I’m often asked by parents of children with special needs whether respectful care practices, which are based on trust in our children as competent whole people at birth, can possibly work for them. And if so, how?
Based on the feedback I have received from parents and professionals in the field, the answer is a resounding “yes!” But since my own work with families has not included many of these children, I don’t have experiences and details to share firsthand.
Enter Sandra Hallman, a child development specialist and early intervention therapist who recently contacted me by email.
I have been following your blog for a few years now and have to say thank you for all the wisdom and raw honesty that you share with your audience. I have learned so much! I often tell my colleagues and clients that I have learned more from your blog and Magda Gerber‘s RIE approach than I did during the seven years I spent studying child development.
I have worked with infants and toddlers (and some pre-school and school-age children) with special needs and their families for about 15 years. I have been blessed to work with some amazing people in my field and am so grateful that one of my colleagues told me about your website. I have been reading, learning, and implementing the information from your blog articles, and I have to say that my work with families and children has become infinitely more effective, yet at the same time way more simple. It almost feels wrong, though I know it’s not.
In the world of Early Intervention and those working with children with special needs, there tends to be a “do, do, do” mentality instead of “watch, wait, and wonder.” I think that we, as therapists, often don’t feel like we are being effective unless we have our hands on the child “facilitating” some sort of position, skill, or activity, or are giving out commands for them to follow. I remember a saying from one of my professors in grad school: “Don’t just do something, stand there.”
That made sense to me, but I didn’t know how to just stand there (i.e. just be with and support a child and his caregivers) until I learned the RIE approach from you. And the progress that I see in children and their parents is like nothing I had observed before! It’s incredible, and it always works when the parents follow through. Of course, it’s a process, but the parents who seem to “get it” and implement a little more readily than others, consistently see greater progress in their child’s development or resolution of prior issues (i.e. sleep).
I have a desire to create an Early Intervention alternative for families, an approach where therapists are trained in the RIE philosophy and blend their expertise and training in whatever area they specialize in with the best practices in Educaring. I just don’t even know where to begin and wondered if you have had any similar conversations with anyone, or if any thoughts come to mind. If nothing else, I’d just love to connect with like-minded people who can inspire me and fuel my dreams to ultimately help more children and families learn the incredible principles of RIE.
I’d love to know your thoughts on my thoughts…
Thank you for your time!
Sandra Hallman, MS, CEIM
Naturally, I jumped at the chance to have Sandra share some of her specific experiences in detail, and she graciously agreed.
Here are a few examples of my observations on how educating parents in the RIE philosophy and implementing this approach during therapy sessions has elicited positive outcomes related to the parent-child relationship, overall development, and behavior.
Possible Autism and Severe Behavior Concerns
Ethan was a 2-year-old boy who had been receiving speech therapy, developmental therapy, occupational therapy, and social work supports for a few months prior to my meeting the family. He was also referred to a developmental pediatrician for concerns about Autism. Ethan’s mother was desperate for help with his frequent, intense, and very long tantrum behaviors, which had not improved at all after about six months of therapy. She shared that they couldn’t go out to eat at restaurants or even to the store because his behavior was so difficult to handle.
Some of our sessions revolved around mealtimes and store outings. During these challenging routines, Ethan’s parents were provided with supports to slow down, observe, acknowledge, and co-regulate (i.e. allow emotions to be fully experienced, expressed, and released without judgment). When Ethan lost control, the parents remained calm, accepting and supportive. This, in turn, provided Ethan with an increased sense of safety and trust in his parents, which I presume decreased his levels of stress and dysregulation, opening him up to being more available to learn and engage with his world.
Ethan’s mother read several of Janet’s articles and quickly became well versed in implementing RIE-inspired parenting. Within a few weeks, Ethan presented as a very different child and was beginning to engage in more purposeful and symbolic play, use speech to communicate, show enjoyment during social interactions, and separate in familiar environments from his mother more easily. His body awareness and motor planning also appeared to increase, and his sleep became more regulated. More specifically, Ethan was able to participate in meal times without tantrum behaviors (which previously happened at almost every meal, per mother) after he was allowed to work through a very long tantrum at mealtime during one of our sessions.
Janet often talks about the healing power of a toddler’s tantrum in her blog, and I truly believe this to be true. After parents and I support a child through a very intense tantrum, it’s almost like a switch gets flipped and their nervous system is re-set, which equals a well-organized, engaged child who shows profoundly increased social and play skills. In the past, prior to my knowledge of RIE, I considered a session without a tantrum a success. Now, as difficult as it is for everyone to get through, I consider a session where a child is allowed to fully feel and express themselves during a tantrum (which has occasionally taken up almost an entire session) a huge success! Especially when the parents can be supported through it and see for themselves what it looks like on the other side of the tantrum. More often than not, the child wants to cuddle with/stay close to their parent for a while and demonstrates affection that is rarely observed.
One last anecdote about Ethan…when the developmental pediatrician saw him (which was a few weeks after his mother started implementing RIE-inspired parenting techniques), he asked Ethan’s mom, “What are you doing here?” He wondered why she had brought him in with the initial concerns of possible Autism, because he certainly didn’t present this way any longer.
A Child with Down Syndrome “Who Didn’t Know How To Play”
If you have had any experience with children who have Down Syndrome, one of the things you likely observed frequently is throwing…everything. In one of the centers I worked there was a huge emphasis on hand-over-hand to “teach” children how to play “appropriately” with toys.
Emily was a child who had been participating in the group program for several months where this strategy was widely used and taught. When I started seeing Emily for individual developmental therapy and talked with her mother about her strengths and what she enjoyed doing, her mother adamantly stated, “She “doesn’t play with anything. She just throws everything!”
What a shock it was for both her mother and me in our first session when this two year old little girl purposefully initiated play with a shape sorter and completed it independently with occasional “sportscasting” (what I consider co-regulating). It just took a little bit of encouragement and prompting from me to help Emily’s mother take a step back and allow her daughter to initiate and engage in play that until this moment she thought was impossible. This continued to happen every single time we met, where Emily would surprise her mother with all kinds of play skills that she never knew Emily possessed. And all this happened not because of some magic therapeutic intervention or hand-over-hand assistance, but because we just “stood” there and trusted Emily’s developmental process after providing her with the opportunity to explore. After watching, waiting, and wondering, we joined Emily’s play and added other ideas, all of which she was able to imitate, expanding her play even more.
I think one of the most difficult things for us to do as therapists (and adults in general) is to slow down and allow the child to lead the way, showing us where they’re at, what they’re interested in, and then, if the opportunity presents itself, joining them in a playful interaction that shows them we are attuned to them and value their ideas. I’ve learned that when children feel that we “get” them and have confidence in them, they are much more likely to respond with joint attention and play, reciprocal interactions, and imitation/demonstration of higher-level skills that are likely buried under a lot of stress, overstimulation, and insecurity.
The Mystery of Sleep and Hyperactivity
This brief experience still baffles me sometimes when I think about how simple the answer was to the sleep and hyperactivity issues that were going on. I was seeing a toddler for therapy, and one day her mother shared concerns about her other child, three year old Jenny, who had difficulty transitioning to sleep and frequent night wakings, as well as her very high, disorganized activity level. The mom shared suggestions that her pediatrician had offered (i.e. no TV during the day, changes in diet), but she didn’t feel these were issues or the cause of her daughter’s dysregulated sleep and hyperactivity.
After our first one-hour session, it was very apparent to me that Jenny was stressed out by the authoritarian parenting style her mother had demonstrated during our time together, and in my opinion, this was likely contributing to her many areas of dysregulation. After giving Jenny’s mother my solicited opinion and information about RIE, two weeks later I was shocked by how well-regulated Jenny was and how different her mother interacted with and parented her. And, her mother happily reported, Jenny’s sleep was significantly better. Wow! I almost didn’t believe it. This dramatic change definitely confirmed for me the power of the parent-child relationship and that it can be either a source of stress or a source of support for a child. To be sure I could believe what happened in just two weeks, I asked Jenny’s mother if she did anything else differently to address the sleep, and her answer was “no.”
Ex-Preemie with Sensory Integration Dysfunction or Lack of Limits and Emotional Regulation?
Noah was born extremely premature and showed many of the typical ex-preemie challenges around sensory processing. I started seeing him when he was about 2.5 years old, and at that time, I was fascinated by sensory processing and all the “tools” that could be used to help support integration for a well-regulated nervous system. Noah presented as what some refer to as a “sensory mess,” as he had limited attention, decreased body awareness, difficulty motor planning, high levels of sensory-seeking behaviors (i.e. climbing, jumping, throwing), as well as sensory-avoiding behaviors/sensitivity (i.e. gagging, tactile defensiveness).
I initially approached all of these challenges strictly from a sensory perspective and implemented many of the calming/organizing activities that Noah’s OT recommended. They occasionally worked for short periods of time during my once-a-week, 60-minute sessions. Even the most helpful sensory tool (compression garment), which appeared to be a miracle the first time we tried it, only lasted a couple of weeks and then seemed to have no organizing effect for Noah. His occupational therapist and I spoke multiple times and collaborated extensively to share things that did and didn’t work, but ultimately, neither of us felt like we were providing Noah’s parents with any effective long-term strategies.
The challenges that were presented during my work with this child and family were what helped me shift my focus and look for other possible resources. I was completely out of ideas. So I took what I had just started learning about RIE and implemented it into my work, and voila! I’m certainly not saying it was perfect or that the child’s development miraculously advanced to age-appropriate; however, the results that we were seeing in our sessions warranted a call from the occupational therapist. ”Ethan’s parents said he is doing so much better in your sessions. What are you doing?” I sheepishly replied, “I’m setting limits and acknowledging his emotions.”
That was just the beginning…the hardest part was helping the parents learn to set limits and acknowledge emotions as well. For many parents of ex-preemies (or any child who spent time in the NICU) this is incredibly hard to do because any negative emotion that is exhibited by their child often triggers the trauma they experienced, and all they want to do is make it stop. To most effectively help these children and their families, I believe parents should be provided with trauma-focused therapy with a mental health practitioner before ever starting therapy services for their child. I believe the “therapeutic” affect this can have on the child is more powerful in the long-term because it supports the very relationship that will have the biggest impact on the child’s development.
Even though I’m still learning and often fumbling my way through this work, I’ve found it to be so much more effective and rewarding since learning about RIE and sharing this parenting philosophy with families. I’m so grateful for Janet and all the other RIE-inspired resources that have helped me better understand development, how to support it, and that respectful parenting is what every child thrives on, special needs or not!
Sandra Hallman, MS CEIM has been working with infants, toddlers, and pre-schoolers with special needs and their caregivers since 2000. She has provided families with service coordination in Early Intervention and developmental therapy in a variety of settings, including home, school/day care, community environments, and hospital. Sandra also has a private practice providing families outside of Early Intervention with supports around challenges they experience in parenting. She is NDT (Neuro-Development Treatment http://www.ndta.org/ndt-certification.php) and NIDCAP (Newborn Individualized Developmental Care and Assessment Program http://nidcap.org/en/) trained. Her areas of specialty include prematurity, attachment, behavior, and routines-based intervention.
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(Photo by Maria Grazia Montegnari on Flickr)