Monday, December 21, 2009

What is Co-Regulation?

Co-regulation is the "dance" of social interaction. It is one of the earliest means of communication developed in infancy.

Co-regulation is unpredictable, but not too unpredictable. It rests on the premise of "My actions are influenced by, but not controlled by, your actions, and likewise, your actions are influenced by, but not controlled by, my actions."

For example, think about having a conversation. What you say is going to be influenced by, but not controlled by what your partner says. Your partner's responses, likewise, will be influenced by what you say, but you do not control their responses. It is unpredictable, in that you do not know exactly what your partner will say, but it is not so unpredictable that you are confused. Your partner's responses are influenced by your responses, so your partner will likely respond with something that is on-topic and makes sense.

This "dance" develops in early infancy through a series of daily interactions with parents and caregivers. Think about a simple game of peek-a-boo. It might start with mommy hiding her face behind her hands and peeking out. If baby responds with a smile, or a giggle, mommy might do it again. As the game goes on, mommy might add more variations to the game, hiding her face behind a blanket, for example. Baby might also respond in different ways, laughing at one variation, studying another, and eventually, turning away and signaling that the game is over. The game is unpredictable, but not so unpredictable that it becomes confusing for either mom or baby.

Children with autism have difficulty with co-regulation. They have difficulty seeing the underlying patterns that help us to make sense of the interaction, so to them, co-regulation is completely unpredictable. Many individuals on the spectrum respond to co-regulatory interactions by either a)withdrawing, either into themselves, or physically leaving the situation, or b)trying to control the interaction - talking incessantly about a preferred topic or insisting that their partner follow a script.

So, how to we help our children with this? The first step is to spend time just "being" with your child. You are not trying to get any specific response from your child, you are simply "hanging out" with no agenda. This can be tricky at first, as many children will respond by either trying to withdraw or controlling the interaction. This is where we often recommend sitting side by side on a couch or a porch swing. Make sure there are no distractions around (tv is off, no special interest toys or video games, etc.).

The rules are as follows: You cannot leave. This is a strategy we've often referred to as "I won't make you do anything, but I'm not letting go." Hold your child's hand, if necessary, and gently but firmly insist that you are sitting together for the duration. Start with small intervals (5 minutes, or even less, the first day, build up from there). The object is to let the child know that s/he must stay with you, but that you are not going to try to "get" them to do anything in particular. This is a sore spot for many children on the spectrum, especially those who have been through behavioral programs and are used to therapists who expect them to perform specific tasks. This is not about performance, it is about learning how to interact. It may take several days, but once your child knows that s/he is not going to be pressured to perform, their resistance generally lessens.

Rule #2, do not allow the child to control the interaction. This is where some children will attempt to take control by talking about an obsessive topic of interest, or insisting that you engage in a script with them. If your child is talking about an obsessive interest, tell them that we are not talking about that right now. If necessary, wear headphones to give your child a visual cue that you will not participate in the interaction. Don't worry if s/he keeps talking anyway, just stay with them, but do not engage in conversation about the obsessive topic. Use the same strategies with a child who tries to get you to participate in a script. Stay calm, do not participate, and hold on, even if your child is upset. This is where it is important to set a limit, until your child makes the discovery that s/he is not being asked to perform. Once that occurs, the resistance generally fades, but it can take time, so be patient.

Setting the stage for co-regulation is one of the more difficult aspects of getting started, but it is critical to future success. This part can be difficult for parents, because you are often feeling like you are not really "doing" anything. Trust me, you are setting the stage so you and your child can "do" great things later. Getting through your child's initial resistance is difficult, so make sure you have support and downtime of your own, because staying calm is critical. Hang in there, take your time, and know that your patience and faith will pay off.

In my next post, I will discuss taking this from "hanging out" into co-regulation


poohder said...

yay! love your posts, so glad you're back

Popo said...

thanks that really helped me in my work with autistic children