Post #4 in category. We recommend reading posts in numerical order.

Early sensorimotor responses in infancy are largely automatic, reflexive, immediate and constrained to the present moment. They are narrow in range, rigid, and often disconnected from planning and intention. Only when these early sensations and movements are stored, associated, and integrated with experience across other developmental domains do they support language, reasoning, emotional meaning and relationship.

Sensation itself is never merely raw input. It is a biologically transmitted impression, quickly shaped by the nervous system, and may be affected by the individual’s previous experiences. It is often filtered by what has been felt before. Higher cognitive and emotional processes may exert a powerful top-down influence, shaping how sensation is perceived, tolerated, used and remembered. Even the most elemental sensorimotor learning unfolds within a broader developmental and interpersonal context.

Ian

Ian, nearly three years old and diagnosed with Pervasive Developmental Disorder, did not turn when his mother called his name. He did not reach for food, grasp it, or bring it to his mouth. According to his parents, he had “no history of independent, unassisted self-care.” He was passive, his movements poorly coordinated. He had little interest or engagement with the world or the people around him.  

From early infancy up to the present, Ian was spoon-fed by parents, grandparents, and caregivers. This was done not only out of concern for his perceived incapacity but for practical reasons. His grandmother explained that encouraging self-feeding felt futile, messy, and time-consuming. Feeding him directly kept his hands, face, clothes and surroundings clean and allowed meals to end quickly.

Like many caregivers of children with developmental disabilities, Ian’s family believed that total care was both necessary and morally appropriate. The child was believed to be helpless. Doing everything for him was their responsibility and obligation.

Ian did not respond to spoken language. He did not orient to voices or to his name. Yet his hearing, auditory processing and vision had only been minimally assessed. He had never been evaluated by a developmental pediatrician or pediatric neurologist. His parents were told by Ian’s pediatrician that there was no cure, so they felt there was no reason to pursue further testing.

The Beginning of Relationship

When Ian first arrived at the Center, he appeared profoundly disengaged. His facial expression was vacant. Eye contact was fleeting or absent. He showed little emotional or physical response to objects, to adults, or to playful overtures that were usually motivating for even much younger children. He seemed to exist at a distance from his surroundings. Reminding me of the phrase quoted by Tziporah Koslowitz, “He was [like] a person who goes away behind his eyes.”

On a subsequent visit to the Center, a talented and empathic therapist sat quietly on the floor near him. After a few minutes, when Ian seemed more settled in the room, she gently placed Ian in her lap.

She did not rush him or hold him on her lap. After a few moments, she sensed that he might want to move away. With minimal physical guidance and long pauses, she encouraged him to crawl off her lap, waiting deliberately to see whether he would initiate any movement on his own. After giving Ian a chance to move on his own, and he did not respond, she gently helped him crawl off her lap.

When he was on the floor beside her and slowly turned to look at her, she picked him up again and returned him to her lap. Once more, she waited.

This simple sequence, lap, pause, help to climb off, glance in her direction, help to climb back into her lap, was repeated three or four times during the session. By the second or third session, something had changed. Ian’s movements became more coordinated. He slid off more quickly. He seemed to remember how, the sequence of movements, the coordination of his arms and legs. By the third session, he appeared to enjoy the action and the repetition. The act of leaving her lap and then climbing back onto her lap had become a small but motivating activity, a sort of playful game.

When the therapist noticed this emerging enjoyment, she altered her role. She did not automatically help lift him back onto her lap. Instead, she looked at him and spoke to him in slow, clear, unembellished language, telling him that he could climb up if he wanted to.

If he showed any interest in climbing back onto her lap, she offered gentle assistance, observing carefully how much help he actually needed and providing only minimal physical help, observing how much he accepted her help and how much he resisted.

After a few days, Ian began to linger in the comfort of her lap, occasionally looking up at her. Over time, with minimal support, he climbed up by himself and climbed down again. When crawling on the floor, he turned toward his therapist and returned on his own. By the fourth session, he was actively engaged, initiating the sequence with anticipation and pleasure.

His therapist then introduced subtle variations. Sitting on the floor, she extended her legs and placed Ian between them, guiding him to crawl over one leg, then the other. At first, this required help. Soon, Ian began doing it spontaneously, but slowly, even continuing to crawl over both of her outstretched legs in succession. When the therapist resumed sitting cross-legged, Ian spontaneously and independently climbed into her lap, rested there briefly, climbed down, and returned again.

What appeared to be a simple motor game was in fact many things at once.

A Living Assessment

This activity was designed to support Ian’s motor coordination and the emergence of agency, but it was also a living assessment. As the therapist engaged with Ian, she was continuously taking mental notes, learning what captured his attention, how much physical support he tolerated, the pace he required, the timing of pauses, the emotional meaning of proximity, the beginnings of coordination, collaboration, confidence and trust.

She observed how Ian signaled interest and refusal, how long he needed to organize his body, when his persistence increased, and when fatigue or disinterest appeared. She learned how much language was helpful and when her silence was better. She tracked changes across sessions, what was stable, what was emerging, what remained inaccessible? She was planning how to build on current priorities and prerequisites. How to improve her mediation and interpersonal connection with Ian.

During these sessions, Ian’s mother and, occasionally, his father and grandmother were in the same room, watching the process. They were learning to see Ian differently, not as passive or incapable, but as a child who could learn to initiate, to adapt and take pleasure in effort when the conditions were right.

As the therapist learned how to mediate Ian’s development, she was also influencing his parents’ and grandmother’s expectations, teaching them how to slow down, when to wait, when to repeat, how to help without over-helping, and how to patiently expect and be involved more without overwhelming him.

These sensorimotor activities were never the treatment plan in themselves. They were one aspect of a much broader Parallel Assessment, an ongoing process that examined the whole child, the whole relationship and the long-term development plan. Cognitive, emotional, communicational, sensory, motor, social and family dynamics were always in view.

Over time, these early activities were gradually reduced as new challenges were introduced. Yet Ian loved the lap-and-leg games so much that they became a ritual at the beginning and end of sessions for months. They had become anchors of safety, competence, and connection.

Soon, Ian entered the room with a bright smile. Social motor play evolved into practical self-help activities. Throughout this process, Ian’s therapist deliberately shifted the active mediation from herself to Ian’s parents and grandmother, coaching them to become his primary partners in learning, play and development.

Sensory Regulation

Infants regulate not only their feelings and actions, but the amount and kind of stimulation entering their nervous systems. They turn away, avert gaze, close their eyes, pull back, or become still. These are not signs of defiance, but adaptive strategies.

When such strategies fail, particularly in children with low sensory tolerance, distress may escalate into avoidance, crying, anger, aggression or passivity. Parallel Assessment therefore attends closely to levels of arousal, modifiability of alertness, sensory preferences, aversions and accommodations.

Some children seek little stimulation because sensory input is unclear, unpleasant, disorganized, or even painful. Others are hypersensitive or hyposensitive to touch, sound, movement or proximity, or a combination of both at different times. Daniel Stern observed that certain children may tolerate nonhuman stimulation while finding human gaze, touch or engagement overwhelming.

The goal is not constant calm, but flexible regulation. Parents and mediators learn to expand a child’s tolerance gradually, matching stimulation to the child’s signals and teaching self-regulation through relationship.

Some Goals of Parallel Assessment

Parallel Assessment co-actively assesses and influences the child and each of the child’s adult mediators’ attitudes, feelings, expectations and interactions. Some mediators overstimulate, speaking louder, moving closer, exaggerating expression, offering unnecessary food rewards, becoming too verbally and physically active in an effort to capture and control the child’s attention and responses. In Ian’s case, repeatedly calling out his name, intrusive physical control, and escalating intensity increased his withdrawal.

Most adult parents, caregivers, teachers and therapists mean well. But sometimes, deep down, they do not really believe this particular child can change. They may underestimate the child or themselves, feeling sorry for the child and for themselves. They may be unaware of how their own emotions and beliefs shape their actions and the progress of the child. Some well-intentioned mediators are frustrated, exhausted and worry that time is being lost. Some mediators feel they have run out of ideas, of strategies. Feel alone.

In the beginning, only one mediator consistently believed in Ian, came to know and to understand Ian, and adjusted herself to Ian, slowing down, observing, remembering, planning, waiting, initiating and responding, and continually evaluating his progress and her own.

With her direct intervention with Ian, and her instruction and mediation with his family, and with Ian’s other therapists and teachers, a collaborative development team was constructed. Ian’s progress revealed not only his growing capacity, but what becomes possible when collaboration with all of the child’s important adult mediators combine to enhance the child’s learning and development.

Ian’s story reminds us that development does not occur in isolation. To help a child grow, we combine the ongoing Parallel Assessment with an evolving Parallel Development plan and mediated learning activities relevant to the child’s current and future life.

While working and playing with the child in meaningful activities, we gradually improve our interpersonal relationship and two-way communication with the child. We are learning how this particular child is feeling and thinking, and how they can learn how to learn and enjoy the process. All the while learning more about ourselves, how to improve our mediation and how to help others help this child.  

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