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The Impact of Sensory Processing Challenges on Emotional and Symbolic Play Development

Serena Wieder, Ph.D.
Director of Profectum Foundation

This feature article discusses “play” from the perspective of DIR®/Floortime™, a methodology for understanding and coaching parents in relating and engaging with their children. The author, Dr. Serena Wieder, is a clinical psychologist who worked extensively with the late Dr. Stanley Greenspan to establish the DIR®/Floortime™ therapeutic methodology. Currently, Dr. Wieder is the Director of Clinical Training at the Profectum Foundation, which offers a range of training opportunities and certificate programs in the Foundational Capacities for Development and DIR as the model relates to regulatory and autism spectrum disorders and other special needs. (See www.Profectum.org)

 

What is emotional development? How do we measure the level a child has reached emotionally?  Often in the evaluation of young children, this question is not addressed. In thinking about “emotions,” many diagnosticians only consider problematic “emotions” such as anxiety, poor impulse control, poor frustration tolerance, inattention/or mood disorders, rather than focusing on a broad range of emotions. More complete thinking about the domain of emotion encompasses constructs such as dependency, empathy, competitiveness, jealousy, and retaliation (and many others).

Underlying sensory processing challenges can contribute to emotional challenges that affect attachment, relationships, and thinking. Hypersensitivity to touch or sound, not knowing where one is in space, poor balance and coordination, poor timing, and poor comprehension of what one hears are some of the ways competence, self-confidence, and self esteem can be derailed while anxiety and self-doubt soar.

So what, then, do we do?  We know that even the youngest infant experiences simple emotional states. Their states are visible on their faces and in their bodies/gestures. Quickly an infant can go from bliss to fury. What we are interested in is what processes an infant must undergo to become a person who can communicate, interact, and reflect. This can also be conceptualized as the emerging capacity to symbolize emotions.

Let’s make this discussion more concrete by considering five children:

Johnny only plays with trucks and trains, on a never-ending journey to nowhere.



Benny relinquishes his beloved puzzles to play with Legos, building ever-taller towers empty of people or purpose but fitting together so they don’t fall.


Sarah wants to be a princess waiting for prince charming with no meddling sisters or jealous stepmothers in sight.


Danny growls ferociously as T-Rex prepares to charge, ready for the heroic victories he will inevitably have, but only he can move the figures as you look on.

Sammy yells, “Bar the pirates, the witches, and the ferocious tigers,” armed with his rescue hero fire hose to keep all at bay.

When children play, each choice, each toy, each drama is a symbol reflecting their emotional developmental level. Symbols are crucial in our world so rich in symbolism. Toys, words, movement, art or drama, can each have representational meanings and can elicit experiences and feelings in a safe way that allows a child to learn, interact, and express life’s dramas. Play choices also depend on a child’s sensory motor profile, which shapes how well they can actually execute their ideas. The development of symbolic play, while separate from sensory and motor abilities is also interwoven with sensory and motor development; the level of symbolic play is dependent upon the child’s arousal level and ability to modulate sensation. Other related developmental proficiencies that also affect symbolic play are: auditory processing, language comprehension, motor planning, sequencing and visual spatial abilities.

There are so many variations on themes when children play. Each child will “make believe” using different solutions to scenarios they construct. Often, protest, avoidance, withdrawal, self-absorption, tantrums and other forms of anxiety and helplessness meet adult intrusions into the child’s solution as the child insists on his way. Indeed it may be that the only way he or she knows how to perform a certain task is his/her way.

Let’s take a look at two children to notice how much variation in symbolic play can occur. Johnny, as stated above, is so preoccupied with his trucks and trains that he has not practiced any other “play moves” so he is unable to move efficiently in space to find a destination, and he does not  have experience planning who will be there when he arrives, or providing reasons for the journey;  he has no time to do those things because he is “stuck” in the repetitive mechanics of  his ritualized play theme. Johnny depends on pushing the wheels of the truck from one spot to another and then flipping the truck upside down to turn the wheels “round and round”.  Sometimes he memorizes scripts and continually repeats these.

Danny, on the other hand, can only tolerate what he considers “dangerous” by holding T-Rex, controlling all the moves of everybody’s play. This includes: relying on visual stability in environment, having no surprises, insuring he does all the growling, and assuring that he always wins.

Though Johnny and Danny are very different, each of their play scenarios might be typical for a brief period of time as a child transforms experiences or feelings into symbols reflecting their interests. However, a typically developing child will simultaneously be experimenting and mastering roles and creating dramas through play.

At times, children do get stuck in early play patterns and only know one way to play. We then observe that they lack interaction, flexibility, range, motives and/or the communication of feelings and ideas in play. This “getting stuck” may reflect a Sensory Processing Disorder. If a Sensory Processing Disorder is involved, the result is often rigid and repetitive behavior, constricted emotions and a paucity of new ideas. When this occurs, a gap exists in the child’s foundational capacities for development. The anxiety that often appears can derail social and emotional development.

 

Symbols reflect the hierarchy of emotional development

Why do children build a symbolic world? When do they start? 

Surprisingly, infants begin to build an emotional world almost from the start! It isn’t long before the infant looks for the cuddly teddy bear that was placed in his crib soon after he was born. The infant feels the security it represents because of the repetitive affective interactions and signals given by his caregivers. The parents may have cooed over and over, “baby will not feel alone because he is with his Teddy.”  When the young child feeds her baby dolls, becomes the doctor who fixes boo boos, fixes her broken car, builds his house, and has picnics and birthday parties, the play acts reflect the child’s emotional state. The activities are taking the place of emotions too hard for the child to put into words, but represented by the actions of the play characters.

Even before a child has words to express ideas, he or she will engage in emotional acts related to nurturing, giving or getting pleasure, within a safe and secure environment. Baby books reflect love and kindness and often have a theme of cuddly animals that repeat a simple theme: first there is separation and then there is reunion. In our culture, symbols such as Barney, Sesame Street characters, Winnie the Pooh, and Dora reflect the emerging expectations that young children can solve problems, learn and venture into the world, and succeed.

However, as a child gets older, safety and security may be replaced by fears and magical thinking. In our not so perfect world the door may then open to a range of emotions that include jealousy, anger and aggression. This is a land where evil may prevail and brave heroes must ward off the dragons, witches, and the wicked. As developmental age increases, magic wands and potions give way to rescue heroes and super figures that control the dangers; in this stage, the child begins to contemplate reasons for “good guys and bad guys”. Reflecting on both positive and negative emotions, typically the child begins to understand the nuances of “right,” vs. “wrong,” and he or she begins to use abstractions and symbols to represent emotional states.

How do symbols form? As the young child becomes aware of and begins to understand experiences, (i.e., sees visual stimuli, hears auditory stimuli, smells olfactory stimuli, feels tactile stimuli, or notices vestibular (movement) stimuli, he or she begins to recognize and anticipate these experiences and interactions with others in their minds. The perception of the event becomes separated from actions, in other words it becomes visualized as a mental image. The mental image begins to represent the experience, and the representational images then become symbols. The child no longer has to actually see his/her mommy. He/she can use the image she constructed earlier when he/she holds his teddy bear; the teddy bear is now transformed into a symbol of attachment to the mommy.

Symbols take many forms such as toys, words, movements, music and art. In this stage, no longer must the young child have the “real thing” to explore ideas, to think about and/or to work through experiences. As the child manipulates ideas in her mind, she uses symbols that have taken on meaning through emotional interactions, feelings, and impulses can be turned into ideas which are expressed through play rather than by negative “acting out” behaviors. Symbolic play allows the child to try out different roles than the ones he or she has in reality. These roles differentiate the child from others and are not bound by real time and space. As the child imagines whom, what, where and when, his or her ideas become more complex and symbolism builds. Reality testing develops as the child continues to check if the things he is playing are real or not. The more he imagines and the more complex the play becomes, the higher the child will climb on the “symbolic ladder”;  abstraction and reflection will then increase across a wide range of feelings and relationships.

Sensory Processing Disorder may cause constriction of emotional content and anxiety

Symbolic development often has an uneven course with gaps and constrictions related to the complex interactions between the child, the caregiver and the environment. Consider for example, a child who tends to be over responsive to sensations like sound and touch, and who tends to experience and express affect intensely. He may have difficulty regulating what he feels inside, become overwhelmed or impulsive and be unable to distinguish between excitement and fear, or what is real and not real. On the other hand, consider the child who is under reactive to sensation and becomes self-absorbed. What if the caregiver tries too hard to engage the child in emotion-based communication? The child might then feel alone, unattached, and insecure. If the caregiver instead under-responds and does not feel comfortable with the emotional outpouring, then the child may become confused and insecure. In each scenario, it is important to consider the impact of many related features such as the environment, the task, the relationships and so on, each of which can be either over or under stimulating. These elements influence the development of symbolic function and range of emotions, as well as social graces with which the child interacts, negotiates, and plays with others.

When development stalls, or the child hits a development plateau, and/or if  constrictions and anxiety are evident, the child’s foundational capacities of development must be re-examined, and his or her intervention program should be reassessed. The Developmental, Individual Differences, Relationship Model (DIR), developed by Greenspan and Wieder, was the first intervention model to describe the structural components of Foundational Capacities, integrating intellectual with emotional elements. DIR focuses on the capacities or strengths that promote a specific child’s abilities to internalize experiences and behaviors. Then the capacities serve as the basis for a repertoire of competencies in daily functional skills, learning, comprehending, communicating, having emotional and social competence and ultimately being independent.

Guidelines for intervention

Integrating symbolic emotional experiences into the treatment of the child with Sensory Processing Disorder is an opportunity to strengthen the foundations in which development moves forward with an emphasis on capacities not deficits.

The method generally uses a similar process to that noted below:

  • The therapist observes details of spontaneous play and caregiver-child interactions, forming impressions of the child’s developmental level, interactive capacities, emotional strengths, and constrictions or anxieties.
  • The range of emotional themes that are expressed through the child’s symbols is considered.
  • The evaluation of the child’s sensory processing strengths and limitations is completed.
  • Areas of sensory processing, which support emotional functioning are evaluated.
  • The therapist makes or sees opportunities to symbolize experiences at a level, which the child comfortably can complete. Mastering situations will enhance motivation and decrease anxiety the child (or parent) has or experiences.
  • The child is allowed to discover the symbolic world; if therapist intervenes they respond to the child using a “third person.”  This “person” can be a symbolic action or prop such as a doll, puppet or other symbol.
  • The child generates ideas with toys and equipment the therapist makes available; the child’s lead is followed. He or she may “borrow” ideas from books, videos, obsessions and/or real experiences.
  • The play is at or just below the child’s developmental level. It is imperative to assure the child can establish or maintain the early play themes: joint attention, engagement, two-way communication and problem solving before prompting him or her to climb the developmental ladder of symbolism.
  • The child is allowed time and space to discover what is real or not, pretend or not.
  •  Representation is encouraged but not required; figures have names of family members and friends, or dress-up is used to represent ideas e.g., the fairy godmother is a “good person” but a pirate represents the “bad person.”
  •  The child is encouraged to imagine and create symbolic ideas as he works. This can take the form of images (“Oh no, a giant crab is coming!”), or roles (“Pretend she is a …  construction worker, dancer, artist, architect, storyteller”).
  •  As needed the child is assisted to turn equipment into pretend play ideas, e.g., tunnels to escape, mountains to climb, ships and planes crossing oceans and mountaintops, trapeze artists searching for treasure, etc.
  •  The toys are used to create ideas, e.g., park cars in order to go shopping, or use play food on a picnic with friends, creating a story with a beginning, middle and end.
  • The therapist serves as a play partner (not interviewer, therapist or facilitator) to help the child stay in the drama. Interaction is within the context of the child’s story using affect cues to modulate child’s arousal and help him/her stay engaged.
  • Parents are educated and coached in the moment about how to encourage symbolic play and expression.
  • No matter how advanced the clinician is it is wise to seek consultation and further training in how to incorporate other methods of working with children who have SPD.

 

The Profectum Foundation offers a range of training opportunities and Certificate programs embracing DIR®, advancing knowledge of development and intervention across the life span. The goal of Profectum is developing the models and approaches from which individuals with Sensory – Regulatory Disorders, Autism Spectrum Disorders, and other special needs can benefit. We invite you to participate in the Profectum Academy. )

The material in this article is abstracted from a forthcoming book Hidden in Plain Sight: Visual Spatial Challenges in Autism and Learning Difficulties by Serena Wieder and Harry Wachs.

Dr. Wieder, a clinical psychologist, is the Clinical Director of the Profectum Foundation. She has published extensively including Engaging Autism, as well as The Child with Special Needs, and Infant and Early Childhood Mental Health, co-authored with Dr. Stanley Greenspan. Dr. Wieder co-founded the International Council for Developmental and Learning Disabilities with Dr. Greenspan and now lectures, practices, and consults to clinical and educational settings, through Profectum Foundation.

 




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