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The Preview: Early Childhood

The Dancing Dialogue
Using Children's Movement and Nonverbal Cues to Guide Intervention

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Try incorporating movement therapy into your work this week. Use this free checklist to carefully observe and gauge children's nonverbal behavior.

Suzi Tortora has combined her background in education, dance therapy, and psychology to develop an approach to communication with children who have difficulty communicating or relating with others. In 20 years of clinical practice she has found that by carefully observing the child's movement and actions and then following the child's lead — actually "trying on" the child's nonverbal expressions — an adult can validate the child's experience and develop a social relationship that has been shown to spur growth in many other areas. In a minute, we'll tell you about Eric*, a little boy with pervasive developmental disorders whom Tortora was able to reach through movement and interaction.

Ways of seeing

Tortora, author of the new book The Dancing Dialogue: Using the Communicative Power of Movement with Young Children, calls the approach she has developed Ways of Seeing, which illustrates how nonverbal behaviors can be used to create a bridge between adult and child.

Tortora bases her work on three foundational principles: 

  • Everyone has a need to be "seen," referring to each individual's need to be acknowledged and understood for his or her own uniqueness.

  • All movements have the potential to communicate, regardless of how distracting or idiosyncratic they may first appear.

  • Creating a social-emotional relationship with the child is the essential initial goal that makes all further growth possible.

What is meant by...

A dancing dialogue involves an exchange between a child and a therapist (or other adult) through movements based on spontaneous improvisations. The therapist follows the child's nonverbal cues to create a social relationship that facilitates both the intervention and the child's development.

Using Tortora's approach, a therapist, parent, or teacher can observe and use movement to establish a social-emotional relationship. Following careful observation, the adult can attune and mirror the child’s nonverbal actions and create what Tortora calls a "dancing dialogue."

In the dancing dialogue, the adult shares, supports, and decodes the child's expressions. During the decoding process, verbalizations also become important. Giving words to the child's experience brings cognitive awareness to his nonverbal expressions and supports the acquisition of language.

The adult then uses dance, movement, play, and improvisation to follow the child's lead and extend the communication and interaction between them.

Eric's Story

To understand how Tortora uses careful observation and movement to build a relationship with a child, consider her experience with Eric. When Tortora first met Eric, he was 3-1⁄2 years old and had been diagnosed with pervasive developmental disorders, or PDD.

Eric's parents had worked hard to understand and accommodate their son's behaviors. They had learned to read his nonverbal cues and adapted their home environment to create a world that felt comfortable to him. In the process, however, they enabled him to stay confined to his very narrow social existence and to avoid interactions that involved mutual exchanges, eye contact, and emotional understanding. It also left them feeling Eric was controlling their lives.

Tortora describes where Eric was when she first met him:

Despite a full intervention program for the last 1-1⁄2 years — including sensory integration, applied behavioral analysis, and speech and language therapy — Eric's parents felt he was not progressing enough. He was not relating socially in a typical manner at all. He avoided play with other children, wandering away from them and isolating himself; he had very limited verbal language skills; and he was very reactive to transitions.

Eric became fixated on musical videos and their companion CDs, acting out whole sections in a mesmerized manner and becoming very upset when they were turned off. Eric would resist severely during everyday transitions that required him to change his personal focus such as needing to get in the car, get dressed, go to the store, leave a room, enter a new situation, or stop an activity. His resistance often turned into full-blown tantrums in which he would scream and fling his body down to the ground, rolling and kicking on the floor.

Tortora observed this sort of behavior during the first month of sessions. At first, Eric would not freely enter the dance therapy room but instead would cling to his mother, making his body limp as he refused to walk down the three steps at the doorway. He would loudly protest once they made it in the room.

With her Ways of Seeing method, Tortora looks for an entry point to get a child to respond. She observes that a child, especially along the PDD and autism spectrum, can get very caught up in repeating actions in a robotic manner, losing connection to his surroundings. Tortora mirrors those actions as a way to enter the child's world but changes some qualitative aspect to stimulate focus, attracting the child's attention to the here and now, drawing him out of his private self, and asking him to connect and respond to his immediate environment.

See how she did this with Eric.

Eric loves jumping on the mini-trampoline. He seems to go deeply into his own private world, propelling his long, firm body up and down in a mesmerizing, rhythmic pulse. His face is frozen in a gaping smile and his eyes are glazed. He bounces for several minutes as Mom and I watch from afar. Where is Eric right now, I wonder? What is he thinking about — is he aware of us? There is nothing in his current actions that says he is registering our presence at all.

In an effort to engage him socially, I stand on the floor in front of his bouncing body and bend and lengthen mine as I say, "Where is Eric?" Without missing a beat or gazing toward me, Eric adds a turn to his jump and immediately has his back toward me! At once, I run to face him, and again, without a sound, he adds a turn away from me! Yes! Despite the lack of eye contact, his actions say he is definitely aware of my presence.

Next, I place my hands at his waist and support him to jump even higher. I help his jump get so high that I hold him above me suspended in the air and say, "Where is Eric? Let me see those eyes." I hold him like this until he looks directly at me. I then let him resume his jumping with my assistance.

After a few more jumps I repeat these actions, requesting social engagement through eye contact. He enjoys the added bounce my assistance provides and in turn is willing to give me the feedback I'm requesting. A social relationship begins to bud.

Tortora learned some things from this exchange:

  • Eric loves to jump. Jumping is often associated with excitement. But seen in the context of this session, Eric's jumps do not reflect excitement but instead seem to be self-stimulatory.

  • Despite the fact that the jumping seems to keep Eric in his own world, Tortora does not immediately inhibit it but instead observes it carefully to find a way to work with it.

  • She notices the mesmerizing pulsing quality of the jump, observing that the jumping is giving Eric deep input in his joints. Both his lack of active, animated facial expression and his full-body actions influence Tortora's response and intervention.

Eric's willingness to look at Tortora to sustain her help with his jumps is significant. He learns that connecting to others through sustained eye contact has value; it opens an avenue through which to have his needs and wishes understood. Eric's mother is witness to the play and learns how to encourage eye contact during her interactions.

Breakthrough

Both at home and in his sessions, Eric demonstrates keen musicality. He listens with deep interest to the instruments, lyrics, tempo, rhythm, and feeling of the musicals he watches, intently reenacting the dance steps he has learned. Initially he does this as a solitary activity.

Identifying Eric as a "musical learner," Tortora incorporates music as a key teaching tool. About 2 months into sessions, Eric makes a major breakthrough in his ability to stay related.

During the session, I follow Eric's lead, mirroring his Irish step-dance stomping as he jumps on the trampoline to the strong rhythmic pulse of the music. When the beat changes to a languid, soft melody, Eric slows his actions down, and with my assistance, slowly melts onto the bed of the trampoline, lying on his back.

I hold his legs, gently swinging and rotating his body around while we hold each other's gaze. I then lift Eric off the trampoline, all the while maintaining eye contact with him. We continue our gaze while I scoop him into my arms, slowly swaying him closer and farther away from my face while moving him through the air—first high above my head, then at shoulder height, then slowly bending at my knees to hold him upside down. I vary the distance and position of his body, while keeping him mobile (to help him stay attuned) in order to explore what spatial positions enable him to most comfortably keep his eyes focused.

The constant motion supports Eric's enjoyment and desire for mobility so that he stays engaged for an extended amount of time. Immediately, as the music again changes to a faster, more rhythmic pulse, Eric begins to take our dancing dialogue across the floor, repeating his step-dancing stomp and smiling broadly as I follow suit. When the slow section of the song returns, I take Eric into my lap and begin to slowly rock and sway with him to the melody. Eric softens in my arms and holds my gaze.

As the music begins to shift to a more active beat, I place Eric next to me on the floor. Still gazing into my eyes, he reaches his hand to touch my face. I follow suit and touch the same places on his face, softly labeling them. Together we clap our hands to the music.

As the music swells, Eric gives me an excited look and stands up. Taking a Riverdance-like pose, he begins to prance with distinct rhythm, across the room, looking over his shoulder to check that I am with him. Now our private world opens up as our partner dance takes up the whole room. As the session continues, his mother joins in, taking my place during the slow sections of the music. Eric and his mother leave the session quite peacefully. His mother reports that, during the afternoon, Eric was calm, composed, and very loving toward her. Soon after this session, Eric began to initiate such partner dancing by imitating parts of his favorite musicals.

Eric's active engagement and intervention represent a breakthrough.

Moving to the Classroom

The next step in intervention is to help Eric's parents find a preschool placement for him. Every special education program his mother visits says either that there is no room for him or that Eric is not ready for that program because he lacks social awareness. Although he has made progress, his current level of relating cannot support a group setting that does not have a one-to-one aide.

Tortora recommends Eric have a trained aide in a small general preschool setting. The small class size will create a supportive and less busy setting with typically developing children who can serve as role models for appropriate social engagement. Once Eric creates a relationship with his aide, she can act as a bridge between these children and Eric.

Eric's parents find a placement and, early in the school year, Tortora visits. She demonstrates how to encourage more social engagement between Eric and his peers.

I enter school with Eric and watch as he takes off his coat and is greeted by his aide. She immediately engages Eric in a lovely exchange using a stuffed bunny to sing to him. The bunny hops on different parts of his body as she labels them. Eric provides her with good eye contact and warm smiles, clearly delighted by this play.

A classmate, Josh, looks on, gleefully commenting on the bunny play. A little while afterward, Josh leaves the room and begins to paint at the art table in a different room. Eric enters the painting area, lingering and looking around but not getting engaged in the activities. Josh verbally acknowledges Eric's presence and asks if he is going to paint. Eric, seeming not to notice, begins to wander around the three rooms.

Josh asks, "Where’s Eric?" I jump in and say, "I don’t know. Where do you think he is?" Josh responds, "Maybe he is playing Hide-and-Seek!" What a great idea! Leave it to the creative mind of a child to direct the intervention. Not wanting to miss the opportunity, I chime in: "Yes! He must be playing Hide-and-Seek. Let's go find him!"

Josh is game immediately and begins to search for Eric, stopping for a moment to cover his eyes and say, "One, two, three. Ready or not, here I come!" as he runs off to look for Eric. With me close behind, Josh finds Eric standing in the center of the room alone with his back to Josh. Josh stops nearby, gleefully pointing and saying, "Here he is!"

Eric barely looks at him and begins to wander away into yet another room. I take this as acknowledgment and enthusiastically say, "Oh! Yes! Josh found you! You found him, Josh — Oh! Where is he going now? Can you find him again?" Josh is deeply invested in our game. He covers his eyes right away and starts to count "One, two. Ready or not, here I come.” This time when he finds Eric, I ask him to look into Eric’s eyes so that Eric can notice and acknowledge that Josh is there. Josh says, "I found you," as he looks directly at Eric. He then comes over to me and begins to talk about how he notices that Eric speaks differently.

Pain Management for Infants and Young Children

Currently, Dr. Tortora is creating a multisensory program at Memorial Sloan-Kettering Cancer Center in New York to support pain management for infants and young children undergoing painful medical procedures. To learn more about Dr. Tortora’s work at the center, go to The Andrea Rizzo Dance Therapy Foundation.

Tortora points out that the key s never to miss an opportunity to turn Eric's solitary behaviors into a social interaction. This occurs by following Eric's lead and by joining in his activity and turning it into a social contact.

Eric's aide attends his dance movement therapy sessions several times a month to continue to learn how to encourage Eric's social-emotional expressivity. In this way, with his therapist, his aide, and his mother working as a team, Eric's interventions can be stretched from therapy session to school to home. By creating a "dancing dialogue" with a child in this way, the therapist and other adults can open the door for great improvements in the child's social interactions and development.

*Names have been changed to protect privacy.

 

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