I’ve spent the last 15 months working as a contract SLP in the school system, after working primarily in Early Intervention. In Early Intervention (working with birth-three year olds and their families), I learned how to look through a developmental lens at the child’s behavior. Is the child throwing the toy because he doesn’t yet know how to start interaction? Is he throwing the toy because he’s angry and doesn’t have the words? Is he throwing the toy because dad is on the phone and he wants a reaction?
However, in the school system, I got caught up in looking at only the skill and pushing forward for the child to accomplish that skill. For example, make the child say “I want the ______ “ (e.g., ball) before I give it to him, holding out until that child either complies, becomes enraged or decides to ignore me. If I were in the home, I would instead playfully interact with the child, modeling the words, and then trust that when the child was calm and engaged enough with me the words would come on their own.
One approach is not like the other.
There is a difference in therapeutic approaches when working with children having delayed development. These differences both apply to the therapy a child receives as well as their evaluation and service plan.
Top-Down Approaches (AKA Behavioral)
Looking at development from the “top-down” revolves around the skill the child DOES NOT have. For example, the child may not be able to sit still in the classroom. Therefore, goals from this type of approach are geared toward increasing the amount of time the child can sit still. But my question to you is this: Is the child sitting still and in a calm, alert learning state mentally?
Even further, if this child is keeping up the appearance of learning, they very well may not qualify for services even if they aren’t able to learn adequately in the classroom environment. Services taking more of a top-down approach leave the teacher/parent and child taking on the bulk of the responsibility for learning as the child now has “access to curriculum”. A top-down approach is a behavioral approach, looking at the outside behaviors and focusing on shaping those behaviors. Some common behavioral approaches are: ABA, Pivotal Response and T.E.A.C.H.
Bottom-Up Approaches (AKA Neurodevelopmental)
Looking at development from the “bottom-up” requires a look “under the hood”. This approach seeks to understand “why”. Like the five-year-old kid that keeps asking “why?”, the point of this approach is to find “the missing link” and then fill in the developmental gaps. I often find that when I seek to understand “why” for the outside behavior, it’s clear the instruction is ahead of the child developmentally.
A bottom-up approach is a neurodevelopmental approach, looking at the underlying foundation for learning to find out why the behaviors are occurring. This approach then scaffolds the child’s ability to learn based on his/her particular developmental “gaps”. The DIR/Floortime (Developmental Individualized Relationship) approach is a neurodevelopmental approach developed by Dr. Stanley Greenspan.
For a minute, think about a subject that was hard for you to understand in school. How did you feel? How did you respond? Accounting was always my nemesis. After failing and dropping out, I finally re-took the class with a “C” (maybe a D, actually). Later on, I had to retake it to pass my MBA coursework. That time, I had to take a completely different approach. I needed to get a better foundation. I decided to take it at the community college instead of the university. The instructor was passionate about accounting (believe it or not!) and was not only more accessible to her students but provided the foundation I needed to understand the material. I am convinced that I never would have passed without going back and getting a better foundation.
What happens when you push a human being to do something they are not equipped to do? I think we can narrow it down to a few options: 1) Retaliation—the strong in spirit will fight back in an effort to be heard. 2) Avoidance—those who rely on flying under the radar to survive will shrink into the background. 3) Compliance—the person will comply (either right away or after trying one of the other two behaviors). But is “complying” really the same thing as “wanting to”?
How do you react when someone tells you to do something? Do you dig in your heels and do the opposite? Do you comply half-heartedly? Do you think about it long and hard and then come to the conclusion it’s a good thing for you to do?
Of course, the scenario of deciding it’s the right thing to do will provide the greatest result. Let me ask you—how old were you when you had this capacity? I can tell you I finally started to check my inner child and consider suggestions honestly just a few years ago (and I’m 35). Even still, my first instinct is to rebel in frustration as opposed to consider the suggestion. A friend of mine is 39 and still digs in his heels when he’s told he should do something “for his own good”.
What does your child do when you tell her to clean her room? Does she already love to clean and therefore “wants” to do the task at hand? Does she hate cleaning her room and may eventually do it because you asked?
The point is, we often see some pretty disruptive behaviors in the school environment . . . Do you think the child “acting out” is wanting to become a behavioral problem? The more I work with kids, the more it seems they are born with an innate desire to please. Yes, even these pleasers can have a breaking point, where they appear to no longer care. But the truth is likely that the child wants to sit down and pay attention but her mind doesn’t learn the same way as her peers.
So what do you gravitate more toward? My years of experience have taught me that some approaches just aren’t a good fit for a particular family, despite my preference and encouragement toward using a neurodevelopmental approach. What do you think is best for your child? Have you or your child’s team considered “why” the behavior is occurring, or just the behavior itself?
Lastly, I urge you to take a look “under the hood” and imagine for a moment why this child is behaving the way she is . . . you may be surprised at what you find!
Morgan Hickey is a certified speech language pathologist, certified infant massage instructor, certified breastfeeding specialist and a DIR/Floortime Practitioner. She specializes in preventing, identifying and remediating speech, language, feeding and oral motor delays and disorders. She is an active member of the International Association of Orofacial Myology (IAOM) and American Speech Language Hearing Association (ASHA). She is the owner of Speech Innovations, PLLC and provides comprehensive and innovative speech language pathology services to all ages through her private practice. www.speechinnovationspllc.com