Interview between Speaker 1 (Meg) and Speaker 2 (Rachel Coley)
Episode 34 – Strengths-Based Early Intervention & Parenting
[Introductory note]
Hey, it’s Meg! If you’re an OT or a speech therapist who loves this podcast, you’ll enjoy my free training, ‘Four Essential Strengths-Based Strategies for Autism’. In this training, I dive deep into the places where many therapists are getting autism wrong, talk about why it matters way more than we realize, and teach four concrete strategies that you can start using right away. We even talk in-depth about what we know now about autism learning styles, because when we can shift our perspective and truly consider how autistic kids think and learn, we can start generating more meaningful and effective interventions to help our clients find more joy, independence, connection, and acceptance in their lives. Visit learnplaythrive.com/masterclass to start learning right away.
[Introductory music]
Welcome to the Two Sides of the Spectrum Podcast. A place where we explore research, amplify autistic voices, and change the way we think about autism in life, and in our professional therapy practices. I’m Meg Proctor from learnplaythrive.com.
Meg: Before we get started, a quick note on language. On this podcast, you’ll hear me and many of my guests use identity-affirming language. That means we say, ‘autistic person,’ rather than, ‘person with autism’. What we’re hearing from the majority of autistic adults is that autism is a part of their identity that they don’t need to be separated from. Autism is not a disease, it’s a different way of thinking and learning. Join me in embracing the word ‘autistic’ to help reduce the stigma.
Welcome to Episode 34. In the last episode, I promised you all that there would be a follow up on the sensory experiences of autistic mothers. That episode with autistic OT and mother, Sarah Selvaggi-Hernandez, is in the works. But in the meantime, I am really excited to share with you today’s interview with Rachel Coley.
Rachel is an OT, the founder of CanDo Kiddo, and a mom to three kids. Rachel’s work at CanDo Kiddo taught me how to be a parent. She taught me how to play with babies, keep them safe, and support their development when I first became a mom in 2017. And our worlds have begun intersecting in the last few years as Rachel navigates the world of parenting neurodivergent kids in the best possible way. It’s been really exciting to watch how that personal change has impacted her business as she looks for ways to make her own work around infant development more strengths-based and affirming of different ways of developing. In this interview, we talk about those changes she’s making in her business, we talk about what she’s learned as a parent, and how that’s changed the choices that she makes as a therapist. And we even take a big picture view about what we as therapists can do to change the systems that are harming neurodivergent kids, as well as what we can do within ourselves to show up better for our clients. We tackle big things and small things and everything in between in this episode. Here is the interview with Rachel.
Hi, Rachel, welcome to the podcast!
Rachel: Hi, Meg! Thanks for having me.
Meg: Yeah, it’s such a pleasure. Okay, so we’re going to explore your journey as an OT and an infant development specialist, but also your personal journey. Let’s start there with your story. Tell us a little bit about your family, Rachel.
Rachel: Yeah, so I have the background of being an OT, which I figured was gonna make me a superb mother, right?
Meg: Yes. [Laughs]
Rachel: So, my husband’s a little bit older than I am and we met a little bit later, so we wanted to cram pack our kids in rapid fire, rapid succession. So, we had three kids in less than three and a half years. And one of the effects of that, not only is it just intense —
Meg: That’s intense.
Rachel: — but we didn’t get to know each one of our babies before I was pregnant again. So, we didn’t know until after I was pregnant with our second that our first was going to have needs that were going to be difficult to accommodate with a very pregnant mom or with a baby sibling. So, we discovered that once we already had baby sibling, and then for some reason, we thought, you know what, let’s have one more. So, yeah, we have three and they are all very, very different people that came out of the womb, just very different from each other. And I think that is a really big thing that has impacted me as a therapist, is just realizing how much it’s not really what the parents’ doing, you know. We can impact them, but they really are their own unique little people. And so, my husband works full time outside of the home, and I started staying home with my little, the first one, and started this online business just on a whim. I had some friends asking to share activities with them for their babies. And that’s where CanDo Kiddo started. So, now I do that and also do the stay-at-home mom gig, but my kids are all in some level of childcare these days.
Meg: Oh, that’s so wonderful. I relate so much and I’m sure anybody listening who has children relates too, to how different your kids are than you expected them to be, and how different parenting is, and how much less control we actually have over what people come into our lives as our children. And, you know, you and I have had this conversation before about how we’ve changed the way we work with families now that we have kids of our own. And there’s things I know we both look back and sort of cringe about. One of mine, I look around now at my messy house and my little kids and, you know, the laundry I can’t fold, and during quarantine I’m sure my three-year-old at the time would have benefited from a picture schedule. Yeah, right. And I think about those lists of 10 homework assignments that I would give working parents of three children.
Rachel: Yeah.
Meg: And just kind of perkily like, “Here’s the 10 things you can work on before I see you next,” and then I’d say, “Did you do it?” And the ridiculous of that just makes me laugh and also cringe, because that’s not the support those families needed. What are — what are your things? What’s changed for you since having kids about how you support families?
Rachel: Wow. So, yeah, I think some things changed just by virtue of becoming a parent. And then other things changed because my kids are — two of them — are differently wired. And my son has several diagnoses that I like to collectively just call neurodivergent, because I don’t think any of those diagnoses would really inform people about who he is. He doesn’t fit a lot of molds at all, even those diagnostic molds. And so, that also has informed — he receives lot therapies — and that has really informed being both sides of the therapeutic relationship; being both the parent and then also having been the therapist. For sure, there are things I cringe about.
I think one of the biggest ones I’ve been thinking about lately is I used to evaluate kids. They would come into the clinic — so, I’ve worked in inpatient hospital setting, outpatient medical model setting, outpatient sensory, I mean, I’ve worked in every early intervention in the home, every context you can imagine for kids. So, I used to conduct evaluations with the child present for the parent interview portion. And I guess, conceivably, that’s because of billing or because I was trying to simultaneously observe the child. But man, I would never do that again. I would try to get that parent interview either prior to the eval, either through e-mail, or Zoom, or a phone call, or have the parent be filling it out in writing if they were able to do that while I’m watching the child, just because I do not feel comfortable having those types of conversations in front of my child, not because he doesn’t know his diagnosis or know that he has challenges, but there’s just candidness I think a therapist would benefit from knowing that I don’t want to say in front of him or his siblings. So, that’s a big one. I used to come out in the waiting rooms — I think I’ve told you this before — I used to come out into waiting rooms and stand in a crowded waiting room and tell the parent how the child did during their session in front of the child.
Usually at that point, the child loses any regulation that we’ve gained during the session because now we’re talking in a crowded waiting room, and they’re ready to go. And so, I think just being a lot more conscious of the little ears that are listening and protecting that relationship between myself and the parent, and the parent and the child, and everything else. I’m much more naturalistic. I used to be naturalistic to begin with. I love home care, I loved working in a childcare facility on staff, but I’ve come even more so to the point where, if it’s feasible, I would want to see a child in the environment as it normally is, in terms of like, how many people are there? What time of day is it? What was the rest of his day like before that session? I know that’s not always practical for scheduling purposes. But if I was offering home care or had it available, I would not limit it to the home. I would make sure that I’m also seeing that kid in every context because I know my children, in particular my son, is totally different in presentation, in different contexts. See the same kid, but he presents very, very differently.
Meg: Rachel, I used to do that too, going back to our first point of interviewing parents in front of a kid and also explaining things about what we’re going to be doing and why in a way that wasn’t always strengths-based in front of the kid. And part of that is the insurance requirement that the kid has to be present for the session. And that’s tricky, but important, like you said, to find a creative way around. And also, I worked with a lot of non-speaking young kids. And to be honest, there was probably some element on my part of not presuming competence, not realizing that that child was forming their self-identity at that moment, and following the conversation and interpreting it however they interpreted it.
Rachel: Yeah, I worked with a student in Vermont who was incredible. She was about 16-years-old. And she didn’t get any sort of communication device until she was probably 12 or 13. And she was completely non-speaking, and she started communicating at a level that like, rattled her parents because they realized, in hindsight, how much had been said right in front of her. So, that one child really shaped that aspect of my career.
Meg: Yeah. On Episode 9 of the podcast, we had non-speaking AAC user, Ido Kadar, who understood everything and didn’t speak until he had a device that he had learned how to use. And he talked about what it felt like to hear people call him low-functioning.
Rachel: Uh-huh. And on the flip side of that, that functional label, I have a child who, diagnostically you would call ‘high-functioning’. I will tell you as the parent in our household, our functional level, I would not call high as a family. And so, that can be misleading in both directions and just not a helpful label.
Meg: It’s not. Yeah, for your child that doesn’t reflect how much daily life might be challenging for him and how much support he might need. I want to ask you, Rachel, you talked about working in a clinic, where you come out to the waiting room and say, “Here’s how the session went,” and we’ve sort of talked about this before. I know in my career, I’ve had sessions that felt very performative. Like, I took a kid into the clinic, I usually had parents — I always had parents present — but still, I would orchestrate this beautiful session where they performed all of these skills, because I had set everything up just perfectly. And it was kind of about my ego, I think, than more about the kids actual daily life and that family’s needs. What’s your perspective on that, now that you’ve been on the other side as a parent getting therapies for your child?
Rachel: Yeah, I would say that one of the things that through the experience of having a lot of therapists for my kiddo, the ones that have really impacted his life and our collective life as a family, are really the ones that don’t present as the expert and keeper of all knowledge about my child. That’s a really disempowering dynamic to have as the parent. I’m sure as the therapist, it’s empowering, because you have all the knowledge, right, about this kid, and you’re the one that can help this family. And now as a parent, it’s the therapists that come alongside me and say, “Wow, yeah, your kiddo is different. And, you know, I don’t have a quick, easy answer, because if I did, you probably would have found it by now. So, let’s — I’m going to help you. But we’re going to do this together.” And it’s just such a collaborative process. And those are the ones, not the ones who can have my kid do a perfect session. They actually don’t shape our lives, because that will never be replicated at home. So, it’s definitely informed my practice too, and made me a lot more humble. I feel a lot more comfortable being humble, seeing myself as an equal partner to a family. I didn’t feel comfortable in that as a young therapist. So, I think that’s partly just an evolution and maturing of my career and my professional self-image. But also, the parenting for sure has informed that.
Meg: I think it’s worth lingering here for a second because those feelings of imposter syndrome that new therapists have, or therapists who are new to a setting even have, can really get in the way of actually helping families of neurodivergent kids and this idea of ‘fake it till you make it’, we kind of have it wrong. It’s like, fake that you know what you’re doing. I think what ‘fake it till you make it’ should look like is fake that you feel comfortable and confident enough to learn from a child and from a family, and validate their experiences and the things that they’ve tried and the knowledge that they have, and not try to prove that you know something and that you’re gonna swoop in and change something.
Rachel: Yeah, and I think too, I think prior to where I am now in my career and personal life, I think I sort of separated the psychiatric component or psychological components of OT to those settings. Like, I kind of siphoned it off like it was a separate thing. And definitely in the past seven years, I have, through parenting, I have really embraced the fact that you cannot pull the mental health, the relational, all of those, the psychological components of disability, of families, of interaction with your environment, of employment, all these things that we’re supposed to work towards outside of the psych model, we still have to bring all of the mental health stuff into that. And I think that part of the value of sitting with a parent and ‘faking’ as a new therapist that you’re comfortable in the uncertainty and in a more equal partnership with a parent is holding space for them. That’s a bigger part of the process than I realized.
You know, if you have a kiddo that you’re only seeing for handwriting, maybe the psychological component isn’t as big. But that’s not usually what your audience, I feel like, is working towards. And so, I think, yeah, I think that we just have to really realize how interactional, functional, and relational, and dynamic between people — I think, as a parent, one way that that shows up for me is I realize, the apple doesn’t fall far from the tree. So, like, my middle needs a lot of help with executive function. Guess what? So does her mom. So, I am a really bad candidate to figure out how to support her executive function because I need help with my own, you know, or my husband is not robust in his neurotypical social skills. And so, when we have a child who is also struggling in that area, my husband’s not the best person to support that. So, I think just realizing that, you know, sometimes the role of the therapist is to help everyone.
Meg: Yeah, I love that. And I also really love this comment that you made, that sitting down and working on handwriting is not where most of our listeners are moving towards. That’s where they might be. But our hope is that they’re going to be able to look at a child and say, “What do you need to joyfully and authentically participate in your daily routines?” Is it neater handwriting? Is it? Or is that just what the therapist is feeling comfortable teaching.
Rachel: And how does it feel to a parent? Like, for you to say like, if an OT in school, for example, they did this last year. They evaluated my son and said he doesn’t qualify for OT. I’m like, first of all, are you really an OT? Because he needs a lot. But it was because it was all through that school model. He has great handwriting, he has great, you know, posture in his chair, all those things are fine. But as a parent, it just feels so — it would feel so insulting if someone drew up like a handwriting goal for a child that that’s just so far from what our family is struggling with and what he wants. He doesn’t care. So, yeah, definitely, I feel like there’s a lot of tension between the medical model and how it informs our practices and our settings. The medical model versus the strengths-based model, and the more naturalistic and cooperative. And that’s where that fear of imposter syndrome is too. I mean, you get out of school and you feel like nobody taught me all the interventions. I don’t know. I mean, it was all theory, what — where are the interventions? I need to go to a hundred CE’s, continuing ed courses, so that I can gain all these interventions. And I realize now there’s a little bit of that that has to happen, but the most important things that you can offer a parent are not, like, easy button answers to every problem.
Meg: Yeah, there’s so much space to push back against these limitations. I worked in the schools, I worked on some handwriting stuff. And it was not all I did, because there were enough of us pushing for what the role of OT in the school should be and there was no one to stop us. We created the culture of our department in rural North Carolina. And we were occupational therapists, not handwriting therapists, because that’s what we demanded to be. And I realized people have all of these real logistical barriers to that and you have to be brave and put yourself out there and work towards the therapists that you intended to be.
Rachel: Yep. And you can also be strategic, not dishonest, but strategic in your documentation. I had a friend whose child is somewhat similar to my oldest and she recently was very upset because she asked for the OT documentation. She couldn’t be at one of the sessions and she asked to get the note. And the therapist shared with her and she was really upset because there were things on there like handwriting and just, you know, tying shoes and things that parents really didn’t care about. And I said, you have to remember who the audience is. I think you should request, instead of requesting the session note, I think you should request a conversation because if she’s billing insurance, I can tell you that what she’s emphasizing here is not the portions that maybe benefited your child the most.
Meg: That’s a great point. Yeah. Who is that documentation for? I also want to be clear that we’re not saying there’s no role for OT in handwriting, because for some kids, that is one of the most important things we can support them with in the school system. So, autistic speech language pathologist, Rachel Dorsey, just developed a course for Learn, Play, Thrive on strengths-based goal writing for autistic students, and it’s for OT’s and SLP’s. So, she had a neurodivergent OT consult. Well, I went through it after she finished and I was like, there’s no handwriting goals. And she was like, I don’t think handwriting goals are strengths-based for autistic students.
Rachel: Yep.
Meg: And I was like, okay, good answer. And people already know how to write them anyway. So, let’s show them how to write self-advocacy goals too.
Rachel: Yeah, absolutely.
Meg: Okay, let me circle back around. Are there any other ways that being a parent to neurodivergent kids has changed how you approach your work as a therapist?
Rachel: Yeah. So, actually, experientially, I went through something as a parent that impacted my paradigms around OT, and that was that we did a semester last year of ‘unschooling’ with my son. And we did it in a community, a private school, that was a private school that was an unschool community, if that makes any sense. But it was just a very, very — it goes way beyond just non-traditional, it’s just like a whole other framework for learning. And so I, for lack of a better term, I got to see kids from 18-months-old to 18 in the wild. Like, in the most natural, amazing setting for kids. Things to play, things to read, things to build, just amazing. And they were free to dictate their own schedule; to be in groups, to be alone, to dig in dirt under a tree for an hour, whatever. It’s swing when you need to swing, you know, all of it. It was amazing. And I guess it just made me realize that like, how much time are we spending as therapists and as a whole society putting our energy and attention on trimming the corners off of square pegs because we have a round hole, instead of going in search of a square hole? Like, it’s almost like we don’t believe and that’s sort of what you’re doing, bringing the strengths-based information to therapists, like, it’s almost like we don’t realize that there are square holes out there. And the best way to support a square peg is to find a square hole, it’s not to shave off corners.
And so, you know, for example, the thing that stands out in my mind the most about the unschooling environment was that kids, even 13, 14, 15-year-old kids almost always preferred to move across campus in ways that were not lined up, with their hands to themselves, walking quietly. They almost never did that, it’s not a natural thing for kids to do. And so, you know, by not forcing them to move across campus any other way, there was no problem. But if you took a natural child’s inclinations, and put them in a school setting, and don’t allow them to spin down the hall, run their hand down the cinder blocks in the hall — which I remember that sensation from being a little kid because I used to sneak and do it — but if you allow them to move in their natural square peg ways instead of confining them, then so many of them don’t need school OT at that point. They don’t need a sensory diet. They do their own, most of them, when afforded the environment and the opportunity to do it. And that was just really powerful. Because I was thinking, you know, there were plenty of neurodivergent kids in our unschooling community, and you could hardly tell — I kid you not — you could hardly tell who would have had a diagnosis. Because they were able to meet their own needs, and were supported for who they really are.
Meg: That’s so lovely, and highlights this point that the challenges that an autistic person experiences in this world, or any neurodivergent person, don’t exist inside them. Those challenges are real. It’s not rose-colored glasses, right? That being neurodivergent is just a good thing. It presents challenges. But the challenges aren’t from inside of the autistic person, they’re from the way that autistic person’s needs and strengths and challenges interact with their contexts and their environment.
Rachel: Absolutely. Yeah. And so, what’s changed for me is I’m a whole lot more apt to change the context.
Meg: Yes.
Rachel: To change the environment or change what we’re asking this kid to do. Stop asking kids — I mean, I understand it’s the industrial educational complex, right?
Meg: It is.
Rachel: Like, we have to walk nicely in the hall because there’s 25 of you and one teacher and we’re on a strict schedule. And you need the sensory brakes because your system can’t sit for an hour. So, that’s why we have to add it in artificially because we’ve stripped away the natural opportunity for you to meet this sensory need, is that interaction.
Meg: I think that’s overly generous too. Like, I don’t think it’s just necessary to get through a school day with lots of kids. I think we’re teaching kids to be docile because it’s in the interest of a lot of people.
Rachel: Yep. Yeah, and I think I have this sort of mental image that I have kept since being in the unschooling community and just daydreaming, where on the left side, it’s like all these amazing qualities that children, neurotypical and neurodivergent kids have. And some of them we would perceive societally as good or bad, you know, shy, outgoing, loud, quiet, you know; all these things, visual learner, movement learner. Then you have on the right side all these amazing ways to fit into society with your strengths. And then you have this gauntlet in between them that’s super narrow that is school. And it just is — I really feel like to meet the needs of this kids, to a certain extent, we got to burn the whole thing down. Which isn’t — which isn’t a very feasible suggestion, right?
Meg: Right.
Rachel: It’s like, sound like a great action step, Rachel. But I do have this sense of like, we keep trying to artificially manipulate this gauntlet. But what if we just widened it? What if we just made it a wider path to go from these things about you to this amazing place in society where you’re going to fit in and really build a life on your strengths? But that middle section has to be more flexible.
Meg: It does.
Rachel: Otherwise, you’re just making people really disabled and really miserable in this interim period, you know?
Meg: Yeah, I think it’s a great call to action because it helps therapists step back and evaluate from a more systemic perspective. Because it is, it is a hard thing that we’re asking. Can you be strengths-based and neurodiversity-affirming in a culture that doesn’t allow for that? Well, actually, it’s really hard. And part of what we’re saying is, yes, it’s really hard, and you’re against something impossible. And we have to be brave and challenge it, and do our best work within whatever limitations we have as well. But it’s useful to at least be able to see clearly what you’re seeing, otherwise we’ll missattribute. “Oh, the problem is the child,” “Oh, the problem is just this one teacher.”
Rachel: Yeah. Well, and it’s also pretty easy to dismiss the idea of — to say, “Well, since we can’t burn it all to the ground and come up with a new system, then we can’t do anything.” But I think there’s small tweaks we could make. For example, if I was in a school right now, I think one of my big pushes to the administration, and this is really coming from being a parent, but when we’re grouping children into classes, what would it look like to cluster children with similar sensory needs into classes, rather than what they do right now is distribute equally sort of intellectual abilities so that no one teacher has the same intellectual diversity in her class. But, I mean, what would it look like to say, “Okay, these are the kids that need a lot of movement and a lot of help with regulation. We’re going to give them more access to the playground and the outdoor classroom that we built.” And this class that really does well with a lot of structure and a lot of desk time and a lot of adult-directed activity, some kids thrive in that. Great. So, that class won’t need all the support of the OT and the whatever. Plus, you could consolidate. The OT could spend more time with the kids who need it. But they also wouldn’t need it as much if we had an environmental context that was meeting their needs. But when you have a class that’s 25 different sensory systems and neurologies, it’s really hard for one person to meet all those needs.
Meg: It is really hard. Yeah. What a creative idea. I love that. We’ve been facing that with pre-schools. I’ve talked about my son just a little bit only to say that he has very strong interests and he’s very interested in the things he likes and not interested in other things. And he went to an arts and crafts pre-school last year, a visual arts pre-school, and he was okay there. But he told me every day he was bored and didn’t like it and didn’t want to go. And now he’s in an explicitly strengths-based space that has a lot more movement opportunities and a lot more math and science, which he’s four but he loves. And oh, it’s not that my kid hates pre-school. You know, we wondered, “Oh, do we just have a kid who doesn’t like school?” It’s that he’s in the right place now. And this is a privilege, right? We shopped all around town and found this perfect place that is also an explicitly neurodiversity-affirming place, just because that’s their values. And it’s, you know, I’m projecting forward to school. It’s tricky. There’s real limitations and real challenges and a lot at stake. It’s our kids sense of self, their sense of competence, and their well-being at stake.
Rachel: Yeah, absolutely. And I do have to balance, or strive to balance, as a parent who’s advocating for my child. I also, I think the OT in me always feels the additional weight of advocating for kids whose parents don’t have the privilege to advocate, or the knowledge to advocate, or the, you know, connections to advocate. That’s something that I recognize that I do have the privilege of, and I’m not just looking out for my son and trying to get his needs met. He represents a lot of other kids.
Meg: Yeah, that’s so important. I do want to ask you one more thing about your son. So, your kids’ stories are your own and you’re so good about respecting that boundary on social media. But one that you’ve talked about a good bit with your son’s permission is his journey to get a therapy dog. Can you tell us a little bit about the therapy dog?
Rachel: Yeah, sure. So, he’s a service dog in training. So, a therapy dog, it’s actually quite different. So, a therapy dog, you want a therapy dog to be social and friendly to anyone and everyone. They move around a room at a nursing home, or at a library, or at a school, you can be a facility dog. So, a service dog is sort of the opposite. A service dog is trained to not pay attention to all the people in the room, only pay attention to your person. So, you wouldn’t want to have a dog and expect them to be [31:14 bow].
Meg: I love this distinction. So, a service dog.
Rachel: Mm-hmm.
Meg: Okay.
Rachel: Yep. So, by ADA definitions, Americans with Disabilities Act, the service dog is a dog that performs specific tasks that mitigate a disability. An emotional support dog just does what dogs do and makes you feel good, and a therapy dog helps groups of people. It doesn’t have tasks that it’s trained to do to mitigate their disabilities. So, we got Archer for two reasons. Number one, my son has a special interest in animals, and pets, and dogs. I also share that special interest. And so, a very meaningful occupation for me is pet ownership. And we got to a point where our house was intense, and emotional, and volatile enough that it was very difficult to have a regular dog. It just was a lot. And so, in speaking to dog trainers, we got the suggestion to try for a service dog and see what that would do. And at first, I was like, I don’t think he really needs that much, because they’re very expensive, it takes a lot of time to train them.
But as I learned more about what they do for psychiatric disabilities, which I don’t consider autism to be that, but he also has diagnosed anxiety that that is his major barrier to function. And so, as I learned more about that, I just didn’t realize how much this dog could be trained to do to mitigate his disability. So, like, for example, we’ll be starting scent work soon. And we’ll train Archer to eventually be able to track a scent through the school building to the classroom door. So, the classroom door would have a scent on it. And his task would be to lead Rowan, who has social anxiety and also sensory issues around groups in an echoey school lobby, the dog could lead Rowan to class to mitigate his school refusal and school anxiety. So, it’s really cool and really exciting to think of how much this dog could really make this kiddo independent.
Meg: That’s so lovely and such an interesting extension of what strengths-based work can look like, right. Going through the sensory and social environment of the schools is not going to be a strength for him, and we’re not going to teach them to like it. We’re not going to teach him to — actually, what we would be doing is teaching him how to hide his actual feelings and act like he likes it. Look around, say hi, don’t do this, do that. Like, just teaching him to stuff all of his authentic feelings down and act in a way that makes other people feel like he likes it. We’re not going to do that. It’s never going to be a strength, that’s only going to harm him. But he loves dogs and feel safe with dogs. So, can he make it to the classroom feeling comfortable and also continuing to be authentic to himself with his dog?
Rachel: Right, yeah. And I think it’s important too, and this is an area I want to get into some content creation about, but it’s interesting because service dogs for autism tend to be task-trained to do really interesting things like tethering a child to a service dog to prevent elopement, which I understand the use for but it’s — I’m not planning to do that and wouldn’t feel comfortable doing that. Dogs interrupting stims and things like that, I’m not on board with that. So, I think that there is room for the autism service dog world to shift to be more strengths-based as well. But for me, it’s also just what a gift for him to be able to have his special interest next to him at all times. So, what I find is that he gets to cut the small talk. People don’t say, “Hey, where do you go to school? What grade are you in?” They say, “Ooh, what a cool dog. Can I pat your dog? What’s your dog’s name?” And so, it’s just this constant invitation to, “Let’s cut the chitchat. You want to talk about dogs?”
Meg: I love that. In a recent episode with Rachel Dorsey, she said that one of the things she had to learn about neurotypicals — she’s autistic — is that we chitchat to establish emotional safety before going into content of real depth, which is not just the right way to do it. It’s just this way that we do, right. And she said, as an autistic person, chitchat feels really inauthentic and uncomfortable, and I would rather get right into talking about my interests or things that I love and care about. And that is so interesting. You’re absolutely right. When we are interested enough in something, we do that too. I’m gonna cut right to the chase before I even say hi. And I love that you’re saying, “And actually, that’s his social style and that works for him.”
Rachel: Yeah. And I think if it wasn’t a dog, another way to adapt that would be like, if your kid is really into fire trucks, let him wear a fire truck shirt every day, because that — I’m using that as an example because that was Rowan’s thing several years ago — that is the entrance. That’s what someone’s gonna talk to him about or assume, “Oh, he likes fire trucks. That’s a great way to speak to him.” You know, like, I think that we’re uncomfortable as neurotypicals with too much redundancy. Like, why would I buy him the same shirt from Target five times, like five copies of the same shirt? Well, because this is a great conversation starter for him, you know.
Meg: Oh, I love that. My husband has also worked as an OT in the past and he often started sessions by asking kids about what was on their shirt. And I could never decide how I felt about that. Just as a woman, I don’t want to be asked about my clothes. But he pointed out that kids often wear their interest on their shirts, and it was a great place to start.
Rachel: Absolutely.
Meg: So, now I think, hearing you say that, I really love it.
Rachel: And my response so often is, “Oh, I love your shirt,” to little kids. But what I should be saying is, “Oh, looks like you like unicorns. I like unicorns too,” or, “I don’t know about unicorns,” you know. So, shifting that little praise thing that we do, like, “Oh, that’s cute”, “Oh, that’s — I like your sparkles,” but instead, letting that be the conversation starter. Because I think little kids don’t do small talk well, either, right?
Meg: Yeah, I like to play dumb too and be like, “I can’t remember if unicorns are real or not.”
Rachel: Yeah.
Meg: And let them tell me what they know about it. That’s great. You mentioned content creation so I want to loop back to your business. So, when I was a new parent, or preparing for new parenthood in 2017, your eBooks and your website were pretty much all I read to prepare myself to properly take care of and promote the development of my kids, and I gave them to everybody around me. And it’s been really interesting as our world started to intersect, and as your own journey has changed as you learn about neurodiversity. It’s been interesting to watch the cascade of effects that has on your content and your business. Can you walk me through that a little bit? How does your lens change now as you look at infant development?
Rachel: I think one of the biggest ways is how it has impacted milestones and how I use, or not, don’t use milestones. You know, when I started, I was a new content creator and business owner and I was really keen to provide parents with what they wanted. That’s how you could succeed in business, was to give people what they were asking for. What are they searching for on the internet? Well, they’re searching for baby milestones. So, of course I want to put that content out there. But as my business has grown, and I’ve gotten a little bit more confident, I guess — back to that theme of confidence — as I’ve gotten more confident, I’m a little more comfortable leaning into verbiage and paradigms that push parents a little bit outside of the mainstream. I can’t push too hard because I don’t want them to just unfollow and not hear it. But I just stretch a little bit more into describing children by their stage or what skill they’re working on instead of their age. I really talk about less emphasis on the actual big milestone and more emphasis on the process, ‘where’s your child in the process’. I encourage parents to compare their child to their own child, however many weeks or months ago versus comparing to other children.
So, just kind of reframing milestones. I don’t think that it helps parents. I really don’t think that it helps parents, even of children who do have developmental delays, to know what month their child is supposed to clap. Because then, if their child doesn’t clap at the end of that month, like one day later, a lot of parents will panic, and they think their child has a clapping delay. But there is no such thing. I would only be concerned with not clapping at that specific age if there were other things that would give me clues to a bigger kind of developmental area that was in need of some support. But I think by emphasizing these individuals splinter skills, for lack of a better word, to parents — now, as professionals, we need to know them. But to parents, I just think it’s not helpful. And I’m not even convinced that the narrowness that we present them in is fair to kids. We appreciate that adults, some adults, are really coordinated and do a lot of sports. Some adults are not super coordinated and they stay in the back during the aerobics class, or they don’t do the aerobics class. We kind of acknowledge that. Some people are very talkative and great with words, others aren’t. But why — we’re like confining these kids or expecting that in infancy, they’re all going to be identical and that something’s wrong with them if they’re not. It’s just an interesting thing that we acknowledge on one end of the lifespan and not on the other.
Meg: I love that, that you’re saying help parents compare their child’s development to their own child, what are they working on, what’s the next thing they’re working towards, what are their emerging skills, what can they do. And move away from age norms, which are so irrelevant for so many kids and so, for lack of a better word, just offensive in so many contexts, moving towards actually looking at the child. What can they do, what’s their next step, what are they working on.
Rachel: And what are their strengths? I mean, that’s an interesting concept when I think about how do you apply strengths-based mindset to early intervention. I mean, when you look at the developmental profile of a child, it’s usually not that they’re equally good at all areas of development. They have some that are stronger and some that are not. If you look at what a child is interested in playing with, some are more interested in this type of play, some are interested in the other. And so, I think, instead of comparing them to a developmental check sheet or your neighbor’s child, if you can say, “Oh, I am learning about my kid, and who they are, and what their unique personality and developmental profile is,” like, “Oh, interesting, my child is not, you know, walking as early as someone else’s child. That’s not because there’s something wrong.” I think milestones are really helpful for catching medical diagnoses, like disease processes, for lack of a better word, and things like that, that there are treatments for and I’m not belittling that. I think it’s important for professionals to know those. But, you know, there’s a reason why we go to our pediatrician so much in the first year or two, they’re keeping pretty good tabs on these kids. And so, I think parents can relax a little bit and acknowledge that, you know, yeah, my child is shy, he clings to me a little more than other kids. I don’t need to fix that.
Meg: Yeah.
Rachel: There’s nothing wrong with him. That’s something to learn about him.
Meg: That’s great. Yeah, the last thing any parent needs is more anxiety and fear because of a cultural perception of how their child should be developing, as opposed to who their child is, and how their child is developing.
Rachel: And that’s exactly the verbiage that parents ask, like, “Is my child doing what they should be at this age?” or, “How much? What should my child be doing at this age?” I think it’s such an interesting question that we should like, just completely replace, because I don’t know. Tell me about your child. What do you think? You know, what does it look like they want to be doing right now? You know, like, I think that there’s a different way to sort of frame it.
Meg: I want to ask you about one more challenging area that therapists ask me about a lot, and you have this advantage of being on both sides. And that’s when therapists and parents have different perspectives. What advice do you have for, well, for parents who are looking to advocate for themselves and for their child, but also for therapists who were on the receiving end of that advocacy from a parent?
Rachel: Yeah, I think this is going to relate pretty closely to what we talked about when it comes to confidence and the power dynamics in that relationship, because it’s just not as threatening if you’re coming from a place of sitting metaphorically on the bench next to the parent instead of in a coach position, or in a more powerful position. It’s not as threatening in that scenario when a parent says, “Hey, you’re spending a lot of time working on this. That’s not really what we need,” or, “I’m just, I’m not really comfortable with the way you phrase that with my child. That’s not how we speak about those things,” or, you know, any number of ways that you could make suggestions to a therapist, ideally with a tone of collaboration, but as a parent, that doesn’t always come out.
And that’s something for therapists to just acknowledge, don’t be offended by it, but this parent has a lot and this is probably not the first time they’ve had to advocate for their child. But I think that it’s just a lot easier to respond from a place of either ‘I need to change to support this family better’, or maybe there’s another therapist who’s a better fit. I mean, if you are coming at something from a different lens than a parent and you can’t reshape your practice to be at that same point, there are other therapists that are going to be a better support. And if you view your job as not to bestow all your wisdom and knowledge to this family, if it’s to really just help and support this child and this family, then it becomes a lot easier to hear that advocacy and to really look for answers and solutions.
Meg: I love that I’m so glad we came back around to this point. And it’s interesting to me how much personal work we have to do to be good therapists. I think people who become social workers, psychotherapists, psychologists, they know that. They undergo a lot of their own therapy because they know they have to work on their own stuff. And we sort of hear about therapeutic use of self in a token way in school, but the process is really very challenging.
Rachel: So true. I think that is a big shift in my business, is I think I initially use therapeutic use of self in a sort of token way. Like, “Oh, here’s cute pictures of my kids doing these cute play things, and you can do it too.” And then as it has been more evolving, I feel like that therapeutic use of self has become really more of that self-growth and just doing the self-growth a little bit more publicly, maybe than other people, because I have that platform. But yeah, that is a big part of my process, is that really owning — there’s so many things that in graduate school, things like that, or like at the end of your evaluation, I used to have to put a strengths section and I would just bullet point like, basically copy and paste, like family support and blah, blah. But, you know, at their core, those things are really true and valuable. It’s just the way that we interpret them is a little off. And even family-based care is the same way, like family-centered care or client-centered care. It’s sort of a — I think I misunderstood it until I was in the position I’m in now.
Meg: You know, sometimes we talk about central coherence for autistic kids meaning being able to see the big picture versus the details. And when you’re saying that I’m going, oh, man, we all have poor central coherence. Because I learned about occupation-centered practice and strengths-based, and it meant writing the thing on the evaluation, right? Well, no, that’s a detail. That’s actually not the big picture. The big picture is something completely different.
Rachel: Right? Yeah, for sure.
Meg: I love this conversation. I love how we’re challenging ourselves and other therapists to both become softer and more receptive as therapists, and also braver and more critical and perceptive in the world. And neither of those things is easy. But I think that’s what it takes to create change.
Rachel: Yeah, and to really bring value to our profession.
Meg: Yeah, absolutely. Well, of everything we’ve talked about today, if therapists listen, walk away with just one new shift, one new idea, what do you hope that big takeaway might be?
Rachel: I guess its that interactional nature of human development and function. And that has different manifestations. It can be, you know, the relationship between — I’ve always thought of it as the relationship between the therapist and the client, the child or adult, depending on your practice. But it’s really that, and the relationship between the family, or the partner, or whoever, and the therapist, and the relationship between the client, the family, and the school. Like, it’s all so intertwined, and I think we have to treat it as such. I think I’ve — that’s another thing I’ve given lip service to or believed to a certain extent. But if you really, really own that, it makes your practice look very different. Because that sort of thing doesn’t really happen in a clinic with a waiting room. So, I think that just treating the whole system as interactive, and relational, and challenging what we think of as function, I think that is a big one for me. That’s a personal challenge of rethinking what’re functional goals. What’s functional for this kid, not what’s functional from a societal paradigm.
Meg: I love that. I feel like that last point you made, we could have a whole podcast episode on. That’s such a big one.
Rachel: Yeah.
Meg: Because often, we use the phrase ‘functional’ to mean ‘neurotypical’.
Rachel: Yes. Or ‘functional’ in terms of what is valued by our society.
Meg: Yeah.
Rachel: Yeah. But I — I don’t know. I think it’s — that always gets back into a conversation about capitalism, but…
Meg: Yeah, we like to go there on the podcast every, at least every few episodes. [Laughs]
Rachel: Yeah. ‘Cause it’s like, when we think of function, so much is related to what’s going to eventually put you in a position to earn money and to contribute either services or goods to society, like, so, I think… I don’t know, that’s the standard we hold. That is what informs every way that we judge, or compare, or expect children, is how are you going to eventually make some money?
Meg: Yeah, as opposed to joyfully and authentically participate.
Rachel: Yeah, and I always use it now. You said it, and it literally like, knocked me back. But like, “Building a life on your strengths.” And since I heard you say it, like that has really — it’s in our notes that we take to IEP meetings. It’s like, that is our goal, is that our kid, he has so many strengths. We’ve got to build, and he’s gonna have a wonderful life based on him. We just have to get through the next few years. But I want those next few years to also be built on his strengths.
Meg: I love that. And that was me quoting Dr. Kristie Patten, the NYU OT chair. When she said that, I went, “You know what? I have to rework all of my trainings.”
Rachel: Right?
Meg: I had the same response.
Rachel: That one phrase just can — just meditate on that, I guess. So, that’s my key takeaway. Meditate on building a life of strengths, because that is sort of the definition of occupational therapy.
Meg: It should be.
Rachel: Not to make you more functional. We say that, but it’s really to create a meaningful life based on your strengths.
Meg: I love that, Rachel. Tell us what you’re working on now and where we can find you online?
Rachel: Well, in addition to IEP meetings and training a service dog, I am mainly just continuing to put out content that is high value to families and that can help, like I said, just resonate with something deep within parents and help them shift just slightly, slowly, over time and help kind of promote and support their own individual development.
Meg: Awesome. I will link to your website and all of your social media in the show notes. Thank you, Rachel.
Rachel: Awesome. Thank you. It’s good talking to you, Meg.
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Thanks for listening to the Two Sides of the Spectrum podcast. Visit learnplaythrive.com/podcast for show notes, a transcript of the episode, and more. And if you learned something today, please share the episode with a friend or post it on your social media pages. Join me next time, where we will keep diving deep into autism.
