Lunesta, Rozerem, and More: It’s Showtime for the New HypnoticsWhen I think seriously about rhythms of interaction, I am sometimes unable to suppress phrases from the song and dance number, “Step in Time” (Walt Disney, Mary Poppins). Link your elbows, kick your knees up, flap like a birdie, call the chimneysweeps, eventually enticing the children, Mary and even others in the household into a rollicking, evermore-intricate choreography.

While I and the children and families I work with are not perilously perched on the rooftops of London, the challenges of autism and other developmental disorders often feel as precarious. Moreover, it’s the admonition to step “in time” that rings clear and true, for ours is a need to evolve anew in successive moments — forming a well-timed dance of interactions that raises both feelings and functionality. And it only works if we are “in time.”

Within these parameters, being rhythmically in time can be deceptively complicated. Music and the tactics of Floortime, co-founded by the late Stanley Greenspan, M.D. and his colleague Serena Wieder, Ph.D (Greenspan and Wieder, 2006) guide my work (Denton and Weeks, 2014) with young children who, by chronological age, are expected to be communicating and interacting but whose neurology and interwoven psychology subvert those abilities.

One Tap

Danny was such a boy, just three — so quiet and unresponsive that he appeared nearly mute and deaf. His parents also noted that he rarely made eye-contact. Upon arriving in my office he sat next to his mother on the carpet and I, too, sat and then waited to see what, if anything, he would do. Gingerly, he reached one hand to touch the cold metal bars of a large xylophone. I did not pick up the mallets and “play properly” to show how it was done. Rather, I bowed my seated torso and turned up my face toward his, then imitated his movement. Tap. I paused slightly and then repeated with slight slaps on the bars so that a faint chime sounded. Danny alerted, stole a glance toward me and patted the bars. I didn’t miss a moment; I joined back in so that we were both now miming an unusual, sound-dampened but rhythmic play.

Waiting, Ripe with Expectation, is like a Musical Rest

Importantly, the rhythm that first bound us, however, was not in the music itself but rather in the micro-rhythmic patterns of interaction. First, there was the space that allowed Danny to acclimate and find his own motivation of the moment — akin to rests in musical performance that are intentional, shared and hold players’ expectations to lead somewhere. He had the lead with that timing, and with the single pat he made upon the bars. Then, by imitating him, I joined and validated his motion. From that foundation I could elaborate, hoping now to lead him to the next level — repetitive, harder taps that would produce sound and felt vibrations if he would follow.

Picking up the Tempo

When Danny did follow, there was no space or time for me to lose if we were to become simultaneous partners in play; in other words, the tempo of interaction picked up. Not only did we continue dyadic play, but with the shared underlying beat, I was also able to add my singing of a children’s song. Suddenly, we were a couple making music together. When Danny stopped, I stopped. Yet, crucially, showing with my face, with the way in which my voice suspended (not dropped) and by the way my hand remained uplifted that I was waiting for him to come back in  again, a rest, not an end. Initially, he looked up at me with surprise when, from my deferred state, I resumed playing right along with his doing so, but then, upon repeated stop/starts, sported a grin that told me he was getting this little game where he had control. Our interactive turns and junctures evolved so clearly that, in retrospect, the form could be mapped, complete with precise timing indicated for each action and reaction.

Infant Research of Interpersonal Timing

In fact, a meticulous form of infant research that has been evolving for decades supports the communicative and relational importance of such bi-directional processes and the extremely complex timing contained therein (Feldman, 2007; Jaffe et al, 2001). While effective multi-modal responses occur naturally and are continuously built upon in typically developing infant-mother dyads, older children with developmental challenges, such as Danny, and their caregivers often need heightened guidance to recreate these effects. Music, with its fluid, adjustable rhythmic pulls and changes, often helps; but it can also serve as a broader template when we seek to cultivate meaning through well-timed vocal, facial and gestural interactions.

Danny’s Moment

Danny and I played for some time, eventually getting to “playing properly” with mallets, too, that produced a wonderful strong sound and elicited all kinds of body choreography. But the moment of triumph for Danny occurred shortly after the initial tapping/singing/starting/stopping interactions. The little boy who purportedly couldn’t express himself, leaned his head and body far backwards, stretched out both arms and with a beaming face, vocalized a long, exhilarated “Ahhhhhh,” then continued to evolve.

Danny’s response and its context is a powerful illustration that the result of a child’s caregiver applying attuned micro-timed interactions creates a positive adhesion in which the child is able to react and, indeed, to lead as a genuine communicative partner. Whether in musical or in any other kind of play, actions and sounds that lay upon rests, turn-taking beats, solo moments, unison and natural acceleration and slowing, allow us  to “step in” time with each other.

Citations

Denton, D. S. and Weeks, K. (2014). Parent Singing in Relational Treatment of Children with Autism Spectrum Disorder. Imagine, 5(1), pp. 80-84.

Feldman, R. (2007). Parent-Infant synchrony and the construction of shared timing; physiological precursors, developmental outcomes and risk conditions. Journal of Child Psychology and Psychiatry, 48 (3,4): 3239-354.

Greenspan, S. I., and Wieder, S. (2006). Engaging Autism.  Cambridge, MA: Da Capo Press.

Jaffe J., Beebe B., Feldstein S., Crown C., Jasnow  M. (2001). Rhythms of dialogue in infancy. Monographs of the society for research in child development. 2001; 66(2):1,132. Serial No. 264.