Domains of Development

Communication Domain: “Communication” is the totality of means/strategies that one uses to understand and convey meaning.  It can include speech and language, but it also includes non-verbal forms that are always present.  With the exception of written communication, language and speech are almost always accompanied by emotional and other forms of gestural communication.

Behavior is communication: It is axiomatic in the field of Functional Analysis of Behavior that behavior is communication.

In this regard, communication is either intentional or unintentional.  Even if a person has no intention to communicate to another, observers will still make inferences regarding the meaning of the person’s actions.  In this sense, all behavior communicates something to others.

Social/Emotional Referencing/Non-verbal Communication: Early on, the most important thing to learn to do is to “track” the emotional signals emanating from others.  Newborns are typically fascinated by the face, and spend many hours looking at how combinations of muscle contractions and eye-movements combine into “gestalts” that we call facial expressions.  At first, movements of the mouth, the eyes, and muscles in the face appear to be unconnected, but very soon, we see them as recognizable facial expressions.  As we grow and accumulate experiences with others, we learn how these emotional gestures signal emotional states, and how emotional states help us understand other people’s intentions.  The better we understand others’ intentions and perspectives and feelings, the better we are at anticipating their reactions to things.

Poor ability to read others’ intentions leads to a world of unpredictability and unwelcomed surprises.  We’re all pretty good at this, but it is an imperfect process leading to frequent but minor breakdowns and repairs: clarification, re-assessment of the other.

We systematically evaluate a child’s ability to make use of emotional information (understanding emotion signals; perspective-taking; intention-reading) to form their own courses of action.  Does the child stop to look for the information (the common notion of “referencing”) while embarked on a course of action?  If not, there will be less ability to flexibly adapt to others in an ongoing and reciprocal manner.  Does the child recognize relevant information from irrelevant information?  These are the “means” of relating to others that we assess.

We ask these questions and others like it to estimate the relationship between a child’s social/emotional perception (how he or she searches for and comprehends social/emotion information [references]), and how that child uses that information to remain coordinated in social/emotional interaction.

Gutstein and Sheely have identified the hierarchical stages of development of referencing skills.  Both Gutstein and Sheely and Greenspan have published scales of intersubjective relating, which we use to evaluate a child’s development in this domain.
A “language” is a system made up of symbols.  It is cultural in that it is learned through direct transactions with others, or through indirect observations of other people using language.

A language represents agreement among a community of speakers that certain sounds, words, phrases and sometimes gestures, have common meaning.

For instance, in the community of English language speakers, the sound string “b-o-y” means a young male.  Spanish or Japanese speakers are not in the community of people that “agree” that the word “boy” is the symbol for a young male – they have their own words for a young male.  It is obvious that a community needs a common vocabulary in order to make sense to each other.

Languages also have rules (or more correctly, “patterns”) that affect meaning.  Language rules govern things like pluralization, pronoun usage, word-order, phrasing, inflection, and so on.

  • A language is a system of communication.  The system has rules that govern its use.
  • Languages use symbols to convey meaning.  Symbols can be spoken words, manual signs, gestures, and in most modern languages: written and/or pictorial forms.
  • Language is specific.  Language is judged by the precision in which it is used.

Spoken or written words can be nonsense.  Spouting off words or symbols is not necessarily language use.  There has to be some intent to convey a specific meaning to a recipient.

Speech is the oral-motor aspect of communication, usually in the form of words, but is also can be in the forms of vocal-play, or babbling.  We are most interested in how speech sounds are used for communication.

There are many scales published that indicate normal sequences of communication development.  We use those that take into account the emotional foundations of language (the means of imitation, joint-attention, “intention-reading” etc.) a child can bring to bear for the purpose of true intersubjective relating.  Along these lines, we look at the typical reasons or “functions” of a child’s communication.  These functions fall into two main categories: imperative (information seeking or giving; giving or following directions, asking or answering questions, etc.) or declarative (for the purpose of sharing experience: observing to others, commenting, describing, etc.).  The scales we use may include:

  • Communicating Partners:[1] This approach looks at the way a child uses communication in social and emotional contexts (e.g., social interaction, play).  It looks at the combination of symbolic and non-symbolic means a child uses for interaction, including verbal and non-verbal means, instrumental and conversational means (i.e. functions of communication), etc.
  • ABLC:[2] This stands for the Affect-Based Language Curriculum, published by Stanley Greenspan and Diane Lewis.  This approach also examines communication development in the context of reciprocal interactions, with specific scales for the development of imitation, pragmatics, and receptive and expressive language skills.  This approach to communication instruction was developed for use with Floortime, but is also useful for parents who are trying to expand their child’s communication in a variety of normal daily-life routines.
  • ABA Programs:[3] There are several individual ABA programs or lessons devoted to labeling (nouns, verbs, attributes) etc. that make good supplemental drilling and practice.  These programs are used when repetition is necessary, such as for strengthening “word-finding.”  We may use ABA to teach simple grammatical structures – only as initial exposure and practice, but not as a primary method.  The ABA epistemology of language is simply wrong, and it would be an unwise overextension of that method to teach true experience sharing communication with a method that focuses only on the verbal content of language and not on the joint-attentional, social and intersubjective uses of it.

Exploration Domain: “Exploratory” behaviors represent the other end of the attachment axis.  People of all ages alternate between social connecting with others, and exploration of their world in general.   A good deal of the infant’s time is spent interacting with the world of objects, a process that sharpens perception and motor coordination with experience, as well as an ever increasing understanding of the physical world.

People also bring to their relationships what they learn from their experimentation, discovery, and experience in the world.  Exploration provides the content for experience-sharing much of the time in casual social interaction.  Exploration is a foundation for episodic memory, providing content for conversation.

We use the term “exploration” to describe the aggregate and moment-to-moment function of cognitive, visual, and motor skills that a child must coordinate in his or her exploration of the world.  There is an analogous relationship between what we describe as the “Exploration” domain and Piaget’s domain of “Object Concepts.”

Cognitive Skills: Cognitive skills have to do with representing the world mentally and using sensory and symbolic representations for problem-solving.  For this domain, we use Piaget’s Stages of Cognitive Development.  Jean Piaget, a biologist and considered by many as a founder of developmental psychology, arrived at his scale through formal observation techniques taken from biology and experimentation. Piaget’s scales have been refined over time, but they have never been seriously altered due to the remarkable reliability and validity of the original research.

Piaget identified several “strands” within the domain of cognitive development. Here, we are concerned mainly about how children develop concepts of how objects work. The scale describes how children develop exploratory means (i.e. the types of actions and concepts a child applies to his exploration and use of objects), which include: the types of actions children know how to use to explore objects; the number of mental steps they typically use in problem-solving; how they use memory to build upon their previously acquired means; the representational meaning to the child of toys or objects (i.e., how the toy might “represent” a real object, such as how a toy car is supposed to represent a real car, or how a child imagines the lives of their dolls or superheroes for example).

Visual Skills: We are particularly interested in a how a child uses her senses (i.e. vision, hearing, touch, balance, etc.) and memory to explore objects.  Visual skills can be a strong learning channel, but very often, children with ASD present with distortions of visual perception and difficulties with storing visual perceptions (visual memory).

Most of the time, perceptual difficulties are not treated separately than the object manipulation skills or concepts that require them.  Instead, we identify an object skill or concept to be mastered, and apply therapeutic methods to remediate the visual perception problem.  This is because children’s visual perceptual skills can be improved with careful, stepwise, and intensive experiences with objects.

Motor Planning Domain: “Motor planning” is a concept that goes beyond simple movement and mental coordination of physical actions.

The brain does just a few things, but in a myriad of complex and exquisite ways.  The Motor Planning Domain looks at how a child brings together all information available to coordinate actions now and in the future, and to review actions from the past.  Motor Planning consists of the following brain functions:

  • Perception: The body takes in sensory information and the brain, receiving signals from sensory organs and from internal (somatic) sources:
  • Meaning making: the brain takes the raw data coming in and makes meaning of it.
  • Attention: The brain focuses in order to find material for perception or thinking
  • Appraisal: Related to the two processes above, the brain decides what is relevant to focus on and what is not; the brain finds patterns in disparate stimuli and events and makes meaning of groupings of stimuli (Gestalt reasoning);
  • Neural Strengthening: This is what is referred to as “memory” or information storage by most.  But the fact is that the brain doesn’t store things as we think it does – it merely rekindles circuitry that was established when something is first experienced.  Further experiences of recall, recognition, etc. create the experience of memory as the perceptual and motor circuitry that originally created the experience gets traveled again (rekindled).[4]
  • Coordinating Action: The brain coordinates movement (praxis) by sequencing muscle firings.  Coordination of action must be constantly updated by perception, and the feeling of action must be perceived sensorially (somatosensory perception of proprioception, vestibulation, tactition, and affect, etc.).

Motor planning therefore refers to how the brain takes in perceptual information (sensory/cognitive perception), looks for information (attention); chooses relevant stimuli (emotion-based appraisal) and coordinates actions (sequences physical actions on the motoric [praxis], and at the executive planning level [ideas, plans for later, review of actions in the past]).

The brain is constantly shifting one of the above elements into and out of ‘consciousness.’   Consciousness has only room for one thing at a time, although we can manage to think of several things at the same time.  The mind keeps everything going on in the background (like running programs on the computer), but consciousness can focus on only one thing at a time (like what is on the screen now).  We shift rapidly and often so that we can keep all relevant things in mind.  Individuals with autism have trouble shifting the elements in and out of consciousness, which is why they can focus on and perform some actions for a long time without variation.  Finally, after perceptual and motor experience has happened, changes are made in the neural circuitry as the result of experience.  There are new connections between circuits, which, when traveled again through some triggering event – is experienced as memory.

In reality, information coming in from individual senses informs and continually updates perceptions in other sensory channels, as well as to guide, in an ongoing way, motor actions, thoughts, and intentional behavior.

For instance, vision spots a pitcher of juice on the table. Cognition (memory, attention, recognition) determines what it is and what it means (re-cognizes).  The emotions take the visual and cognitive information and provide the motivation to develop an ‘action plan’ (‘motor sequence’ or ‘motor plan’) to get some juice.

Due to previous experiences of vision and the motor actions for reaching, the person has some idea what to expect: that the reach will be as far as the eyes predict it will be; prior [motor] experience will tell me how heavy it ought to be and how much force will have to be applied to pick it up and how it will have to be balanced, etc.

Once the object is retrieved, information coming through the senses continues to provide updated information: the object is lighter or heaver or the same as expected; where, or nearer or further than expected [visual-spatial position], and as the person tried to pour juice into a glass, the eyes guide the movement of the hands and proprioceptors guide the force of the movement…
Whether we’re aware of it or not, our senses look for agreement all the time with each other.  It would be disconcerting (or at least elusive) to see an object and reach for it and find that it is further away than it looks, or is heavier or lighter than it looks, etc.  This is an essential form of cognitive-coherence: that the way the individual senses ‘calibrate’ the environment allow a unified and consistent (or “coherent”) perception of the world.

Yet this is the experience of autism.

Tracking Deficits: This is a huge area of remediation.  The vast majority of the time, individuals with PDDs and ASDs do not “track” external events, which is why they are often caught off guard in unplanned, unfamiliar contexts.  We work a lot to separate a child’s attention from his actions so that he can freely shift his attention to external events and back again.

Due to the connectivity and neurological coherence issues we know underlie autism, we know that early problems with motor planning (and most importantly: the way that actions make integrated and efficient use of perceptual information and internal [somatic] feedback for rapid and fluid adaptation to a dynamic environment) interfere with a child’s ability to track events (see Skoyle’s: ).[5]  In respect to motor development, incoherence between visual and spatial perception, balance (vestibulation) and proprioception slows motor development down, and in turn, diminishes the way a child benefits from motor actions he or she takes in the world.  It is the reason for a lot of the circular, repetitive, scripted, looped, and other static features of autistic motor planning.

Piagetian assessment of motor skills for is not only intended only for direct teaching of motor skills (praxes).  More importantly, it is also to assess the “means” a child has developed for “[motor] exploration.”  We want to know how a child is able to use his or her body and hands to get knowledge about how things work.  For instance, the “twisting” motion of the hand is a means that most children develop from watching others do it and/or from experimentation or serendipity.  Once a child learns to twist, he or she can open doors, containers, turn things, etc.  Twisting is now one of the “means” a child can use to explore the properties of new objects.

Self-Help: We perform an inventory of the skills.  We then look at the discrepancy between what a child knows how to do, and what his estimated potential is.

Questions to Ask
What do we think he or she is capable of?”  “What is considered appropriate for a child this age in this particular family?”  “What level of independence should we expect?”

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What can he or she do now?”  “What do other children his age know how to do?”  “How independent are they supposed to be at that age?”

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Discrepancy: The list of skills the child needs to learn, as well as the support systems we plan to use.

From this discrepancy analysis, we determine a list of skills to teach.  There may be many – too many skills the child needs to learn, so we help a parent prioritize.  For teaching a lot of self-help skills, we tend to use Special Education techniques such as:

Task Analysis: The skill or task is broken down into its smallest parts for analysis.  We determine the teaching steps from this analysis.  Steps are small enough to ensure success, and as large as the child can comprehend.

  • Chaining and Shaping: Steps are taught individually or in chains of responses.  For instance, a task analysis of opening a jar is to grasp the jar, twits the top, and take the top off.  A child may have problems with any of those steps.  Therefore, we may teach the steps in a forwards (teaching from the first step to the last) or backwards (teaching from the last step to the first).
  • Shaping is when we take an initial germ of a skill and expand on it through teaching.  For instance, the child may only say, “ba” for “bottle.” We might want to withhold responding until the child can do better.  So if she says “bata” we might respond.  Once she masters that, we might only respond to “ba-tel” and so on, until the skill is performed as it should be.
  • Scaffolding: This has to do with determining how much support to give the child as he learns.  One reason it is called “scaffolding” is that we may not “lower the bar” by modifying the activity significantly so the child can do it.  Instead, we identify parts of the skill the child can do independently, with help, or not at all.  Help is given more copiously when skills are new or difficult, but help is faded as the child can do more herself.

ABA Curricula as a Developmental Domain

ABA Curricula provides their own developmental sequences.  Most curricula for Discrete Trial Programs follow “developmental”[6] sequences originally established by Lovaas.[7]  There have been several editions with variations published since then,[8] but they follow Lovaas’ original sequence to a large degree.

The DTT curriculum programs target “pivotal” responses such as imitation, classification, sequencing, etc. that only with specific work to “generalize” the skills to a variety of natural settings can provide foundations for learning on one’s own.  The individual programs address skills across cognitive, communication, emotion (-regulation), motor and academic domains.  The prime advantage of DTT and ABA in general, is the methodology for breaking down complex behaviors into smaller, simpler, easier skills to teach one at a time.

The fact that many children do not fully generalize their skills and can remain dependent upon prompting and artificial motivation systems is a frequent criticism of ABA, but that is often a matter of unbalanced program design.  With an understanding of typical child development in which to view DTT, we are able to use the curriculum to teach imitation, pattern-finding, serialization, classification, and other skills and concepts that enable a fuller benefit from other, more relationship-oriented skills.

Developmental Scales

Developmental scales provide us with the normal progression of skills development in children.  These scales are usually derived from research and direct observation of the typical development of children and in what sequence individual skills typically emerge.  The research underlying the scales of development we use is well-established, valid, and reliable.  These scales cover various and often overlapping domains of development, so we have to draw from more than one usually.  Finally, developmental scales are only supplemental, they are never the source of goals for intervention.  Goals for intervention are derived mainly from systematic observation in the environment.  But developmental scales do a lot to provide context for the behaviors we observe, and insight into what to expect from further development.

Specific Adaptations of Methods for Maximizing Pivotal Social Communication Skills

We do all of our interventions with particular emphasis on social and emotional referencing.  We use non-verbal emotion-sharing[9] or social referencing rather than traditional ‘reinforcers.’  That is, when a child has done something well, we make sure to share our joy with the child non-verbally.  This requires the child to look at us for the feedback.  When the child looks, we share our affect with her.  If the child is enjoying the activity, we expect to be able to share a congruent, return of the smile from the child.

If a child needs some sort of feedback for performance, we tend to offer non-verbal social references (e.g., pointing with our eyes to the correct one; nodding ‘yes’ or ’no;’ etc.) in order to strengthen and quicken the child’s reaction to them.  This is true no matter what methodology we’re using – even ABA/DTT.  There is no law that says feedback must always come verbally or with visual, static objects such as points or tokens.

We do not elicit looking though prompting either.  There are many techniques to elicit looking, and even referencing, without prompting.  Normal referencing only occurs when the child looks to resolve some uncertainty of his own – not when they are prompted to “look at me.”

Of course, almost by definition, individuals with PDDs and ASDs do this too infrequently and may not know the meaning of what they are looking at.  This is especially true of facial gesture communication.  However, we have learned many techniques to elicit self-initiated looking and referencing.

We also tend not use behavior modification just so the child can avoid distress.  Many of the positive behavioral support schemes out there are designed to avoid discomfort.  In fact, the child’s distressed behaviors are seen as signs of the reinforcement scheme’s failure.  Instead, the child is given choices, incentives, and other things to compensate for the fact that the child cannot and will not face conditions of under-motivation or negative feelings.  Adults make deals (e.g. “we’ll do this after you do that; you’ll get this for doing that), or provide choices that wouldn’t exist otherwise – just so the child will cooperate.  We don’t do this.  We do not want normal motivation substituted with artificial incentives or even “praise.”  Instead, we use time, patient, firm, and close guidance, along with emotional availability and attunement to help a child through difficult moments and to learn to cope with negative feelings.

We also tend to present all challenges regardless of whether the child is innately ‘motivated.’  Some programs use the child’s favorite toys and activities for programming, as a means of solving the problem motivational deficits.  Both Floortime and Pivotal Response do this – by following the child’s lead.

When we want to follow a child’s lead, we will more than likely use Floortime as an intervention, because at least Floortime has an array of pivotal emotional and social responses to teach from its epistemology.  It is much more emotionally reciprocal with the child than Pivotal Response Training (PRT), [10] and is equipped to handle a child’s negative feelings.

If the child has trouble with motivation, we will use a firm, calm and responsive approach to get the child through moments of poor or dismotivation.  We choose demands that are developmentally appropriate for the child, but insist the child do what we ask, even if we have to wait and get in the way of distractions or extraneous behavior (see the “Therapeutic Pause Technique for Teaching Cooperative Behavior).