Augmentative communication

 1.     What exactly is the RDI philosophy?

RDI stands for Relationship Development Intervention. We shall briefly dwell into the child development process to understand RDI. Even after a painful labour, a mother falls in love with her child. In a close relationship, our brain releases a feel-good chemical called Oxytocin due to which a bond of deep love is formed. It's the same with other family members, father, grandparents… we then welcome the new member into the family. And the child reciprocates as well, as changes happen in the child’s brain as well. That is the foundation of what we call a bonding or connection. 

                     In RDI, we are not talking about this bond; it is already there. When you accept the child as mine. Your love is unconditional. When we talk about relationships, it is about love, caring, and bonding. When we talk about relationships in autism, it is about secured attachment. It is about safety here, and again, we are not talking about physical safety. This is the time to understand the autistic brain is wired differently. They perceive a lot of things as a threat. A request, a question, a performance demand, an instruction given again and again, the facial expression of people, non -verbal cues, the disgust on peoples’ faces, the helplessness in the mother’s eyes. In such a situation, it is difficult for the child and he does not feel “safe”. A child may feel threatened if someone repeatedly teaches them the same thing and keeps asking the same questions. So why does this happen?

                           The body is unable to receive the benefits of an integrated sensory system. Sensory integration is a term that has been used to describe processes in the brain that allow us to take information we receive from our 5 senses, organise it, and respond appropriately. Apart from the 5 senses, there are also the vestibular senses (How to position our bodies and heads) and proprioceptive senses (awareness of the body in space). The sensory system, in the child’s case, is haywire. And their circadian rhythms are also affected. Then comes the interoception skills and understanding of the sensations within our body-- Pain, hunger, understanding of toileting needs. When the child cannot be experiencing or filtering the sensations as we do, it can be overwhelming. Besides this, are the external demands on the child.  

                 When the child's nervous system is overloaded, he requires security. For the child to be calm and receptive to learning. There has to be an intrinsic motivation to learn. So again, we go back to the child development process to understand this better. In the first year, the child learns through the caregiver’s responses and interactions with him/her. The nervous system is ready and in sync with the caregivers. A child learns a lot from the environment on his own. The first six months are just homeostasis. Then the motor milestones begin. Nowhere are we trying to teach the child at this point in time. We are just providing support. Say, around 7 months, the child plays with a ball, all we do is encourage the child through responses. We do not teach; this is round, the colour is red, its 4cm in diameter. It’s a noun. Instead, what we do is we engage with the child and have a shared experience of fun. It is a safe zone. Neither does the child have the language to express, nor me to communicate with the child. Let's now move to a knife or fire. Again, the child understands through our responses and there is no language again. That I can learn through my parents' experiences is secured attachment. 80% of a child's learning is happening from the environment and is happening all the time, and it is implicit. All this happens just by observing and experiencing it one time, which does not happen with our children.

This is also the reason that when we get a diagnosis, we step into the role of a teacher.

             Parenting is a relationship. We are not always teaching our children. Now compare this with a teacher in a classroom. Her role is to complete the syllabus, conduct tests, and give marks. The job is well-defined. She is not looking beyond nurturing or working on the emotional aspects of wellbeing. That is the parents’ responsibility. The moment a child has a diagnosis the parent moves from a relationship into a role. But what happens here is nobody’s fault.

                         We teach them everything; again and again, as we are unable to elicit a response from the child. We do everything for them, not letting them try. And it becomes a threat to them. Our concern and too much effort that we put in becomes very disruptive for their nervous system. It's important to understand here that's when the relationships break and not the bond. Our children begin to resist and withdraw from relationships. It's obvious, and I have witnessed it over 10 years, we play the role of teachers. The moments spent together are gone. We have goals to achieve, so keep teaching the whole day, keep stimulating.  

 

2. If I may interrupt, many times, our children don't know how to engage themselves. And then the problem behaviours begin when they are not engaged. So parents have little choice but to keep their children occupied?

 This is where co-regulation steps in. The children don't know how to take care of co-regulation themselves, as parents we have to do it. Their nervous system did not develop that way. Co- Regulation means putting my mind in your mind. Without telling or instructing you, the parent can help the child explore the world and learn through it. Co regulation is a framework that has been developed in RDI, where through a non-disruptive environment, we help the children to connect with their environment. We talk less, as we don’t want to bombard them with information. We don't go nonverbal, it's a myth. Through a series of foundational skills, like referencing, experience sharing, and helping children to think flexibly; we encourage them to observe the environment and come up with a suitable response to what's happening around them. Co- regulation is a psychological concept and a lot of therapists do it in different ways. RDI has adopted co-regulation in a certain way. It is a human need; but the premise is the same. We all need human connections to learn about others.

             A child of 6-7 months learns by imitation. But what we are trying to get at is imitation in context, not just imitating my body's movements. What's the role of mirror neurons? To enable imitating in context? When these neurons are in deficit, the child does not understand why he is imitating? They do not understand how the imitation can lead them to a functional output.

                               There is a lack of understanding in key areas here. How can this imitation help you resolve the problem? Where does this lead to? They must comprehend the big picture. For example, you need to make tea and there is no sugar. The big picture understanding would be, “I do not have sugar, and how do I resolve the issue?” The person has the skills to make tea, but the know how to buy sugar is where the learning has to happen? There is no right and wrong way. What will work at that moment? At a point of time, the solutions will be different. It's midnight, shops are not open, so have a sugarless tea. Your delivery guy has jaggery but no sugar. What do you do? That's dynamic intelligence. 

                            Static intelligence is when I learnt it in a particular way, and it's my rote memory. But something changes, you do not know how to respond to the situation. I can equip you with all the skills, but things are fluid in our world. When we cannot adapt to the changing scenarios, the learning is futile. If I don't know what the problem is or even the knowledge that a problem exists. How can I solve it?

                                              It is also about executive functions. Solving problems in day-to-day living is what it is all about. How do I perceive the problem? This skill is sadly lacking in autism. What are independent skills or living about? Independent thinking or being able to think for yourself is what it narrows down to. It's about resilience. Can I put to use what I have learnt in different circumstances? It's also one reason we don't try new things with them. We do everything for them. They have never experienced secured attachment. We are doing the thinking for them. We instruct, prompt, facilitate constantly, which does not let them grow as individuals.

                       When we let them think for themselves, we see a lot of changes happening. 

 

3. You mentioned Interoception skills. What are some ways we can work on them?

                       Body awareness or the sense of self are very important. Because the sensory system is deficient, they do not understand, “This is me, this is my body, these are my experiences?” These are my feelings. This is my space. They do not realise, “What is outside of me is not me”. That outside space is a very diffused environment for them. They are unable to distinguish between "this is my emotion" and "this is not my emotion" when they see someone else’s emotions. They feel it as their own, as they cannot discriminate. 

                      The sense of self is diminished. The sense of self is impaired by poor body awareness, and body awareness is impaired by poor sensory regulation. What is required is not filtered, nor is it integrated to produce results. If my experience with the world is sensory, my interaction with the world happens through my senses. For example, if the dress I am wearing is constantly bothering me, I will not be able to focus on you or the work I have to do. The dress is giving me too much information. Every thread in the dress is a stress stimulator for me. My entire focus is on getting rid of the dress. And that's exactly what's happening with our children. If the child cannot make sense of his world. How can he make sense of the outside world? 

                              If the child cannot get a sense of his body, he is going to rock. If my eyes are not activated, the child is going to stim. When we work on co-regulation with our children, it helps them to develop self-awareness. Co- regulation is the starting point, they need help here and are wanting in this area.

                                              Lot of things in autism are based of co-regulation. It is the foundation of social connections. According to Polyvagal theory, it is the reciprocal sending and receiving of signals of safety. It is not merely the absence of danger, but the connection between two nervous systems; each nourishing and regulating the other. Because it is baked into our evolutionary past, it is not a desire, but a need–one developed to facilitate survival. As humans, we are programmed to seek interpersonal connection: it is a biological imperative. Thus, co-regulation is the most impactful process in the development of an individual with autism.

 

4. What would be a thoughtful style of language? Can we talk about declarative language?

                             One is not giving instructions or telling them what to do. It is the language that helps the children to perceive they have to do something. For that, they have to observe their environment. They have to solve a problem. Problem solving, here is defined as solving a problem in the dynamic world. Finding an appropriate response, and a language that triggers the warranted response. For example, I am feeling hot and I want the fan switched on. I tell my child to switch on the fan and he does it. When I say switch on the fan, I have triggered no thinking in him. Later, at a point, my child feels hot and with no one to instruct him. Will he switch on the fan himself? To prepare him for a situation like that, I can say, I am feeling very hot, and wait for a response. And now when he references me, I can look at the switch or the fan. My child has now realised I am expecting something from him. What's my mom telling me? Let me look at her. So, joint attention. What does her body language say? So I think I should switch on the fan. Similarly, stating, I am feeling very thirsty, wishing I could have something to drink. When we talk like that to our children, they think of previous experiences. It's a way for them to connect their memories to the problem at hand and solve it. We set up a platform for the child today so they can have an independent tomorrow.

                       This is what we call mindful guiding. They have to understand, given a context, which solution works best. We would like them to be independent. This just follows a simple train of thought. I have to cook when I am hungry. If I have to cook, what do I need? If something is missing, I have to buy it? To buy, I need money. Where does money come from? The point I am trying to make is everything is interrelated. 

 

5. For the earlier question you mentioned hinting at drinking something when thirsty? Rather than saying, "I want water". How important is scaffolding in building competencies?

         Scaffolding is the way for our children to connect to the environment. We say something declarative. They do not understand what we mean. Then we simplify it for them. Scaffolding is figuring out the support they need. You don't throw them in the water and let them swim. It's not that we just use declarative language and everything just happens. It is the beginning point, giving the child the experience and giving the thread of thinking. If we use declarative language 20-30 times in a day; the threads are getting formed. Along with declarative language, there are other aspects like joint attention, nonverbal cues, and how I orient with the child. All these are the basis of social connection. 80% of our communication is nonverbal. If you miss on the non-verbal cues of communication, then your foundation of social communication is poor again.

      It is also the foundation for understanding the perspective of another person. If I think the other person is finding me boring, then I shall change the topic. Scaffolding is the process that involves presenting things in a structured manner. Every situation in RDI requires a different scaffolding to be followed. We develop a connection with the child through this process. 

                          The bottom-line is we have to be present and conscious. To see what the child sees at that moment, we have to look at his body language. We have to learn to co-regulate with them. We cannot expect our children to do it and not do it ourselves. It’s a back and forth going on between two in sync people. RDI a way of being. Instead of one hundred therapies, this is the essence of building a relationship with the child. I am not saying not to do therapies. But this is essentially the thoughts that should govern a relationship. To enable the child to be receptive to learning, this is the basic foundation on which you can add the other skills.

                      For instance, consider making sambar, without dal and salt. We add everything else in the right proportion, but the result will not be sambar. The dal and salt are co-regulation. Our children cannot co-regulate, but that's how a neurotypical child grows. 

 

 

6. Why do not all parents achieve the desired results with AAC?

             AAC is alternative and augmentative communication. It's an alternative because it is not speech. When we think of instrumental or need based, the communication is about; I need this thing or I need some information. If you use AAC for only instrumental communication, then it remains at that level.

                    Whether the child goes to a university or is at home, this universal deficit of being unable to share experience-based communication. The inability to share your thoughts, feelings, perspectives and subjective opinion of an experience is a core deficit in autism.

                For a child to understand AAC can be used beyond need based communication, there should be an intent to communicate first. It comes to co-regulation. If the child finds the parent is sharing an experience, then the child feels encouraged to try. If the parents has shown only flash cards, instructed or asked questions, then the child remains at that level. But the parent shares his experiences with no tension. I had a great day, let's celebrate.. How about an ice cream to celebrate? Here, the child has been given an experience of, “What does it mean to be happy?” How does the body feel? What is my facial expression when I am happy? AAC should pave a pathway for them to understand other emotions and feelings. Failing to do that, the child cannot identify his own emotions, as self-awareness is low.

                  Communication goes beyond need based communication and facilitates the child to share his/her experience of the world with others. 

 

 

7. Do we understand our kids better now? Earlier, little was spoken about co-regulation, AAC and declarative language. We end up taking the trodden path of diagnosis and therapies. What are your views on this?

               On a diagnosis, parents go to a doctor. He advises speech therapy, special education, ABA.. all the modalities are looking probably at skill training. RDI, declarative language, are the other skills in your arsenal, not spoken about, but very effective for social communication. How I connect to my environment is important, because the environment is everything. We cannot teach everything in this lifetime.

                    The other thing about declarative language is it is difficult to practise. Even when I tell parents, they come back and tell me they missed out on an opportunity, because they were not mindful or in a hurry.  Practical application is about slowing down, being mindful, not being very verbal, and observing the non- verbal cues.

                    In RDI, we don't change the child; we change the parent. RDI gives the framework on how to co-regulate with your child. With neurotypical children, they drive the interaction or conversation. However, with a neurodiverse child, if I do not co-regulate, I shall not be able to reach him/her.

 

                      Thank you Mini Dwivedi for doing this interview, and amplifying the need for a connect and social communication with our children.