybody else. Also, although this was an unusually dispiriting Floortime sessions, deep down I suspect that it was not that unlike what happens everyday, and that I may be fooling myself on an ongoing basis into thinking that our sessions are going better than they really are. For instance, even on weekend mornings, when Uma is usually pretty well regulated and free of anxiety (unlike most schoolday afternoons), I often have this “imprisoned” feeling during our sessions as well. This has been a rather depressing realization.