At the request of parent advocates, teachers, clinicians, colleagues and families, I wrote this overview in response to the entirely baseless criticism from board certified behavioral analysts and positive behavioral support advocates that developmental relationship-based practices such as DIR/Floortime are not grounded in science or evidence-based.

Comprehensive Developmental based approaches such as DIR/Floortime are strongly grounded in infant and early childhood mental health, clinical, developmental psychotherapy and Affective Neuroscience and Polyvagal Theory. They are peer reviewed evidenced-based Emotional- Developmental neuroscientific approaches to treat young children through the lifespan with autism spectrum disorder and other biopsychosocial based challenges. Below are resources that validate a comprehensive DIR/Floortime developmental based approach to treat children with ASD and other biopsychosocial based challenges and the developmental affective neuroscientific foundations that justify its use as a primary intervention approach with children and families.

In 2011 preliminary results from a fully randomized control trial of 51 children with mild to severe autism, ages 2 years 0 months to 4 years 11 months, were published by the MEHRI Foundation at York University, Canada. Participants were assigned to either a target treatment group (DIR Floortime, 25 children) or community treatment group (26 children, 16 received ABA). The study evaluated the viability of the DIR/Floortime treatment approach in areas of social-emotional, cognitive and language functioning. PET scans of all children were taken prior to trial start and post-trial to record any neuronal changes. What was quite remarkably demonstrated were clinically significant and clinically meaningful subcortical and prefrontal cortex/ executive functioning changes demonstrated among participants in the targeted treatment vs. control group.

Data sets among participants in the targeted DIR/Floortime treatment group (one child here presented in video below) revealed significant increased activity in the prefrontal cortex area (e.g., executive functioning responsible for emotional regulation, ideation, motor planning and sequencing); significantly reduced adverse subcortical functioning (e.g., attenuation of the limbic hypothalamus, pituitary and adrenal axis, this included reduced overall size of the amygdala responsible for All or Nothing responses); increased activity in the FFA (fusiform face area of the fusiform gyrus) which is responsible for scanning, reading, interpreting and processing the intentionality and facial affective (emotional) expressions of others. Post treatment measures in prefrontal and subcortical network activation were found to be more consistent with what we observe in healthy developing children. These prefrontal and subcortical changes were directly correlated with specific milestone increases in simple to increasingly complex circles of social-pragmatic child/parent interactions and were demonstrated in the targeted treatment group vs. the community group.  Re-analysis of trial result data in 2015 further revealed that the targeted treatment group considerably outperformed the community group on number and length of utterances produced and in various speech act categories. https://www.youtube.com/watch?v=4TRL1TMwsuA&t=11s

The published preliminary and follow up data on the 2011 MEHRI Foundation study (cited above) as well as separately other previous and current controlled randomized trials supporting a comprehensive developmental based approach, such as DIR/Floortime as a primary treatment methodology for young children and older diagnosed with ASD can be found at http://www.icdl.com/research (Casenhiser, D. M., Binns, A., McGill, F., Morderer, O., & Shanker, S. G. (2015). Measuring and supporting language function for children with autism: Evidence from a randomized control trial of a social-interaction-based therapy. Journal of Autism and Developmental Disorders, 45, 846-857)

The following is a one hour and forty-minute talk with video presentation given by one the most experienced, internationally renowned DIR/Floortime Occupational therapist, Rosemary White, OTR/L. This talk and video presentation is extraordinarily useful for both families and clinicians as Rosemary explains in a remarkably detailed and nuanced perspective the theory of DIR/Floortime methodology in everyday practice. https://www.youtube.com/watch?v=lp3o2yqYPWs&t=2349s

The following white paper by Diane Cullinane, M.D. is an overview of the scientific evidentiary support for the DIR/Floortime methodology to treat infants, toddlers and older with ASD and related affect-sensory and social pragmatic communication-based challenges:

 July 2017: https://docs.google.com/a/icdl.com/viewer?a=v&pid=sites&srcid=aWNkbC5jb218aWNkbHxneDozNzJiNGQxYzQyMWEzZTIx Updated: October 2020: https://affectautism.com/wp-content/uploads/2020/10/Evidence_Base_for_DIR-2020.pdf

Below are the Clinical Practice Guidelines of the Interdisciplinary Council Developmental Learning (ICDL) published in 2001. It is a comprehensive overarching view of the biopsychosocial components that form the neuroscientific foundations for a comprehensive Developmental assessment and treatment approach for individuals diagnosed with autism spectrum and other biopsychosocial challenges. The chief editor is the late Dr. Stanley Greenspan, M.D. (former head of NIMH, Mental Health Study Center and the Clinical Infant Development; co-founder of Interdisciplinary Council Developmental Learning and the DIR/Floortime methodology). It is co-authored by many of the foremost professionals within the biopsychosocial sciences. https://www.icdl.com/dir/bookstore/icdl-clinical-practice-guidelines

Now, it is extremely valuable for all primary caregivers and clinicians working with infants, toddlers, older children and adults with autism spectrum challenges to begin to read the voluminous evidence-based research which supports not the older, antiquated, simplistic surface and non-scientific behavioral-based models (ABA) but rather evidence-based Developmental Emotional Neuroscience and biopsychosocial approaches such as DIR/ Floortime. Relationship-based approaches such as DIR/Floortime do not like behavioral-based (ABA) methodologies have your child comply with adult-directed behaviors to complete tasks on a checklist. Rather, there is a moment-to-moment gentle focus on guiding you around your child’s natural curiosity. As we begin to follow your child’s lead, we developmentally and naturally begin to support the Functional Emotional Developmental capacities for spontaneous and meaningful joint attention, back and forth two-way emotional problem solving, symbolic play and social-pragmatic communication/language with others.*

The Functional-Emotional Developmental capacities that support all emotional-cognitive and social-pragmatic communication/language development can only properly emerge in an environment where your child first feels-felt, feels-heard, feels-seen and feels-safe with others. When this happens we begin to see a positive shift in your child’s sense of well-being through more consistent co-regulated interactions with others. For example, Your child’s way of feeling and relating in the world (underlying physiological state regulation or autonomic nervous system) beginning to adaptively shift from various states of stress (i.e., a high sympathetic-adrenal arousal or parasympathetic withdrawal or shutdown) to underlying feelings of safety and thus a greater internal regulation or an interoceptive (bodily) sense of felt-safety with others and the environment. This is accompanied by positive sympathetic mobilization, such as play, joy and excitement to explore and engage with others.

Both felt-safety and positive sympathetic mobilization are needed in order to maintain the foundations not just for, “eye contact” or “completing tasks” (i.e., as traditionally and robotically defined as completing items on a checklist) but rather reciprocal, dynamic and meaningful shifting frames of attention, back and forth reciprocal two-way emotional problem solving, complex use of symbolic ideas and social-pragmatic communication/language with others. (*From a developmental perspective it is not just “eye-contact” or compliance to tasks on cue but your child’s capacity to process other people’s moment- to-moment facial cues, gestures, intonation of voice which is deepened through back and forth social-emotional engagement) https://www.icdl.com/dir/fedcs

Relationship-based approaches are based upon an understanding of each child not demonstrating “Problem behaviors” that need to be corrected but rather an understanding of each child’s physiological state regulation (e.g., his/her autonomic nervous system) of felt-safety with others and the environment is fundamental. In other words, is your child feeling internally safe and therefore receptive and open for engagement with others or is s/he in a autonomic state of sympathetic-adrenal defensive fight/flight or withdrawal and, therefore, not safe and not receptive and open to engagement (and consequently an exacerbation of sensory processing challenges and externalizing behaviors)?

There are two core observations that are essential for primary caregivers and therapists to take into account:

1) What is happening inside your child (intra-personally) and between others and your child (inter-personally). How is your child experiencing the world? Is it too noisy? Too distracting? Too overwhelming? Too underwhelming? etc.

2) How are those experiences with the world registered, assessed and processed by your child’s sense of well-being with others (i.e., his/her autonomic nervous system experiencing the world as safe, unsafe or life threatening during back and forth emotional-reciprocal engagement with others)?

Relationship-based approaches make a fundamental distinction between the biopsychosocial complexity of your child's Functional-Emotional Developmental capacities, Individual sensory-affect-modulation processing and Relationship-based differences and the Applied Behavioral Analysis’ view of your child as a set of reinforced external contingencies (learned tasks) presented on an itemized checklist and performed on cue.

While we acknowledge that those practitioners who advocate for behavioral-driven models are often immensely pleased in their accomplishments of successfully targeting how well the child habitually and reflexively responds to a series of memorized tasks, what it is critically overlooked are the underlying core Emotional Developmental capacities that are necessary for any clinically significant and clinically meaningful reciprocal engagement and social-pragmatic communication/language. 1) Deepening reciprocal child/parent attachment and attunement which creates the underlying supportive neurodevelopmental foundations for back and forth reciprocal engagement, expanded simple to complex ideation and social-pragmatic communication/language and secondly, addressing each child’s individual emotional-sensory processing challenges in the context of child/primary caregiver relationships. As therapy proceeds what we are addressing are not newly acquired “surface behavioral responses” but in a developmentally systematic and comprehensive manner the biopsychosocial foundations that support each child’s emerging sense-of-self and his/her social pragmatic communication/language and engagement with-others.

Applied Behavioral Analysis (ABA) maintains that your child demonstrates progress when s/he is successfully redirected from so-called, “Behavioral excesses or deficits to more appropriate cognitive tasks and socially significant behaviors.” This involves each child producing on command from episodic or semantic memory a set of cognitive or behavioral tasks in order for the child to comply with the checklist of rote requests and commands per the toddler’s IFSP (Infant/Toddler Service Plan) or at any point going forward in the child’s IEP (Individual Educational Plan).

That’s all fine and well if we adhere to a Skinnerian evaluative factory-produced model of behavior. However, if when we use our emotional intelligence and look through an affective-developmental lens at your child not simply on the surface (e.g., his/her so-called off-task behaviors or inattention that needs to be re-conditioned) but from a comprehensive evidence-based approach (i.e., psychobiological and social) we begin to gain some deeper insight with respect to what is behind the external or symbolic manifestation of any behavior. This involves an understanding of your child’s autonomic nervous system (i.e., feelings of safety or unsafety or approach and withdrawal behaviors) and thus towards a better understanding of the emergence and adaptive nature of all behaviors behind the label, “Challenging behaviors.”

How Moment to Moment Interactive Exchanges and the Surrounding Environment are Interpreted by your Child

What is generally overlooked or regrettably not understood by the vast majority of behaviorally oriented therapists is your child’s interoceptive (internal) and exteroceptive (external) biopsychosocial experiences with others and his/her surroundings with respect to how all events (i.e., reciprocal and interdependent social-emotional interactions with others and the environment) are interpreted by your child with respect to his/her moment to moment sense-of-self or agency. In other words, how the “outside world” is internally processed and interpreted by your child’s sense of agency (or sense-of-self) and his internal or physiological state regulation (e.g., his autonomic nervous system) in direct connection with others and the environment as Safe, Unsafe or Life threatening.

Applied Behavioral Analysis minimizes any notion of sense of self or agency (e.g., how your child is registering, assessing and processing cues of interaction as being safe or unsafe) and instead views your child essentially as a blank slate who is driven and reinforced by his external environment (e.g., implementing new changes through mechanical schedules of reinforcement by changing the antecedent or consequence of the “challenging behavior” in order to bring about the “desired behavior” vis a vis operant conditioning). Behaviorists view your child as it were strictly from the outside-in rather seeing your child as an independent agency in moment to moment interactions with others, i.e., registering, assessing and interpreting bodily-based states, feelings and thoughts with others-and-the environment. This includes an understanding of the autonomic nervous system where all so-called, “challenging behaviors” are biologically-psychologically-and socially understood not as “Appropriate vs Inappropriate” but instead as adaptive and emergent conveying your child’s internal sense of well-being with others.

Your child as a whole person-organism-with-environment necessitates an education (by all clinicians that work with you and your child) that behaviors are not merely shaped by reinforced responses to the environment, a tabula rasa (blank slate) if you will (that can be re-conditioned through repetitive training of certain tasks on certain schedules of reinforcement) but rather the external manifestation of behaviors understood as emergent and adaptive properties of each individual’s overall and implicit sense of well being. In other words, behaviors not simply understood as cognitively driven or intentional but subcortical and autonomic where the child’s moment to moment experiences with others and the world are autonomically registered as safe to engage, unsafe to engage or withdrawal/shutdown from engagement.

In Applied Behavioral Analysis “behaviors” are labeled or categorized without involving your child’s agency or “sense-of self” (i.e., how your child is internally registering, processing and assessing the world) and instead, in a blind and presumptuous reductionist manner, schematically and egregiously labeled by educators and therapists as, “Appropriate or Inappropriate” in accordance to arbitrary measures of “normalcy” without any curiosity, emotional or neurophysiological understanding of what is actually happening beneath the surface for your child (i.e., Is your child is in a state of relative homeostatic calm and availability for engagement or too stressed out to engage?).

So what we are left with in behavioral based methodologies is that your child can be trained on imitative well-performing task-behaviors and yet his/her psychosocial sense of agency and well-being, his/her internal or homeostatic regulation or neurophysiological stress levels can be completely compromised or out of control (e.g., excessive stress manifesting in high elevated cortisol levels),

Can behaviorists re-train your child to perform rote academic and other tasks? Yes of course quite adeptly followed by the perfunctory check mark or a token and high-fives! On the other hand, can they begin to understand and cultivate the underlying foundations of your child’s internal (interoceptive) safety- and-curiosity that will encourage nuanced engagement, social-pragmatic communication, reading gestural and facial cues by slowing down, registering and processing his/her environment through back and forth co-regulated interactions with others lending itself toward a more integrated and healthy sense-of-self and well-being? No! Absolutely and unequivocally not one iota.

(The reason why it is not is that, “Progress” becomes defined and operationalized within the confines of testing protocols that will achieve one goal, the continuation of special needs educational program funding. The child’s sense-of agency in that regard, for example, how s/he is actually processing, registering and perceiving the world and the underlying foundations of felt (interoceptive) safety becomes a moot point or doesn’t even enter into the picture. The latter respectfully and meaningfully enables your child to move up the developmental neurodiversified ladder but the focus, however, is strictly on your child’s mechanical surface-performance of tasks/skills that can be routinely and robotically implemented. In other words, a read-out of behaviors and tasks performed by your child without any sense of agency or “sense-of self”).

However, as we begin to guide you to understand the subtle layered complexity of your child’s neurodevelopmentally complex emotional and Individual processing differences, we begin to dramatically move away from an emphasis on your child’s rote or trained memorization of surface response performance-tasks executed (e.g., efficient left brain compartmentalized checklists that are disseminated to mark the child’s progress with vapid and puerile emojis and gold stars in order to falsely satiate parents’ sense of the progress of their child) and instead towards an evidence-based biological-psychological-social perspective, which entails an understanding of your child as a whole person and his/her internal physiological state of registered Feelings of Felt-Safety with others and surroundings.

Feelings of felt-safety and accompanied desire to more spontaneously, sustainably and reciprocally engage with others becomes neurophysiologically speaking accompanied by reduction of stress hormones, such as cortisol, vasopressin, epinephrine and a corresponding increase in oxytocin, dopamine and serotonin. However, when others and the environment are not registered as safe by your child, there is a dampening of your child’s HPA axis (hypothalamic, pituitary adrenal axis) and correspondingly an increase in stress related hormones, such as, cortisol, vasopressin and epinephrine. This is manifested in your child’s autonomic sympathetic-adrenal nervous system which becomes adaptively and highly mobilized for defensive fight/flight or parasympathetic withdrawal/freeze or dissociation behaviors.

As a parent you most certainly will ask what are the visible signs of increased defensive feelings of fight/flight or withdrawal? How does the above outwardly manifest? It is visibly apparent in your child’s visual-facial, auditory-prosodic, tactile-gestural affective mood, motion, emotion and communication with others. One of many examples, 1) Your child’s flat facial affect or emotional expression, looking away from others or into space along with 2) Your child’s reduced capacity to process the full auditory range of human voice (dampened middle ear or stapedius muscles not due to physical impairment but rather felt-stress) and instead re-attuned to low-frequency bandwidth outside the typical range of processing human voices. This often gives the misleading impression to parents and educators that their child is intentionally not listening. 3) A withdrawal from or conversely an over-seeking for various sensory inputs in order to feel his body more completely (e.g., input to muscles and joints or proprioceptive input and body in relationship to space/balance or vestibular input). 4) All of the above are quite naturally accompanied by behavioral manifestations such as excessive crying, throwing of objects, meltdowns, etc.

An important point that needs to be emphasized with respect to the above is that if your child’s physiological state regulation (or autonomic nervous system) is in under a state of perceived threat (i.e., fear, stress, anxiety) indicated, for example, by a high-sympathetic-adrenal state of fight/flight defensive behaviors or hypoactive parasympathetic withdrawal/freeze state (i.e., complete lack of energy and/or dissociation) what becomes exacerbated are your child’s sensory affect-modulation processing challenges across his unique profile of visual-spatial, tactile-gestural and auditory-prosodic interactions with others and the environment (e.g. over-responsive, under-responsive or mixed responsivities in the above).

For more than six decades we have seen smashingly rewarding behavioral and pharmaceutical marketing campaigns with respect to the traditional two-prong approach of psychotropics and Applied Behavioral Analysis and/or CBT. Not unexpectedly this has resulted in widespread public acceptance of masking symptoms by feigned heroic attempts to shape or redirect a child’s surface behaviors. What relationship-driven approaches such as DIR/Floortime critically address but continue to remain conveniently and egregiously ignored by educators and behaviorists are in fact the deeper connections behind the external or symbolic manifestation of every child’s surface behaviors. It is here we turn to the foundations of Interpersonal Neurobiology (what is occurring not just inside the child but between the child and others) and begin to look at the neuroanatomical and neurophysiological underpinnings of our central and autonomic nervous system. https://en.wikipedia.org/wiki/Interpersonal_neurobiology

We find feelings of excitement and joy to take in the world are directly connected with our feelings of safety with the world or if we perceive others or our surrounding as threatening then our sympathetic-adrenal system becomes adaptively mobilized for defense, fight or flight behaviors or when under more severe affective distress (i.e., immediate perceived life threat) our sympathetic fight/flight defensive behaviors can become unavailable and instead we might immobilize to a state of parasympathetic faint, freeze or shutdown.

Our child’s or our own feelings of feeling-felt, heard and seen and thus feeling safe with others and the surroundings or not feeling-felt, heard or seen and thus not feeling safe with others and the surroundings are part of what is referred to as non-declarative or implicit-procedural memory. Non-declarative or implicit-procedural memory involve early subcortical parts of our brain (i.e., the right bodily-brain connections that constitute the foundations beneath symbolic ideational thinking and formal language usage or the left prefrontal executive areas). They are not a part of child’s intentional or willful behaviors that can be trained through ,“behavioral modification”, as popularly expressed by Applied Behavioral Analysis or cognitive behavioral therapies. Why? Isn’t everything about changing learned behaviors? No.

Precisely, because what we are addressing here are the subcortical affective or primary feeling-emotional regulation areas of our interpersonal (interbrain-interbody) connections with others beneath the words, that is, 80% of functioning below the later emergent capacities of rational thinking and formal language. Simply stated, What does it feels like to the infant, child and adult to be in the world? This actually begins prior to the emergence of language and any “conscious-decision making” (i.e., subcortical areas which include, the insular, limbic hypothalamic, pituitary adrenal axis, amygdala, periaqueductal gray, anterior cingulate into the autonomic nervous system).

Moreover, when teachers and clinicians act as though behaviors are merely a set of appropriate or inappropriate learned responses to the external environment that can be re-trained through operant conditioning* they often result in exacerbating further levels of autonomic stress and dissociation. See 2012 Porges S. The Quest For Safety: Emergent Properties of Physiological State. https://www.youtube.com/watch?v=MYXa_BX2cE8

(*The principles of operant conditioning are based upon the assumption that to effectuate change in the child’s so-called, ‘non-compliant” or “inappropriate behaviors” is done by placing that child on schedules of reinforcement, which involves using different environmental contingencies or external reinforcements to render those changes. The educator or behaviorist technician attempts to change the Antecedent or the motivating operation, what precedes the child’s observable Behavior and/or the Consequence, the reward/punishment that follows and maintains the undesirable behavior. However, what is behind any behavior (once we remove the decades long infantile signifiers of desirable or undesirable behaviors) from a fundamental scientific biopsychosocial perspective are the physiological state regulation and autonomic nervous system where all “Behaviors” are understood as emergent and adaptive properties of the child feeling safe, unsafe or perceived life threat are never taken into consideration.)

However, let us move away from what essentially is considered by most, including the AMA (American Medical Association), as the pseudoscience of Applied Behavioral Analysis (or puerile simplistic reductionism and tabula rasa (blank slate) model and turn to real science. (https://www.icdl.com/about/news/ama). Found in our 500 million-year-old reptilian and our more recent 220-million-year-old mammalian brain are primary feelings or emotions which can be referred to as our biologically instinctual or affective system. This is comprised of seven clearly identified primary drive areas: Seeking system, anger/rage system, fear system, panic/grief system, lust system, care/nurturance system and the play/laughter system. Despite many decades of hubristic claims by behaviorist aficionados these primary affects are not learned or can they be trained and produced on command. They are core features found in the early evolutionary wiring of our midbrain and limbic areas (See 1998 Jaak Panksepp, Affective Neuroscience: The Foundation of Human and Animal Emotions) https://www.youtube.com/watch?v=hTzoeIJhKGE https://www.youtube.com/watch?v=qf4ZFwyVJ2A&t=1934s.

Our primary instinctual feelings or emotions, the seven primary affective systems mentioned above, are not simply the individual’s conditional responses to external contingencies (reinforcers) but are built-in instinctual circuits (brain stem and mid brain regions) which are transformed by our biological-psychological-social experiences with the world. It is beginning in infancy and prior to the maturation of our rational thinking (prefrontal cortex/executive functions) that through a complex dance of moment-to-moment primary caregiver/child affective reciprocal relational engagement the infant’s brain through co-regulated interactions (cooing, smiling ,reaching, touching, playing) with the mother begins to form patterns of maturing neuronal patterns by producing proteins that enable the synapses to form and begin to wire up the early subcortical foundations (e.g., LHPA, limbic hypothalamic, pituitary and adrenal axis, insular, hippocampus, ventral tegmental area, anterior cingulate and autonomic nervous system) to the prefrontal cortex/executive functional areas (i.e., complex ideation, planning and execution of ideas and the emergence of language).

One of the most important points here and one of the greatest discoveries in the last few decades is that beginning in infancy our biological-psychological-social experiences with others and the world significantly determine how DNA is transcribed and translated by RNA and, therefore, become phenotypically expressed, that is, how certain genes are turned on, turned off or remain silent and how the proteins which are produced that form synaptic connections and early procedural memories vis a vis environmental influences and early attachment experiences are formed (see, epigenetics https://developingchild.harvard.edu/resources/what-is-epigenetics-and-how-does-it-relate-to-child-development/). Children’s development is not just maturational-dependent but experiential-dependent. These experiential dependent processes actually begin in utero especially during the third trimester as the mother’ levels of stress cross the placenta and the fetus responds accordingly (e.g., excessive levels of cortisol in contrast to the production of cortisone). From birth and as the infant matures into a full social agent by six months these biopsychosocial processes are directly influenced by the mother/infant dyad in moment-to-moment mother/infant visual-facial, auditory-prosodic, tactile-gestural exchanges and communicate between the primary caregiver and infant’s mind-brain-body, sympathetic and parasympathetic nervous systems.

Our earliest moment to moment back and forth child/primary caregiver exchanges begin to form the underlying foundations for healthy secure, insecure- ambivalent anxious, avoidant or disorganized attachment. Moreover, this interpersonal neurobiological back and forth affective emotional-signaling does not just begin in utero and end in childhood but is a core foundational feature (i.e., assessed and registered feelings of internal safety with others and surroundings or our sympathetic nervous system mobilized for fight/flight or, if not available, parasympathetic withdrawal/shutdown behaviors) throughout our lifespan in our daily exchanges/relationships with others and our environment.

Therefore, any reductionist behavioral conception of the child’s so-called, “non-compliant” or “willful behaviors” subject to modification through clinicians selectively targeting the antecedent and/or consequence (i.e., the child through the principles of operant conditioning is taught to acquire compliant tasks/behaviors by the clinician changing the contingencies maintaining the so-called, “problem behavior”) while ignoring the greater fact that the child remains in an underlying state of right brain limbic-autonomic distress (i.e., sympathetic-adrenal activation or hypervigilance, fight/flight or parasympathetic hypoactive withdrawal and dissociation) is not only neurophysiologically ignorant, it is unremittingly destructive and potentially abusive as it invariably circumvents or inhibits a much more needed compassionate biopsychosocial approach and understanding with respect to cultivating the neurophysiogical and psychosocial conditions required for registered felt-safety for that child to interact with others and his/her environment.

What has been well-established by many decades of evidence-based Affective Neuroscience, attachment theory, developmental psychotherapy, psychoanalysis and Infant and Childhood Mental Health is the understanding that all behaviors need to be neurobiologically and psychosocially understood not as willful and compliant or non-compliant but as adaptive and emergent properties which are directly connected to and influenced by the child’s primary affective system in co-relationship to others. These primary emotions are found in the brainstem regions as mentioned above are unconditioned biological instincts and are an integral part of our interspecies heritage as mammals and is what Jaak Panksepp refers to as, “Tools for living” (Panksepp, J. 1998 Affective Neuroscience) https://www.frontiersin.org/articles/10.3389/fnins.2018.01025/full#:~:text=These%20ESB%20sites%20are%20concentrated,been%20elicited%20from%20the%20neocortex

Now, depending upon what particular affect is prominent in any given back and forth reciprocal interaction (e.g., the seven systems of seeking/curiosity, care/nurturance, lust, fear/anxiety, anger/rage, anxiety/panic/sadness, play/laughter) we can always translate any one particular affective state from the perspective of the child or older as, "Is it safe for me come near you and to engage with you and explore the world or is it not safe for me to come near you, engage with you and explore the world?”

Again, these early right to right emotional right brain communication areas are outside what we typically conceive as, verbal thinking or “conscious awareness” or the later and more fully developed prefrontal areas or tertiary brain (i.e., executive functions of attentional planning, ideation, sequencing, language and declarative memory) which critically begins to mature during the first three years. As previously mentioned, they are part of what we refer to as un-willed, non-declarative or instinctual implicit-procedural memory (in contrast to consciously recalled declarative memory, rational thinking and verbal language - which emerge later on and which all traditional education has always been hyper focused on).

This is an integral part of all our interactions and part of our early developing subcortical limbic-autonomic system and is also involved in the rapid processing of our interpretation/assessment of the other person’s facial, auditory and bodily movements and is (at the same time) registered with respect to our interoceptive or somatic/bodily-feeling awareness expressed by our older (dorsal vagal) and newer (ventral vagal) branches of our autonomic nervous system. The above is referred to as neuroception (the body’s detection system of cues of safety or threat) and interoception (how it is internally registered ).

There are several specific areas that are involved in registering processing and interpretation of interpersonal face-to face engagement with respect to how we are interpreting the other person’s facial affective expression, tone and inflection of voice or prosodic elements of speech and body gestural movements determining whether the other person is safe or not safe to approach. These areas are largely situated in the right superior temporal sulcus, temporal parietal junction and fusiform face areas. Our autonomic nervous system or subconscious registration and assessment of social-emotional interpersonal cues of safety or danger (i.e., safe-to-approach or withdrawal behaviors) have been defined by the world’s leading expert on the autonomic nervous system as Neuroception (S. Porges 2003).

Neuroception is outside what we typically define as awareness or perception. It is an instinctual built-in detection feature system of our mammalian autonomic nervous system with respect to our capacity to register, sense and assess others’ bodily-facial movements, motion, emotion and tone of voice/intentionality as either safe to come near, not safe or signaling life threat. The primary brain regions where this is largely activated are in the temporal-parietal junction and superior temporal sulcus (which processes biological motion in contrast to mechanical motion and includes auditory-prosodic vocalizations) as well as the fusiform face area of the fusiform gyrus (processing of faces). This instinctual intra-and-interpersonal assessment, registration and processing of bodily-facial communicative cues (visual-facial, auditory-prosodic, tactile-gestural, gustatory and olfactory) occurs in 30 milliseconds, which is long before it reaches our executive prefrontal or rational-decision making areas.

Our body’s neuroception sets the moment to moment intra and interpsychic foundations with respect to assessing/determining our felt-sense-of-safety or lack of safety with others and our surroundings. It thus informs the overall affective mood or nature of our experiences with respect to the child’s or adult’s threshold capacity to maintain attention and engage in relationships with others (i.e., internally regulate through co-regulation back and forth social interactions with another). How your feels takes primary precedence over what behaviors are modeled and externally reinforced and forms the basis of embodiment and interaction with others. (Note, Interoception is the body’s visceral sensory correlate to Neuroception. It is how the child/adult internally feels at a bodily-based level, i.e., hungry, thirty, scared, queasy/anxious.)

Beginning from birth the earlier primary affective instinctual states (identified as discussed previously by the well-renown neuroscientist and psychobiologist, Dr. Jaak Panksepp, seeking/curiosity, nurturance, lust, fear, rage, anxiety/panic, play/laughter) are mediated first by the infant/primary caregiver dyad. In other words, in the moment-to-moment nuanced positive reciprocal warm and inviting or adverse and withdrawn emotional early child/parent co-regulated interactions. The immature brain of the newborn continues to rapidly myelinate (highly conducive and rapidly responsive neuronal connectivity facilitating our child’s transition from ingestion vagal reflexes, breathing, sucking, swallowing, vocalized cries to social-engagement) during the first year of life as the earlier subcortical areas and autonomic nervous system (i.e., limbic, hypothalamic, pituitary adrenal axis; anterior cingulate, periaqueductal gray, and insular into the autonomic nervous system) begin to connect to the toddler’s developing prefrontal cortex/executive functions (i.e., ideation, planning and execution of ideas) and between 14-16 months the onset maturation of the Broca and Wernicke areas for the receptive and expressive processing of spoken language.

To briefly summarize the above, what needs to be understood by clinicians and families with respect to how all children learn, grow and develop is that the infant’s and toddler’s biological-psychological-social processes are critically determined by not just maturational dependent but by experiential-dependent and highly complex moment-to-moment attuned (and expectedly frequently misattuned but during healthy secure based attachment co-repaired) back and forth reciprocal nonverbal visual-facial, auditory-prosodic, tactile-gestural moment to moment co-regulated interactions. Furthermore, “Behaviors” are emergent properties of how one feels (i.e., safe to engage and maintain back and forth engagement or adversity and withdrawal from engagement). An early and healthy illustration of this is a mother naturally engaging her 3-4 month old in back and forth smiling, cooing, vocalizing, reaching, tickling and laughing. An early and unhealthy illustration of this would be a mother negatively or not responding natural cues for curiosity and desire to bond, play and engage.*

*An early demonstration of this is beautifully illustrated in the well-known, “The Still-Face Paradigm Experiment.” https://www.youtube.com/watch?v=FaiXi8KyzOQ

These parent/infant exchanges do not just begin at term but in utero as positive and negative stress hormones begin to cross the mother’s placenta during the third trimester and, depending upon levels of the mother’s affective stress can, for example, due to excessive negative stress result in excessive cortisol in contrast to cortisone helping to form a certain challenging predisposition (e.g., a potential tendency toward a more cholic and fussy baby rather than a baby who more easily calms) but then, post utero, become organized into complex patterns of biopsychosocial experiences that are at each moment inter-regulated (i.e., infant/toddler experiences of the world begin to become neurobiologically organized and internally regulated by co-regulation of the child/parent dyadic back and forth reciprocal-social-emotional interactions which forms the basis of attachment).

We repeat, these biobehavioral and later psychosocial co-affective emotional exchanges which forms our brain-body neuronal connections in relationship with others cannot be reduced to the utter bankruptcy and schematic simplicity and of, “Learning Theory or operant conditioning”, the Skinnerian antecedent, behavior and consequence (ABC) map, the basic foundation of all ABA methodologies, which leaves out the intervening variable or what takes place before all overt learning takes place and is an underlying or implicit part of all our communication (e.g., bodily movement, intonation of voice, visual-facial and tactile gestures) beneath the words, from birth through the lifespan, namely our physiological state regulation or autonomic nervous system.

It is also quite critical to note that these biopsychosocial processes are not as previously thought intrapsychic (i.e., contained within the skull of a single individual) but rather intersubjective and dynamic regulatory affective states that are mediated between two brains, for example, the mother's right emotional brain with the infant's rapidly developing right emotional brain (e.g., the inter-regulatory attachment system of the right orbital frontal cortex, right amygdala and right anterior cingulate, insular into the autonomic nervous system). This has been exhaustively demonstrated during the last two decades in Developmental Affective Neuroscience through near infrared spectroscopy and PET scans with infant/mother dyads. Moreover, separately, in adult psychoanalytical clinical practice and research, not just surface-based behavioral empirical data observation but supported by incontrovertible scientific-evidence-based infared spectroscopy, the notion of a one skull world (or a skin encapsulated egoistic self) has now shifted to a two or multi-skull world of a right to right emotional brain implicit interconnectedness beneath the words. (see, 2021 Dr. Allan N. Schore, Ph.d On Emotional Neuroscience And Affect Regulation https://www.youtube.com/watch?v=qPsF7mwYsEw&t=3924s)

These intersubjective prelinguistic visual-spatial, tactile-gestural, auditory-prosodic and pheromonal child/primary caregiver communications begin to optimally or deleteriously (dependent upon the primary caregivers’ attachment style and the child’s underlying physiological homeostasis and autonomic nervous system) begin to wire together subcortical to prefrontal connections and significantly determine the trajectory of his/her social-emotional, linguistic and cognitive expressed capacities. In fact, these biopsychosocial developmental processes of early reciprocal preverbal affective/emotional signaling (i.e., somatosensory, visual-facial, auditory-prosodic, tactile-gestural emotional co-communicative processes) represents how all infants (typical and non-neurotypical) begin to explore their world and coordinate their senses (e.g., visual-facial, auditory-prosodic, tactile-gestural, olfactory and gustatory) with their gross and fine motor movements and significantly begin to form sustained and meaningful relationships with others and the world (i.e., the infant’s emerging object-relations or sense of self in a world of others).

While each infant’s senses (touch, sight, sound, smell) and fine and gross motor movements are typically intact at birth, they have not yet substantively formed into fixed or neuronal regulatory patterns and rhythms with others. They begin to coalesce into dynamic interconnected relationship-based patterns and rhythms through highly-attuned back and forth social-emotional interactions initially with primary caregivers and then others (e.g., beginning with back and forth reaching, touching, smiling, frowning, cooing and an increased diversity of prosodic vocalizations). We refer to this intersubjective orchestration (more specifically, infant/parent emotional right to right emotional brain connectivity) which begins to create the foundations of relatedness for the infant with the world as the child’s sensory-affect-motor system. Basically, it is how all typical and non-neurotypical children begin to learn, grow and develop. See, Greenspan, S. 2004 The Role of the Emotions in the Core Deficit of Autistic Spectrum Disorders - The Affect Diathesis Hypothesis https://drive.google.com/file/d/0B4eYdf4hpBzyRi12eWp5OWx5NE0/view

What needs to be clearly understood is that all infants do not simply begin to register, process and interpret what they are hearing, seeing, feeling and touching simply as a predetermined part of their genetic or maturational programming but as an integral part of their visual-facial, auditory-prosodic, tactile-gestural interactions which are an integral part of their developing autonomic sympathetic and parasympathetic nervous systems through experiential-dependent co-regulation with another.

Now, when children do present with genetic anomalies or exposure in utero or postnatally to neurotoxins, e.g., which can result in endocrine disruption, autonomic and immune compromises and manifest in neurodevelopmental challenges such as autism spectrum challenges, they often have tremendous difficulty in maintaining simple regulated/co-regulated engagement in the reciprocal exchange of autonomic, implicit-procedural nonverbal signals (i.e., emotional-cueing and responding with others, visual-facial, auditory-prosodic, tactile-gestural, which in fact comprise 93% of all communication, 7% is verbal).

Notably, expressive language which both in terms of maturation and developmentally is a later downstream capacity is often moderately to severely compromised because its emergence is precisely dependent upon these earlier subcortical developmental capacities of the infant and toddler to regulate through co-regulation with primary caregivers these earlier implicit-procedural nonverbal and reciprocal dyadic emotional interactions (i.e., visual-facial, auditory-prosodic, tactile-gestural affective communications) first with primary caregivers and then others.

When a child (or older) experiences moderate to high levels of stress and anxiety (e.g., either due to biologically based reasons as in spectrum challenges and/or child/primary caregiver family dynamics) the social-emotional engagement system becomes to various degrees unavailable. This is not due to, so-called, “aberrant or inappropriate behaviors” which can be “successfully modified” through reward/consequence based contingencies but rather an understanding which involves basic affective neuroscience.

This is an understanding not just of the stimulus and response (e.g., the behaviorist manifesto or the reductio ad absurdum that everything is the reinforcement of environmental contingencies) but rather the missing intervening variable that mediates between the stimulus and response. This is the affective responsivity of the child’s physiological state regulation and autonomic nervous system where the child’s organism is registering and interpreting autonomic stress is understandably and adaptively in a state of defense, fight/flight or shutdown/withdrawal (for example, heightened sympathetic-adrenal arousal/fear resulting in fight/flight behaviors or parasympathetic withdrawal/shutdown culminating in a cascade of physiologic-stress responses, such as eye-gaze aversion, loss of facial tone or flat facial affect; dampening of the stapedius muscle in the middle ear - with respect to the registration and interpretation of the normal high frequency bandwidth involved in processing language and instead a re-attunement to a lower bandwidth which signals background danger or predator sounds). (see, Porges, S. 2011 Polyvagal Theory)

What simply need to be noted at the moment is that the natural emergent and adaptive behaviors of the child, which are labeled and marketed by behaviorists and the general educational system, as, “Appropriate vs. Inappropriate” is nothing short than a profound and schematized ignorance and instead is indicative of your child’s (or older) physiological state and autonomic nervous system under varying levels of stress or trauma as often we see in typical or non-neurotypical development (e.g., disorganized attachment, neglect and/or abuse or neurodevelopmental based challenges). In other words, what is happening beneath the words is that your child’s autonomic nervous system is adaptively recruited. For example, from affective feelings of interpersonal safety to sympathetic-adrenal defensive fight/flight behaviors or, if your child (or any person) cannot fight or flee, then their nervous system adaptively recruited to parasympathetic withdrawal/shutdown, dissociated or freeze behaviors).

(I will discuss the above a bit later on as part of what is well known since the mid 1990’s as The Polyvagal Theory (S. Porges 2011) which details an understanding of the phylogenetic shifts in development that resulted in the emergence of our mammalian social-emotional autonomic nervous system (i.e., facial gestures, auditory processing and vocal communication), where all behaviors are viewed not as in the infantile non-scientific based behaviorist credo of, a written upon tabula rasa of “appropriate or inappropriate behaviors” or stimulus-response models/extrinsic contingencies but understood as instinctual, emergent and adaptive (organismic) properties of the evolution of our autonomic nervous system in our transition from a-social reptiles to social mammals.)

Now, what is typically presented to parents by clinicians as, “challenging behaviors” often egregiously contributes to confounding and obscuring a much more needed developmental critical understanding with respect to the immense significance of the emotional or affective and nonverbal precursors to language which underlie all behaviors, where all behaviors are seen as adaptive and emergent. Essentially, all clinicians regardless of discipline urgently need to begin to gain an education and critical understanding both in theory and in practice of the importance of deepening reciprocal attachment-and-attunement and play through co-regulated relationships (e.g., downregulating sympathetic-adrenal fight/flight behaviors and allowing for social-emotional engagement). This entails clinicians begin to guide parents with respect to the greater underlying primary core preverbal, implicit-procedural challenges associated with all spectrum related challenges (e.g., cultivating the foundations of pleasurable visual-facial, auditory prosodic, tactile-gestural interactions).

Unfortunately, this often goes either completely unaddressed or worse further dissociated and repressed with the child and in the child/family dyad as the focus is generally on memorization and rote compliance to tasks in contrast to an evidence-based scientific and comprehensive understanding of physiological homeostasis, adaptive autonomic nervous system state, implicit-procedural attention, emotional reading of cues (i.e., visual-facial, auditory-prosodic, tactile-gestural, pheromonal cues) and thus resiliency or cohesiveness of connection (two-way reciprocal emotional/affective relational self-and-other processing).

Moreover, it needs to be pointed out that contrary to decades of well-meaning but deeply misinformed behavioral-based therapists, the focus on expanding social-emotional-cognitive and language capacities has absolutely nothing to do with training a child to speak* (despite popular myth) or if the child is nonverbal, the training the child on one to one correspondence with picture exchange symbols (PECS) or signs for functional rote requests (* Skinner’s verbal behavior through repetitive practice imitating sounds/words, or artificial verbal behavior categories referred to as the echoic, mand, tact and intraverbal) but on generating a state of felt-relatedness and intimacy with others.) Speaking does not lead to engagement but comes out of the capacity to form the underlying foundations of deepening emotional-reciprocal engagement and attunement with others, which then sets the foundations (allows) for greater access to executive functioning where verbal communication/language becomes available as an integral part.

What is most critically needed is a major paradigm shift from an antiquated emphasis on disembodied, compartmentalized and absurd “task completion” to deepening reciprocal attachment and attunement, thus helping to shift the child’s arousal/autonomic state regulation of heightened sympathetic-adrenal arousal or in other instances withdrawal/shutdown or hypoarousal to increased feelings of internal (interoceptive) safety (e.g., which results in reductions of excessive levels of cortisol and vasopressin while increasing levels of serotonin, dopamine and oxytocin) and thus, the ability of the child to begin to optimally engage in interactions with another which then, in turn, through a more continuous flow of emotional co-regulated interactive engagement, eventually allows for the emergence of symbols (i.e., holding ideas about things apart from All or Nothing responses) and social-pragmatic communication/language.

This involves first, the opening and closing of many nuanced back and forth circles of spontaneous emotional visual-facial , auditory-prosodic and tactile-gestural interactive regulation first with primary caregivers and then others - beneath the words or as a core feature of our early right to right brain emotional intersubjective communication which developmentally emerges prior to and embedded with all verbal communication throughout the lifespan (e.g., co-affective interactions or preverbal emotional cueing which include facial and somatic reciprocity and prosodic vocalizations).

When behavioral analysts willfully ignore or simply misapprehend the importance of these earlier and critical subcortical affective challenges (i.e., omit or misunderstand the underlying neuroanatomy, neurophysiology and neuroendocrinology as an integral part of a biopsychosocial approach) they commit a great blunder.

For example, instead of beginning to understand and view (let alone admit into existence) the child’s periaqueductal grey (e.g., suppression of pain or pleasure with respect to signals of internal/external threat/danger), superior temporal sulcus (e.g., registering and processing/interpretation of the another’s facial/somatic biological movement); fusiform face area of the fusiform gyrus (e.g., reading/processing facial expressions) and limbic, hypothalamus, pituitary adrenal axis (e.g., strong emotional responses that can manifest in All or Nothing reactions) as underlying regulatory and intermediary processes of the child’s autonomic state of well-being with others giving rise to the “challenging behaviors” (e.g., “Do I feel safe to engage you and others or am I mobilized for fight/flight?”), they proceed to naively view them as only behavioral excesses or deficits to be replaced by more “appropriate behaviors.” Thus, they brilliantly fail to understand that the child is not in need of new contingencies of reinforcement through behavior modification (complete bullshit) but rather wooing.

Sadly this points to a complete lack of understanding with respect to these critical and earlier foundational psychosocial-biological areas, i.e., right to right brain deepening reciprocal attachment and attunement and thus the central core foundational features that constitute interpersonal affect self regulation through co-regulation (as they opt for a primitive plug in/plug out stimulus-response system -which ignores our basic biopsychosocial makeup and complexity). Again, this constitutes a necessary understanding of the child’s neuroanatomy, neurophysiology, neuroendocrinology and psychosocial development and in fact together forms the foundations for the scientific understanding, implementation and practice of Interpersonal Neurobiology, Polyvagal Theory and Infant and Childhood Mental Health.

Instead, behaviorists along with systemic institutional practices that support them (e.g., our general education system which are decades behind attachment theory, inter-regulation theory and Affective Neuroscience in general) ignore the child’s neuroanatomy and neurophysiology and attempt to “teach” these earlier implicit-procedural relationship capacities (i.e., the infant’s or toddler’s feelings of safety or fight/flight or shutdown/withdrawal and associated sensory processing differences) as though these organismic areas (e.g., subcortical limbic-hypothalamic, pituitary adrenal and autonomic stress regulation accompanied by corresponding increases or decreases in stress related hormones) were a simply a set of learned or reinforced external responses or, if you will, the organism left out of the equation and regarded as a tabula rasa or blank slate. In other words, again, a set of commands, declarative memorized responses or discrete/itemized skills that can be first produced through training by command through repetitive drilling (e.g., beginning discrete trial training) and then generalized and maintained through schedules of reinforcement! So what do parents get in return?

They often get - by clinicians using behavioral-reinforcement or cognitive-behavioral based strategies - their “learner” (a derogatory and detached term we prefer to use toddler or older child) to comply, respond or script (in response to what is being selectively targeted on an itemized checklist), which makes them and their child’s classroom teacher feel understandably breathe a sigh of relief but at a great misfortune, as this is not the same thing as their child engaged in spontaneous back and forth social-pragmatic communication. These are the primary core challenges associated with ASD and related challenges, which again emphatically points to the critical necessity to understand and address the child’s earlier biopsychosocial regulatory relationship capacities.

What we actual see in Applied Behavioral Methodologies (which is supported in detailed accounts decades later by now autistic adults who received treatment as children) is a core undermining or repressing of these implicit-procedural social-emotional (affective) relational dynamics (sense-of-self beneath the forced commanded attention or surface trained memory) and individual sensory processing areas (i.e., the child’s earlier right brain subcortical somatosensory and limbic autonomic circuits) This occurs precisely by training the child in selective task reinforcement strategies with respect to what is presented as, “appropriate and functional based tasks” yet in reality are psychopathological or dissociated cognitive-based responses (factory produced assembly line of behavioral-verbal responses on a checklist) which increases overall autonomic stress and adjoining cortisol production.

Moreover, the foregoing forms the basis of self-congratulations and are lauded as newly acquired skill sets which the child had not mastered previously (e.g., trained memorization of play skills and use of functional words). A question that needs to be asked by parents and therapists - but first of course the awareness of a larger understanding than the targeting of surface based skills needs to be present to even to begin to inquire - at what expense? There continues to be a misreading or misunderstanding with respect to the primary core challenges, which are neither deficits in cognitive-based skills or behavioral excesses. https://link.springer.com/article/10.1007/s41252-021-00201-1?fbclid=IwAR1P9EY9V4SHmTBSZ1CIaifhxepDUiMOuFqNWNvWdjcnYqfPl8L-sK0gWFw

With respect to these earlier parts of our not skin-encapsulated single brain but our inter-brain (e.g., intercommunication of mother/infant earlier right orbital frontal cortex subcortical limbic-autonomic circuits) behavioral technicians tend to create the environments for further dissociation and repression of the child’s sense of self and well-being with others. They do so by blithely ignoring the child as a whole under the blatantly naive and misguided focus on “appropriate vs. inappropriate behaviors.” This results in increased levels of autonomic distress and associated stress hormones, such as vasopressin, noradrenaline and cortisol. Early right to right brain emotional functioning (i.e., deepening affect reciprocal attachment in dyadic paired, mother/infant/toddler) is the implicit-procedural feelings with others beneath the words and behind the external or symbolic manifestation of simplistically labeled behaviors and forms the biopsychosocial substrate for the child’s emerging healthy or unhealthy sense-of-self in relation to others either through healthy or unhealthy forms of secure attachment in attunement and accordance with the child’s individual differences.

Interpersonal relatedness or affect-regulation/co-regulation are not a set of operant conditions or cognitive-based skills that can be taught in either typical or non-neurotypical development through dumb-down instantiations of declarative memorization (e.g. the teacher-clinician teaching the child, “We say or do ‘X’ in ‘X’ situation. We say or do ‘Y’ in ‘Y’ situation by repeatedly drilling the child through targeted reinforced behavioral based strategies). Basically the latter include having the child subjected to reinforced itemized checklists of performed behaviors and tasks on cue through external contingencies of selectively targeted strategies of reinforcement - shaping or drilling). This is not how our biology works. This is not how our organism works. This is not how relatedness works. The evolution of our mammalian social-engagement system (which I will cover sections below) is quite bit more complex than the historically bankrupt and trauma induced Skinnerian Learning Theory and operant conditioning which is based upon a reductionist-mechanist machine model.

As a core part of this critical lack of a biopsychosocial developmental understanding of how infants and toddlers grow and develop both in typically and with non-neurotypical relationship based challenges, families of toddlers who receive a autism spectrum diagnosis and often well into adulthood without cessation are subject (in a majority of instances unsuspectingly) to the horrendous and damaging effects of this misguided and destructive emphases by behaviorists overlooking, misreading or circumventing the child’s body-senses-autonomic state and implicit sense-of-self dissociated from integrated neurophysiological-and-affective functioning. Instead, what is opted for is the status quo regurgitation of presented uniform stereotypical conceptions on what educators and families are informed (frightened into believing) needs to be taught and constitute “Socially significant behaviors.” ‘Socially significant behaviors” which are nothing more than vapid force-fed conformity to a set of arbitrary teacher-driven compliant rules egregiously devoid of any psychobiological understanding (i.e., neurophysiological regulation and autonomic function).

For example, teaching “eye contact” as though a “targeted skill” to be taught but not one iota Developmentally understanding what authentic eye contact is as an integral part of safe moment to moment affect-driven relational interactions, which is not “Look at me” followed by an ad nauseam “Good Job” checked mark on a laundry list of skills. Rather, this involves dynamic shifting frames of pleasant facial and somatic back and forth co-referencing with another (e.g., co-narrative meaning making beneath the words) which is adjoined to your child’s internal feelings of safety. On the other hand, understanding your child aversion to making eye contact is not a “learned inappropriate behavior” but rather and this cannot be underscored enough an entirely Normal and Adaptive Response as the child’s sympathetic-adrenal nervous system is sympathetically mobilized with respect to internally registered and assessed internal feelings of fear or threat and, therefore, engages in avoiding eye contact and other related defensive fight/flight behaviors or in contrast but equally parasympathetic withdrawal/freeze or shut down behaviors. Or let us take the example of the child instructed to listen and follow directions on command or cue as part of a reward-compliance based system.

Once again, this is often entirely without any understanding of the child’s underlying homeostatic physiological state. In fact, when the child’s social-emotional autonomic nervous system state regulation reflects feelings of feeling safe with others and the world (e.g., cranial nerves which forms as a single circuit of as part of the parasympathetic ventral vagus nerve in an area of the brain stem known as the nucleus ambiguus, cranial nerves, V, VII IX, X, XI, lower jaw and striated muscles of the face, muscles of vocalization and head turning) in turn becomes optimally available (or re-attuned) for social-emotional engagement. Correspondingly, limbic-autonomic sympathetic-adrenal stress (e.g., cortisol) decreases and prefrontal area availability (executive functioning, planning, sequencing, language) increases (e.g., dopamine, serotonin and oxytocin)

Simply, it is critical for all clinicians and parents to understand their child’s autonomic nervous system or neurophysiological state of negative affective stress delimits or constrains the child’s (or adult’s) capacity for attention, understanding, receptivity and range of pro-social behaviors (i.e., co-regulated interactions) that is able to be dyadically expressed with others at any given moment.

Let us be clear. What is needed are not a series of behavioral-directed responses or declarative memorized trained commands (e.g., the child viewed in a container or tabula rasa with imposed/exposed environmental contingencies of reinforcers that will produce a certain set of responses or a set of directed emotion-less tasks to be cognitively trained or taught, memorized on an egregious and punitive quid pro quo of a reward-compliance based system).

Rather what is needed is a paradigm shift in pausing, slowing down and breathing where clinicians and parents in non-compartmentalizing begin to go to the child’s world and emotionally/affectively sharing/joining in with the child and, thereby, helping the child to increasingly cultivate his/her internal (neuroceptive and interoceptive) feelings of safety with another. This then naturally helps shift the child’s physiological state (e.g., autonomic nervous system) towards a position of greater availability for receptive understanding, reduced hypervigilance, reductions in sensory overload or underload processing challenges toward increased optimal arousal-and-the psychosocial framework for interpersonal relatedness. This cannot be underscored enough. The latter are part of the biological-psychological-social foundations that constitute the healthy or optimal foundations of our instinctual mammalian neuroanatomy and neurophysiology (i.e., the ability to reciprocally communicate and engage with others). They are from a neuroanatomical, neurophysiological and psychosocial foundation critical and non-controversial and yet they continue to be consistently ignored by majority of clinicians in the field.

The systematic attempt to teach these inter-regulated, interpersonal psychobiological interactions as “learned behaviors” which are beneath conscious awareness or the manipulation of external contingencies (i.e., a set of declarative memorized responses or selective tasks or cognitive skill sets - despite professed claims of teaching generalization of those skill sets which is merely an aggregation of these selective or isolated skill sets - or a more horrendous caricature) is neuroanatomically, neurophysiologically and neurodevelopmentally naive. It is to be kind simply inaccurate and not in accord with the science of neuroanatomy, neurophysiology, neuroendocrinology and psychosocial affective regulation of the last three decades. Nonetheless, it has tragically stood the test of time, that is, as serving one particular social narrative and immensely effective and quite profitable and seductive utilitarian/marketing tool used by ABA methodologies presented to families over many generations because they appear (prima facie) to make perfect common sense. Why?

Again, we can directly point to the fact that it is precisely because families are willfully and explicitly not taught the basic foundations of what constitutes Infant and Childhood Mental Health and human Development beginning in Early Intervention. Essentially, how brains and bodies connect through the dynamics of child/primary caregiver relationships. The latter is based upon Affective Neuroscience (in contrast to debunked and antiquated Learning Theory). Specifically, they are not taught about epigenetic and interpersonal relationships of primary caregiver/child dynamics with respect to their physiological state or autonomic nervous system regulation and connectivity of their child’s developing brain in neurotypical development but equally in non-neurotypical development which ameliorates challenges and determines developmental trajectory (i.e., core challenges associated with ASD and related sensory and social-pragmatic communication challenges).

This involves not an optional but vital necessity of re-educating clinicians in the moment to moment guided process of learning how to observe, watch, listen, slow down and deepen reciprocal attachment and attunement in accordance to that child’s functional-emotional developmental capacities and individual differences.

Neither tepidly nor in a piece-meal fashion the sixty-year old behavioral tunnel vision needs once and for all critically needs to be seen from an empathic as well as a basic comprehensive biopsychosocial perspective as emotionally bankrupt, scientifically inaccurate and morally and ethically corrupt Thus, from a Developmental Affective Neuroscience perspective,

1) We are focused not on the child’s surface attention or declarative episodic or semantic memory (i.e., trained rote request/task responding and labeling) and how well those surface trained behaviors can be complied with by the child under the non-compassionate, anti-science and distorted beliefs and practices of adult-led control. Instead, we are focused on the whole child with respect to his/her psychosocial neurobiological processing with others, explicitly his/her interoceptive and exteroceptive feelings of safety and relatedness with others (e.g., shifts in his/her autonomic regulation from safety, to sympathetic adrenal arousal to shutdown and correspondingly the understanding that all behaviors are the emergent and adaptive properties of not a singular contained autonomic systems but rather interpersonal mind-brain-body biopsychosocial based connections).

2) All “behaviors” without exception must be understood not from the folkloristic and antiquated seventy-year old behavioral practices which are adult-directed, controlling and punitive (e.g., the profound ignorance of clinician’s re-directing behaviors under the auspices of “science”, finding replacement behaviors or extinguishing behaviors) but from a neuroscientific biopsychosocial perspective, which developmentally understands that all behaviors are the symbolic or external manifestation of what is occurring beneath the surface and, therefore, as emergent and adaptive features of the child’s physiological state and not as “appropriate or inappropriate responses” (utter nonsense) but as the child’s sympathetic and dorsal and ventral parasympathetic autonomic nervous system (i.e., dorsal parasympathetic, older freeze, immobilization/withdrawal and ventral parasympathetic, newer mammalian social-emotional engagement) which acts as the intervening variable between the “stimulus and response” to perceived safe, unsafe or life threatening environments.

In other words, the focus cannot and should not any longer be on what the child can perform “on task, cue or memory” (i.e. vis a vis operant conditioning of the surface behavior or the reinforced stimulus/response) upon proudly presented but meaningless task-checklists (however, cosmetically impressive) but rather on the physiological and psychosocial interactive regulated/co-regulated dynamics of the relationship and the foundational understanding of the child’s adaptive and emergent behaviors connected to his/her autonomic nervous system state (i.e. feelings of safety, defense or shutdown) with an emphasis on the cultivation of neuroceptive-and-interoceptive safety. This needs to be clearly understood as a relational process which is interpersonally regulated (i.e., regulated/co-regulated or dysregulated) and, significantly, attaining viability in the non-reductionist social-emotional (empathic) dynamic of the dyadic child/parent and child/clinician relationship.

This needs to be accompanied by clinicians and primary caregivers slowing down and listening with an attentive presence and understanding beneath the words to the child’s intersubjective feelings of self-and-relatedness with the world (e.g., primary caregivers and clinicians stopping, pausing, listening, attribution of meaning child’s natural intent; approaching with curiosity, compassion, reflection and respect the nature of the child’s world).

Despite a major paradigm shift during the mid 1990’s in neurophysiology, neuroanatomy developmental psychology, inter-regulation theory, Interpersonal Neurobiology, Polyvagal Theory, Infant and Childhood Mental Health and family systems theory all of which address neurotypical and non-neurotypical challenges and represent an integral part of what constitutes a comprehensive biopsychosocial perspective in Developmental Affective Neuroscience, ABA methodologies are still shockingly and egregiously promoted as, “The Only Scientifically Proven Treatment for children with ASD” and related challenges. Why?

Typically, the roadmap that parents are presented with as their child enters early intervention as a toddler or later with a spectrum diagnosis includes the BCBA or a registered behavioral therapist initially performing a functional behavioral assessment of the child’s “appropriate behavioral tasks and cognitive tasks.” This then followed-up by a functional behavioral analysis which is a more detailed objective analysis to determine precisely what are the antecedents driving/reinforcing the child’s “undesirable behaviors” and the reinforcers or consequences that maintain them.

These so-called, objective observations and data graphing tools are used to evaluate the nature of the child’s behavioral and cognitive task acquisition repertoire with respect to matched neurotypical peers. The purpose is to essentially identify, label and begin to target, “problem or non-compliant behaviors and skill sets” and begin to implement “cognitively driven teaching strategies” to replace the, “inappropriate behaviors with more appropriate behaviors and skill sets.” Appropriate vs Inappropriate, Compliant vs non-compliant tasks/behaviors are arbitrarily defined and without any scientific validity (let alone humanity) in contrast to a comprehensive evidence-based driven biopsychosocial understanding and perspective. ABA methodologies focus on the child performing new sets of surface or declarative memorized responses (i.e., positive reinforcement of the child as s/he performs a set of adult-deemed appropriate routines on cue or command) shown by data driven analysis in the child’s schedules of reinforcement.

When we place aside several generations of the pedagogy of compliant-based traditional schooling (e.g., many decades of enormously successful lobbying efforts such as a half century of pharmaceutical cos. supporting the stream efficiency and enormous profitability of a two-prong approach of psychotropics and behavior modification) and instead more soberly begin to peal away this accompanied farce, “The Only Scientifically Proven Methodology in Treating ASD” contrasted with the reality of the child as a whole in the context of relationship and what presents as the child’s heterogeneous (individual) affective-driven multilayered biopsychosocial functioning, we begin to bring to focus a much more accurate and broader neurodevelopmental picture. We begin to see that ABA methodologies do not for one moment begin to address (i.e., beneath the surface of trained declarative memorized tasks) the child’s earlier and vital subcortical and primary core Functional-Emotional Developmental capacities which are connected biologically-psychologically and socially in the context of interpersonal relationships and are critical for the child’s cognitive, social-and-emotional development.

A comprehensive humane and informed developmental focus that addresses the functional emotional developmental capacities beneath the surface (e.g., beneath declarative recall, redirected trained memorization of adult-directed behaviors and selective tasks and instead address the child’s earlier affective/emotional foundations) is mandatory for addressing any spontaneously meaningful and sustained two-way co-regulatory capacities for meaningful joint attending, engaging and social-pragmatic communication/language.

Essentially, ABA methodologies exclusively targets changing the child’s surface trained behaviors and tasks entirely irrespective of substance, content and process (e.g., in other words any viable attempt to understand the language behind the behavior or what is going on for the child from the child’s, “meaning-making perspective” with other and his/her emergent world and importantly the underlying adjoinedly regulatory components accompanying all emergent behaviors). Continuing on this vein, after a functional behavioral analysis, the analyst implements what is referred to as “schedules of reinforcement”, a specifically tailored behavioral treatment(s) that will be measured over time with the goal of having the child obtain a new inventory checklist of compartmentalized cognitive tasks and behaviors.

Graphing a child’s responses to the behavioral methodology implemented through applied schedules of reinforcement is the modus-operandi for the behavioral analyst to gain effective instructional control, deconstruct and analyze the child’s responses to the particular received behavioral treatment in order to determine its efficacy. That’s all fine and well if we insist on an “adult-led control” pathology and data that measures surface performance but leaves out individual differences but ensures continued funding but we are leaving out the child as a relational being (and the dynamics of how those relationships unfold in a dyad). If the implemented behavioral methodology and treatment plan is “successful” it will clearly demonstrate the child’s measured and achieved progress over time (e.g., "Here my baby, this is a smile. Here is a grimace. Can you smile? Can you grimace?" Good job! You smiled. You grimaced!" Here's your pacy!").

Instead, what Developmental Affective Neuroscience, Infant and Childhood Mental health, psychoanalysis, family systems theory and developmental psychopathology have clearly revealed to us since about the early-mid 1990’s is that the way all children from birth begin to neuroanatomically, neurophysiologically and neurodevelopmentally grow, develop and learn is through early affective (emotional) right to right brain reciprocal child/parent relationship driven/relationship based interactions. This begins through a process of primary caregivers and clinicians honoring, respecting and understanding their child’s biopsychosocial differences with respect to nuanced preverbal affective reciprocal engagement. This consists of calm, secure, warm, reassuring, enticing, joyful and loving child/parent emotional relationship based interactions.

What also needs to be made abundantly clear for all those who work with infants and older children is child/primary caregiver relationship-based engagement (a deeply integral part of our 200 million year mammalian evolutionary functional emotional-developmental process - caregiver/offspring practices) cannot, despite the unconscious obsessive compulsion by behaviorists for instructional control and expediency (vis a vis the schools’ demands for obsessive evaluation and compliance) be broken down or parsed out to a set of declarative memorized cognitive and behavioral tasks or discrete units (marketed particularly with the child with special needs and evaluation scores for continued school received disbursement of funding for programs under the executions of strategies and facade of more “manageable learning for all learners” or “the non-compliant and intellectually challenged child”).

When behavioral based methodologies are used by clinicians with families, they are unfortunately often done so at the major and tragic cost of incurring a complete disregard or lack of understanding with respect to what actually constitutes the family’s understanding of their child as a whole. In other words, even used with the best of intentions in place what is often entirely missing in an applied behavioral based approach is the necessite of understanding of what comprises each child’s psychodynamic and neurophysiological foundations which are mediated through deepening reciprocal attachment and attunement and playful relationships beginning with child/parent emotional reciprocity (respecting and supporting the child’s emerging feelings and range of emotions) and subsequently allows for the child’s Functional-Emotional Developmental Capacities that we typically observe during the first three years of life.

Learning Theory, the Skinnerian model that all behavioral methodologies are based on, insist upon skewing the child up into discrete units or sets of appropriate vs. poorly learned and inappropriate behaviors and tasks and reliably delivers a caricature, par excellence (e.g., the image of the well-performing child who can recall on command or cue an endless list of selective memorized cognitive tasks and adult acceptable behavioral acts on a checklist which is then somehow regarded as “progress”).

In contrast, understanding the early affective or emotional developing patterns of infant/toddler primary caregiver interactions always consists at the core healthy primary caregiver and developmental clinician practice synchronously attuned, misattuned and co-repaired interactions (it is in the co-repair by the parent or the child/parent dyad of the social-emotional interaction which creates the foundations for resilient growth and development). This dyadic process is critical in how each infant’s/toddler's earlier emotional and state regulation foundations, his/her subcortical/limbic areas, begin to neuronally connect to the rapidly maturing prefrontal cortex or executive functions (i.e., ideation, motor planning, sequencing and execution of ideas) during the first few years of life (or as in Functional Emotional Developmental relationship based approaches for children with ASD as a necessity re-visited by going back and addressing these vital earlier missed stages). In other words, what we are addressing here is a dynamic preverbal affective (emotional) dance between the child and primary caregivers and not the emotional and psychic bankruptcy of a data-driven collection of external object-task completion, which unfortunately are blithely devoid and ignorant of any understanding of the mother/infant and toddler dyad of object-relations.

Therefore, when working with all typical and non-typical developing infants, toddlers and older children it is absolutely critical that all clinicians begin to take into consideration the bio-behavioral and affective (emotional) dynamics of primary caregivers and any extended family relationship patterns and how they positively facilitate or adversely impact their child's growth, learning and development. This necessarily includes (for both typical and non-typical presenting children) all clinicians gently guiding primary caregivers to deepen affect-reciprocal attachment and attunement during simple to complex social-emotional interactions around the child’s developing and exploratory object-relations and associated emerging “sense-of-self” with others and the world which are directly connected an integral part of autonomic state (safe, unsafe or perceived life threat) .

When Applied Behavioral Analysis methodologies are used as the primary lens to address so-called, “challenging behaviors and tasks”, the biopsychosocial and empathic understanding of the child’s underlying and adaptive physiological state regulation facilitated by child/parent affective co-regulation (e.g., "Do I feel safe and comfortable to engage with you and the world? or "Do I not feel safe and comfortable to engage with you and the world") is considered quite beside the point or met with blank and fatuous stares. Understanding and knowledge of what is occurring with respect to the child’s earlier either missed or incomplete affect/emotional developmental stages prior to the child's later matured medial prefrontal cortex (i.e., the ability for the child/adolescent to control impulses) and thus what is actually driving behavior (i.e., not object-task reinforcement but "object relations"- the relationship of the child's emerging self-with-the world through safe, comfortable, registered moment-to-moment dyadic affective-social engagement) is not considered particularly relevant to the behavioral technician. This is a problem for us!

Object-relations (i.e., child/parent social-emotional reciprocal interactions) should never be conceptualized or reduced to a set of functionally targeted and parsed out (mechanized, broken-down, checklisted and labeled) object-behaviors or tasks. Nonetheless, the latter appears to most serious-minded behavioral clinicians to be perfectly reasonable and logical without question (e.g., “no psychobabble or intersubjective nonsense or suggestion of affective mood/feeling states”). It is in this vain that a majority of behaviorists continue to remain perfectly content and dismissive with respect to what was once upon a time happily referred to by behaviorists as the “great unknown black box” (the dynamic affective components of physiological state regulation and subcortical processes) even though those contents have been fully split open, understood and shown in real-time, since at least the mid to late 1990’s with the paradigm shift from the behavioral theory in the 1950’s/60’ to cognitive neuroscience in the 1980’s/early 1990’s to Developmental Affective Neuroscience or the language of feelings.

What must be critically understood by educators, families and clinicians is that the exclusive focus for the behaviorist is explicitly - and we can emphatically state tragically - not on the biopsychosocial dynamic relationship between the child’s central and autonomic nervous system (or more accurately, the interpersonal neurobiological psychosocial-relatedness between infant/toddler/parent central and autonomic nervous systems) and the associated positive and stress hormones that are produced (the affective co-regulatory foundations of child/parent of visual-facial, tactile-gestural and auditory-prosodic communications - beneath the verbal that maintain those foundations in infancy and childhood) but rather on the reinforcement of secondary and tertiary cortical processes, e.g., surface motivating operations (the antecedent, behavioral consequence map) and the plethora of managerial data-collection on the child's so-called, well-behaved or onerous ("compliant vs. non-compliant”) behaviors and tasks. It is these so-called, inappropriately “learned behaviors” that are incorrectly and egregiously presumed as the child’s reinforced environmental contingencies which interferes with all 'learning."

Now, if educators and clinicians desire to focus in this manner that is perfectly fine! However, as professionals and parents we imperatively need to draw marked distinction and begin to understand what is real science (i.e., biopsychosocial and affectively driven neuroscience, Interpersonal Neurobiology and Polyvagal Theory) from what continues to misrepresent itself as science, that is, “all learning“ as nothing but a series of inputs and outputs of reinforced stimulus-responses to operant conditioned responses where the again the misguided obsession is an exclusive focus of the child's later developed tertiary brain (e.g., matured prefrontal medial cortex) and ignores the earlier and more primary parts of the brain, namely the affective system and important intervening variable (between the stimulus and response), that is, state regulation and hence eight-tenths of the architecture beneath the cortical function!

What must be made unequivocally clear is that for the behaviorist the focus is almost exclusively placed on the child's surface symptomatology, that is, what the clinician witnesses with respect to what the child is producing in terms of present (selectively) observable (deemed relevant) behaviors and how they are being reinforced and can be labeled, marked and strategically targeted (i.e., misguided and disparagingly labeled, “compliant/non-compliant” or “disruptive /non-disruptive” and thus egregiously missing the point that all behaviors are emergent properties of physiological state of feelings of safe, unsafe or life threatening environments as noted above). The focus is on the child's later developed secondary and tertiary cortical functions (e.g., prefrontal medial cortex with respect to rational suppression of impulses) and not the child's earlier driven Affect Developmental processes (i.e., the child's autonomic state regulation and earlier emotional-developmental subcortical brain foundations mediated by dyadic relations) which informs, drives and influences in utero through the lifespan, all subsequent emotional-cognitive and receptive and expressive language growth and development.

Moreover, the child’s sense or safety or not safety (i.e, physiological state regulation) is further manifested in terms of the child’s over-responsive, under-responsive or mixed responsivities across the child's sensory modulation and motor processing domains (e.g., visual-spatial, auditory-prosodic, tactile-gestural, proprioceptive, vestibular, gustatory). Also, as part of any comprehensive critical assessment we must always separately account for any comorbidities (i.e., pre-existing medical conditions) or other relevant constitutional factors (e.g., screening for the presence of any environmental neurotoxins and dietary intolerances, food allergies, etc.).

Therefore, from a neuroscientific biopsychosocial perspective we must once comorbidities are accounted for regard “all behaviors” as an external or symbolic manifestation (expression) which are always beneath the surface accompanied by (and an integral part of) the child’s emergent and adaptive physiological state regulation. Hence, this returns us to some of the important emotional-developmental questions, such as, "How is the child meaning-making with other?" How is the child interpreting and perceiving his/her world? Specifically, how is the child registering, assessing and perceiving the world in direct correlation to his/her underlying affective states and autonomic arousal? “Is it safe or is it not safe?" Is the child's and the primary caregivers’ central and autonomic nervous systems mobilized for engagement and play and parasympathetic, safety, rest and restoration? Or is the child’s (and primary caregivers’ and clinicians’) central and autonomic nervous system adaptively recruited and mobilized for defense, fight, flight responses or in more extreme instances, dorsal vagal parasympathetic disassociation, i.e., withdrawal and shut-down responses? These are perhaps among the most critical questions with respect to forming relationships, learning and communicating with others, not just for the child but for all of us and throughout the lifespan!

In developmental social-pragmatic relationship based approaches, such as DIR/Floortime, we begin to address not each child’s "selectively targeted problem behaviors" but, again, the underlying physiological and psychosocial relationship-based strengths and challenges (respecting how a child is actually registering, interpreting and processing his/her world) by slowly and gently guiding primary caregivers with respect to encouraging expanding indivisibly small to increasingly complex patterns of co-affective regulation around the child's natural affect/intent. This biopsychosocial developmental process must begin with clinicians educating families and professionals with respect to child/parent deepening affect reciprocal attachment and attunement around their child's natural sensory-affect-motor movements (e.g., visual-spatial, tactile-gestural, auditory-prosodic differences) in order to establish the foundations for meaningful and sustained engagement.

This biopsychosocial relationship-based understanding which systematically and comprehensively takes the child's body-brain-mind integrated development into account helps build (co-construct) the foundations for how every child's central and autonomic nervous system based connections (central stress, limbic, hypothalamic, pituitary adrenal axis and socially adaptive autonomic nervous system) are formed during positive two-way pleasurable social-emotional reciprocal based interactions and play (e.g., cortical-limbic functioning, sensory-motor planning, ideation and execution of ideation informed and driven by child’s autonomic nervous system regulation with regards to reduced fight/flight, freeze responses and excessive stress hormones). Moreover, this Developmental Affect foundational framework addresses typical and non-neurotypical developing children as we begin to address a wide affective range of biopsychosocial developmental functioning (e.g., insecure avoidant dismissive and disorganized attachment to spectrum challenges).

*See, Allan Schore, 2014 Early Interpersonal Neurobiological Assessment Of Attachment and Autistic Spectrum Disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184129/ 2017 Allan Schore, The First 1000 Days: A Critical Period for Shaping Our Emotional Selves and Social Brains https://www.youtube.com/watch?v=lY7XOu0yi-E&t=6s

In either neurotypical or non-neurotypical development it is not a matter of behavioral technicians re-directing the child’s so-called, “maladaptive behaviors” (e.g., where the goal is to train each child to produce an assembly-line of new compliant behaviors and functional tasks in favor of extinguishing non-compliant behaviors and non-functional tasks). Rather, all "behaviors” from a biopsychosocial perspective need to be viewed as the symbolic or external manifestation of what is happening beneath the surface. However, the pseudoscience of applied behavioral analysis and education in our schools in general continue to ignore the evidentiary support for Developmental Affective Neuroscience, as there is expressed precious little if any concern with respect to what is happening beneath the surface (i.e., specifically the child’s central stress, LHPA axis and autonomic stress regulation and the adaptive and emergent behaviors integral to the latter which are always synaptically connected, co-structured/co-determined not by simply the stimulus and response or antecedent training of reinforced tasks (i.e., “appropriate vs inappropriate task-behaviors”) but rather by attuned, warm, empathic and inviting or aversive relationships).

Families who begin to enter therapy at the point of early intervention or in school thereafter, continue to be blithely misinformed by many, educators, developmental pediatricians and other clinicians into assumption that all "behaviors" are cognitively taught and habitually learned and reinforced contingent responses to sets of purely external stimuli, where, for example, the therapeutic focus must be about teaching the child to replace one set of behaviors for another with the goal of each child to to clearly demonstrate and produce a checklist of "more socially acceptable and appropriate behaviors and tasks.”

Rather, all families first and foremost need to be educated by clinicians in early intervention - through school that all behaviors are adaptive and emergent responses which are a directly a part of the child’s state regulation, which is the intervening variable between stimulus and response (e.g., the child’s limbic and autonomic nervous system of safety vs. fight, flight or freeze responses and associated positive and/or negative stress producing hormones, HPA axis). Behaviors meaningfully begin to change not by implementing “schedules of reinforcement” (i.e., changing the surface motivating operation or the antecedent driving the behaviors, ipso facto, targeting surface symptomatology) but through the guided affective (emotional) dynamics of psychobiologically attuned primary caregiver relationships.

Now, what happens when parents are guided to not direct what appears to be the child’s “lack of motivation, inattentiveness, off-task or problem behaviors”, but rather enter the child’s world (i.e., begin to form relationship between deepening reciprocal attachment and attunement) follow the child's lead and systematically begin to form the foundations for warm, inviting relationships around the child's world?

Well, to put it simply, when back and forth reciprocal affective (emotional) engagement begins to become registered by the child as pleasurable and internally safe and secure (i.e., neuroceptively and interoceptively) we begin to see core fundamental changes (shifts of autonomic regulation) in how each child begins to register their intersubjective experiences in relationship to their environment and others; begin to expand their conceptualization of the world and thus begin, as s/he is motivated by increased spontaneous curiosity and desire (i.e., increased joy and comfort in being able to spontaneously co-regulate with others) socially-pragmatically verbally communicate with primary caregivers and others.

It is not through selective or circumscribed behaviors (symptomatology) targeted on schedules of reinforcement with respect to maintaining the Antecedent Behavior Consequence map where children meaningfully learn, grow and develop but rather by parents and clinicians slowing down and engaging in dyadic affect reciprocal attachment and attunement around the child’s (or older) processing differences and interests, that the child begins to form (through dyadic co-regulation) a set of ideations or symbolic representations about the world in contrast to immediate concrete or All or Nothing predominant limbic driven responses.

The latter then naturally allows (comorbidities aside) for the child’s autonomic social engagement system (ventral vagus) which is manifested through neural expressivity of the face, middle ear muscles and the muscles of vocalization and expressive language to come online. In other words, by parents and clinicians cultivating the dyadic affective relationship, which promotes registered and perceived feelings of safety (e.g., engagement and play respectful of and in attunement with the child’s processing differences) natural shifts in behavior occur as the child’s physiological state begins to shift from an adaptive defensive sympathetic posture of fight/flight responses or worse parasympathetic freeze or withdrawal and dissociated responses to one of adaptive availability (i.e., “I feel safe and enjoy being with you and you with me”) for social-emotional engagement to begin.

What I have been discussing thus far entails not redirecting the surface function of behaviors (i.e., as fixed antecedents or labeled nouns) but clinicians guiding primary caregivers into psychobiologically attuned relationships around their child’s individual sensory processing differences, which then confers to the child on an internal or interoceptive level (e.g., midbrain structures of the insular and periaqueductal gray) feelings of “relational safety” during back and forth interactions with primary caregivers and others in contrast to feelings of internal compromise or perceived threat. (e.g., “I want to engage with you. I can engage with you. It is fun to engage with you, It is increasingly curious and desirable for me to engage with you and for us to engage together”).

It is quite remarkable when we begin to contrast this developmental biopsychosocial understanding which translates into an understanding of navigating relationships with the re-training of the child’s surface behavioral responses (essentially, repressing the child’s natural curiosity and impulses) and instead focuses on the child, “learning acceptable behaviors and tasks”, which in practice represents compartmentalize checklists of reductionist based selective and isolated tasks and rote memorizations, ad nauseam (e.g., as clinicians ignore the child’s autonomic nervous system/state regulation and thus miss not an optional but a necessary and critical emphasis on the child’s spontaneous assessing, relating and engaging which must come from an emphasis on cultivating a foundation of relational safety).

Since the early 2000's, we now understand the process of how each child’s Functional-Emotional Developmental capacities begin to systematically and meaningfully unfold and myelinate (rapidly connect the brain stem with limbic areas to the later prefrontal parts of the brain) in the moment-to-moment context of affectively (emotionally psychobiologically) attuned and healthy secure nurturance based engagement interactions or conversely becomes immediately derailed in insecure child/primary caregiver interactions. Now, the this can be due to insecure-avoidant and dismissive disorganized attachment, such as neglect and abuse, or quite separately this can be due to the prevalence of underlying genetic-biological and environmental or other factors that make sustained regulated/co-regulated interactions mild to extremely challenging, as in autism spectrum challenges. We now have several decades of Developmental evidenced-based treatment practices and corroborated clinical data due to improved advances in PET and functional neural imaging beginning in utero and infancy between two brains (mother/child)

The phrase “between two-brains”, a term now commonly used in Interpersonal Neurobiology, attachment research, dyadic psychotherapy and infant and early childhood mental health practices has now for quite some time been referred to by the term, “Interbrain.” The biopsychosocial foundations that constitute the “Interbrain" involve the inter-regulatory communication of the mother’s with the infant and toddler’s right orbital frontal cortex, right subcortical limbic areas, insular cortex, temporal parietal regions, anterior cingulate and the hypothalamic, pituitary and adrenal axis, HPA (our central stress response system). We now fully understand and is well corroborated by infrared spectroscopy studies over the last few decades the child/parent dyad as a single system that dynamically connects between the child's and parent’s visual-facial, auditory-prosodic, tactile-gestural cues and autonomic nervous system and is intersubjectively and affectively translated into feelings of well-being and safety vs. feelings of fight, flight and withdrawal/freeze. These emotional-bodily based (i.e., early right to right emotional brain sensory-affective-motor communications) begin to synaptically wire the child’s subcortical regions to his/her rapidly developing prefrontal or executive parts of the brain, which includes (allows to become functionally operational rather than inhibited) the emergence of expressive verbal social-pragmatic communication/language.

Once again, at the risk of repeating myself, the implications are immensely critical for understanding healthy development and educational practices and moreover implications of biopsychosocial development and family and societal relationships in individual families and on a global scale. The way the infant’s and toddler’s subcortical areas (emotional-limbic parts of the brain) begin to form the synaptic connections wiring the neural pathways first subcortical then the prefrontal areas of the brain or executive functioning (i.e., planning, sequencing and execution of ideas and emergence of language) is not just maturational but child/parent experience-dependent moment-to-moment social-emotional-bodily based communicative interactions.

Therefore, when we place not in the garbage bin but the historical shelf the naieve Skinnerian and Lovassian behavioral interpretative of the child (or any individual) as motivated and reinforced by the ABC map of environmental contingencies (i.e., what immediately precedes the behavior and what reinforces the behavior) we begin to psychosocially and comprehensively understand nature and nurture in a much more accurate, evidence-based supported, dynamic and meaningful fashion with respect to what happens beginning in utero with respect to mother/fetus co-affective positive and negative stressors and postnatal epigenetic connections (the set of molecules that sit on top of the genome and regulate gene expression, that is, what genes become turned on or off, produce proteins and enables synapses to form). These epigenetic connections are critically dependent for optimal growth and development on healthy dyadic child/parent secure based reciprocal affective interactions.

These co-affective regulated intersubjective communications develop by engaging the child in simple to complex back and forth social-emotional visual-facial, auditory-prosodic and tactile-gestural pleasurable interactions. Moreover, with so much emphasis placed on verbal communication by clinicians (entirely understandable by families whose child has been diagnosed with ASD or related challenges and demonstrate mild to severe expressive/verbal language challenges) it needs to be strongly countermanded and underscored that approximately 93% of all communication (the early development of the right emotional brain and in reality the primary communicative, engagement and language challenges of children with ASD) consists of these nonverbal (or paralinguistic) affective bodily-sensory based interactions. Approximately 7% of all communication is what we formally define as expressive/verbal communication/ language.

Unfortunately, what we sadly continue to witness in the vast majority of therapeutic and educational settings is that these nonverbal and paralinguistic sensory-affect-motor areas, e.g., visual-facial, auditory-prosodic, tactile-gestural and bodily based reciprocal affective communications are at best inadequately addressed (e.g., addressed in a highly compartmentalized fashion or isolated fashion) and thus always tend to tragically and unnecessarily inhibit or significantly delay the emergence of spontaneous social-pragmatic communication/language from developing in an otherwise meaningful, integrated and dyadic-relationship driven manner.

Expressive verbal communication/language is an integral part of the child’s maturation of executive functioning or prefrontal cortical regulation. Now, what we see with children with significant delays in expressive communication and language, as for example, in autism spectrum challenges, is that the maturation of prefrontal cortex regulation (executive functioning, motor planning, sequencing and execution of ideas) is significantly delayed or inhibited (as previously mentioned) by and because of the child's earlier and dominant over-activated subcortical limbic (right brain emotional) regions and autonomic stress regulation (i.e., LHPA, limbic, hypothalamic, pituitary adrenal axis). This subcortical dominance and sympathetics activated for fight/flight or parasympathetic withdrawal/shutdown responses acts as a disinhibtor to the child’s ventral vagus system (face to face and auditory-prosodic communication). Our ventral vagus dynamically connects the central and autonomic nervous system and essentially serves as the conduit for our mammalian social-engagement system and thus allows for the higher cortical functions which include language).

This child/parent co-regulation begins subcortically with and expressed by back and forth infant/toddler/parent co-affective (emotional) body to body or autonomic nervous system to autonomic nervous system signaling (registered autonomic feelings of social-emotional safety) and is directly connected to the striated muscles of the face, head and middle ear muscles - attunement to full range of higher amplitude frequency sounds, specifically human voices (serving as the foundations for healthy secure based attachment). The latter includes not just the striated facial muscles, e.g., facial affect used for smiling, frowning, etc., but the recurrent laryngeal nerve -part of the ventral vagus, which connects to the pharynx and larynx - the muscles for vocalization. I will address this at length in the next section).

Therefore, Developmental Relationship evidenced-based treatment approaches, such as DIR/Floortime, which directly addresses the core affective system and is critically dependent upon an understanding of the epigenetic intersubjective (or co-regulated) child/parent early right to right brain-body subcortical foundations necessary for connecting to higher prefrontal cortex/executive functioning (planning, sequencing and execution of ideas, including Broca’s and Wernicke’s area for verbal language which comes online around 14-16 months) with both typical and non-neurotypical developing children are entirely focused around the building and integration of the child’s Functional Emotional Developmental capacities around the child’s natural intent and emerging healthy sense-of-self with others.

To conclude, in either typical challenging behaviors (e.g., dyadic insecure avoidant- ambivalent and disorganized attachment practices or poor institutional and daycare settings) or in atypical constitutional challenges, such as in ASD, it is not the compartmentalization of an inventory checklist of the child's circumscribed or “problem behaviors” that is focused upon (e.g., as we see in ABA methodologies, a delivered bankruptcy or a caricature or rote list of antecedent or consequent driven input/output “trained behaviors”). Rather, it is primary caregivers, therapists, educators and other professionals beginning to understand and utilize their natural/intuitive emotional intelligence to learn how to slow down, attune and emotionally connect and engage with their child's constitutional, developmental and sensory-affect-motor processing challenges (the earlier subcortical and autonomic areas) that significantly enables the strengthening of these underlying neural pathways that lead toward the formation of new synaptic connections and meaningful Developmental milestone advance.

The Infant/Parent Visual-Facial, Auditory-Prosodic, Tactile-Gestural Intersubjective Communications Dynamically Connected with the Orbital Prefrontal Cortex, Central Stress Response System (Limbic, Hypothalamic, Pituitary Adrenal axis) and Autonomic Nervous System (i.e., Safety vs. Fight/Flight or Withdrawal/Shut down). The Understanding of All Behaviors as Adaptive and Emergent Properties of Safe, Unsafe or Life Threatening Environments.

The justification for a biopsychosocial relationship based approach, where the emphasis is placed not on changing the child's surface acquired tasks or declarative memorized behaviors but on the child’s earlier developmental capacities of co-regulated social-emotional engagement and vocalization, such as DIR/Floortime, in treating children with autism and related challenges garnered tremendous evidentiary support by revolutionary advances made in the fields of neurophysiology, neuroanatomy and neuroendocrinology during the mid 1990's. At this point in time there was introduced a new conceptualization of the traditional depiction of Langley’s bifurcated autonomic nervous system (i.e., a set of paired antagonists, sympathetic and parasympathetic attempting to maintain visceral homeostasis) with a separate higher ordered left brain sitting on top engaged in higher thinking or executive functioning (i.e., planning, sequencing of actions and higher rational decision making) to a new and more accurate understanding of our central and peripheral autonomic and somatosensory nervous systems as a single integrated and adaptive social-emotional system regulated by two phylogenetically distinct parasympathetic branches of the vagus nerve. (Porges. S 1995, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation)

The vagus nerve is the longest nerve in the body that directly connects our brain to our body. It runs from the medulla oblongata in the brain stem to the abdomen. 80% of the vagus nerve is made up of sensory fibers that connect to all major organs. It is the surveillance system of the body as it attempts to maintain our body in a state of dynamic homeostasis in the context of perceived cues of internal or external safety or threat. However, it is somewhat of a misnomer to speak of the vagus nerve in the singular as there are now identified two major phylogenetic distinct branches of the vagus nerve. The newer evolutionary branch that emerged with mammals is a myelinated ventral vagus complex which when engaged during healthy social engagement with others helps us calm from otherwise defensive fight/flight responses as our sympathetic nervous system is optimally activated for positive social interactions (e.g., curiosity, exploration, engagement and play).

The ventral portion of the vagus nerve, as cardioinhibitory neurons migrated from the dorsal motor nucleus in our transition from a-social reptiles to social mammals, became neuroanatomically linked and coordinated with five cranial nerves that together formed what is referred to as the ventral vagal complex (V, trigeminal; VII facial; IX glossopharyngeal; X vagus and XI Accessory, Porges, S 1995). The ventral vagus nerve complex (e.g., striated facial muscles/smiling, trigeminal nerve, middle ears muscles/listening, head turning and two visceromotor myelinated pathways one to the heart and one to the bronchi) emerged as part of our development or phylogenetic transition from asocial reptiles to social mammals. It basically provided the neuroanatomical and neurophysiological substrate for our capacity as mammals and particularly humans to nurture, socially engage and communicate with one another by down-regulating defenses in a hostile or unsafe world by beginning to co-regulate back and forth cues of safety via pair-bonding, eye-gaze, vocalizations and touch.

Now, sitting adjacent to the emergence of our newer myelinated ventral vagus is an older unmyelinated parasympathetic dorsal vagus nerve complex. This is where the vegetative or more primitive vagus connects to and regulates the organs below our heart or viscera. Under optimal conditions the dorsal vagus nerve helps us maintain a state of positive equilibrium or homeostasis, for example, when we are in a state of deep rest, such as peaceful sleep or being nurtured in the arms of a loved one. The latter can also be referred to as positive immobilization without defense.,

However, what was discovered at this time was that there was retained in all mammals a much more primitive parasympathetic dorsal vagal response which is a dominant feature in reptiles survival function in freeze or immobilization behavior and thus reducing metabolic functioning under threat but can be adaptively recruited as part of our own defensive shut-down system when we (or any other mammal) are in a state of imminent life threat or perceived defenselessness. This can also be activated when we are not under any “external threat” but in a state of extreme stress/and anxiety and can lead to adaptive states of dissociation or a death-feigning response as in passing out or feinting. In a worst-case scenario, there can be a dramatically reduced or complete cessation of the heart (bradycardia and apeneas).

All mammals' visual-facial, auditory-prosodic, tactile-gestural senses when engaged in an optimal positive and reassuring manner through co-regulated social reciprocal interactions with other conspecifics helps maintain healthy affective states of homeostasis. However, when our sympathetic nervous system is not recruited for secure positive engagement (e.g., positive excitement as in laughter and play or making love) and instead we are frightened or threatened, the more recent evolutionary evolved higher mammalian ventral vagus complex, which serves as a portal or conduit for our co-regulated social-emotional system (e.g., when we feel safe and register and assess for cues of safety with respect to, facial expressions, intonation of voices and well-meaning intent of others) literally goes offline (disinhibits our sympathetic-adrenal nervous system, endocrine release of cortisol, vasopressin and epinephrine) and becomes adaptively recruited for fight/flight responses, (e.g., “My environment is not safe or you are not safe to be around!”). However, if our earlier sympathetic nervous system of fight or flight defense responses are not available as a secondary line of adaptive defense, for example, when we feel (or any mammal feels) hopelessly trapped or perceives to be in a state of dire life-threat, then our most ancient and primitive function of our parasympathetic dorsal vagal complex becomes dominant, that is to say, recruited to our most primitive state of feint or freeze or psychopathological states of disassociation.

Basically, there were two major discoveries at this time that were brought to light with respect to how we should better conceptualize our central and autonomic nervous system. The first, as previously mentioned, detailed a phylogenetically distinct and more primitive unmyelinated parasympathetic vagus nerve pathway function that has been retained (or more accurately re-purposed) in all mammals. It is dominant in reptiles and regulates our earliest homeostatic functions, our viscera and metabolic activities, i.e., bodily temperature, breathing and ingestion and a reduced metabolic activity and a shutting down or immobilization when under perceived life threat. However, with phylogenetic (evolutionary) changes (during our transition from asocial reptiles to social mammals) this unmyelinated dorsal vagus nerve became functionally adjacent (ventral and lateral to the dorsal) with the emergence of a newer parasympathetic ventral vagus nerve complex. The latter essentially serving as an adaptive mammalian neural platform for social engagement (i.e., allowing for downregulating cues of defense, up-regulating cues of safety and co-regulated engagement, nurturance, vocalization/communication and play).

The emergence of the mammalian myelinated ventral vagus nerve complex signaled an evolutionary (phylogenetic) shift from the earliest unmyelinated parasympathetic reptilian metabolic shut down response of the dorsal vagus complex alongside the emergence of a sympathetic fight/flight defense system with the parasympathetic supradiaphragmatic or ventral regulation of our autonomic nervous system (e.g., gazing, grooming, smiling, vocalizations nurturance and play) reducing anxiety, stress and heart rate and increasing availability for engagement and was now understood as a single hierarchical and integrated social-emotional functioning system. In other words, from the simple regulation of homeostatic survival functions, e.g., sympathetic fight/flight or immobilization/freeze in down-regulating metabolic functions in reptiles to the now higher functioning of dyadic affective co-regulated social nurturance of mammals with their offspring (e.g., reassuring visual-facial, auditory-prosodic and tactile-gestural communication with conspecifics). These phylogenetically retained and hierarchical ordered features of an unmyelinated dorsal vagus complex regulating metabolic activities or under life threat recruited to reducing activity or shutting down to a state of feint or immobilization to a rapidly developing myelinated ventral vagus (social-engagement system) that took roughly 300 million years to evolve from our transition from reptiles to mammals rapidly develops in every newborn during the first year of life.

For example, every healthy newborn has a fully formed unmyelinated vagus, which performs the functions of breathing, sucking, swallowing and digestion but only a partially developed myelinated vagus, The latter process of myelination (thin sheath covering neurons which allows for more efficient and rapidly responsive neural connectivity, which begin to connect the subcortical, limbic hypothalamic pituitary adrenal axis and brain stem areas, to the developing executive functions of the infant and toddler brain) occurs over the first year. Beginning with the reflexive functioning of breathing, suckling, swallowing and vocalizations and rapidly develops during the first six months as the infant transitions from complete dependent agency to interactive interdependent agent with the mother (e.g., back and forth reciprocal facial affect, prosodic vocalizations, gestures and play with the parent). (myelination involves increased functional changes from corticoreticular to corticobulbar pathways or brain stem reflexive responses to increased higher cortical functioning)

The second critical discovery was that with a better understanding of these phylogenetic changes (i.e., a shift from the primitive reptilian unmyelinated dorsal vagus to the emergence of a mammalian myelinated ventral vagus) was a neurophysiological hierarchical re-conceptualization of our autonomic nervous system as, for example, a balance system formerly and universally depicted as below the neck chugging away and simply maintaining bodily homeostasis, was now seen as a single and adaptive phylogenetic hierarchically ordered social-emotional system. In other words, it was no longer viewed in a compartmentalized fashion or peripheral to the central nervous system but now understood as a single, bi-directional and integrated biopsychosocial system regulated by three distinct autonomic nervous system circuits (a sub-diaphragmatic parasympathetic dorsal vagus system, a sympathetic nervous system and supra-diaphragmatic parasympathetic nervous system). These autonomic nervous system circuits (our neocortex or our mammalian higher social thinking brain, our defensive fight, flight sympathetic-adrenal system and our brainstem or reptilian gut brain) were now seen not just as a balance system, parasympathetic good; sympathetic bad but also as an evolutionary hierarchical functionally system regulated by these two phylogenetically distinct parasympathetic vagus nerve pathways which adaptively shifts in accordance to sensed cues of perceived safety or danger.

The neural regulation of our socially adaptive autonomic nervous system by the same ventral vagus pathway that connects from the sinoatrial node or the cardiac pacemaker of the heart as a visceromotor pathway to form as a single column in the brain stem neuroanatomically linked with the cranial nerves of the the head, face, eyes, ears, larynx/pharynx, has not only helped our species and all mammals survive but thrive through caregiver/offspring practices (e.g., calm, exploration, nurturance and play - and the associated secreted hormones such as oxytocin, vasopressin dopamine and serotonin) and in the process help down regulate or inhibit defensive fear based fight/flight responses - and stress related hormones such as cortisol and vasopressin. Thus, we have

1) A newer and myelinated (more rapid, responsive and efficient) ventral vagus nerve with connections to the larynx, pharynx, middle ears, face and head (i.e., our social-emotional communication system) which evolved with the emergence of mammals, most developed in humans and serves as an inhibitor or down-regulator (a cardio-inhibitor or what is referred to as the “vagal brake”) of sympathetic-adrenal fight/flight responses (i.e., through social-emotional communication practices of deepening reciprocal attachment, co-affective regulation and play). However, when our higher social-emotional communication system and earlier defensive circuits fail (i.e., sympathetic fight/flight responses are not available as an option, as when faced with actual or perceived danger and we can neither fight or flee as we feel trapped) then our more ancient dorsal parasympathetic vagus nerve pathway is recruited, as our two other adaptive systems, one for calming, reassuring and co-regulating-through reciprocal social-emotional engagement and the other mobilized for defense (i.e., fight or flight) are circumvented. In other words, when our social visual-facial, auditory/prosodic, tactile/gestural co-regulated communications are no longer registered/perceived with others as “safe” and when our secondary line of defense, fight/flight are also not available to us then

2) Our most primitive unmyelinated vagus pathway, our phylogenetically retained reptilian feint, freeze or immobilization response is adaptively recruited. This can also take the form of moderate or severe forms of disassociation, as we see in various diagnoses of psychopathologies. We often see this with young children with developing emergent complex trauma histories, such as neglect and abuse, who register their immediate surroundings at any particular moment as extraordinarily unsafe resulting in extreme anxiety or panic and dissociation.

How Is This Relevant To Working with Children With Autism Spectrum and Other Biopsychosocial Developmental Challenges?

To recap, what was so importantly illuminated by Polyvagal Theory in the fields of embryology, neuroanatomy, neurophysiology and developmental psychology (esp. infant and child mental health and with individuals with a history of early trauma) were the neurophysiological and psychosocial (hence, biopsychosocial) foundations constituting the evolution of an early mammalian to the more fully developed human social-emotional engagement system that enabled all mammals not only to survive but thrive with respect to registering and perceiving instinctual bodily-emotional based sensed cues of safety. or threat with respect to other’ movements and vocalization, communication and nurturance with their conspecifics. The latter has been defined by the term. “Neuroception.”

This is the near instantaneity of registered cues of safety or danger (i.e., approach or withdrawal behaviors) outside the body or between us and others outside our general conscious awareness) and “Interoception” (the complimentary counterpart to Neuroception) or what we register inside our body (e.g., quesy, anxious, unsettled). Neuroception which is largely situated in the temporal-parietal junction and the superior temporal sulcus and fusiform face area directly connects with our autonomic nervous system. It assesses biological movements with respect to cues of safety or danger in 30 milliseconds. (our central nervous system and autonomic nervous system is a bi-directional bottom-up/top-down single system.)

These rapid neuroceptive and viscerally registered cues consist of warm reassuring face to face and auditory-prosodic, tactile-gestural cues (i.e., “It is ‘safe to come close.”) or conversely immediate and perceived cues of threat resulting in fight or flight or freeze (i.e., "It is not safe to come close and I have to flee or freeze and dissociate”). This represented a huge paradigm shift that had tremendous implications for the fields of psychoanalysis, dyadic developmental psychotherapy, family systems theory and infant and child mental health, especially in the treatment of patients with trauma histories ( i.e., insecure anxious-avoidant, dismissive and disorganized attachment, neglect and abuse). However, it also represented a major paradigm shift in understanding and treating children with biological constitutional challenges such as autism spectrum disorder.

During emotional-bodily based, pleasurable back and forth co-regulated/communications in infant/toddler/ parent interactions; visual-facial, auditory-prosodic, tactile-gestural interactions forms the basis of healthy secure based attachment and attunement, which provides the substrate or foundation for the emergence and expansion of ideation (e.g., simple to complex with respect to the ability for the child to symbolize, hold and play with ideas) and social-pragmatic communication/language. For example, what occurs during healthy dyadic secure child/parent engagement/interactions is child/parent auditory attunement, sympathetic mobilization for play/up-regulation of joy and correspondingly parasympathetic rest and restoration.

Or conversely, what we see during insecure avoidant and dismissive attachment are an array of psychopathologies with respect to adaptive sympathetic-adrenal fight/flight responses (e.g., aversion of eye-gaze or aversion from comfortable multi-shifting frames of reciprocal eye contact; increased flat facial affect and auditory disengagement to the normal high-frequency range of human vocalization/language and more vigilance to lower range frequency or predator sounds). In cases of moderate to severe neglect and abuse, a potential life threat response can be activated where our more primitive parasympathetic dorsal vagus nerve is adaptively recruited for withdrawal/shutdown or freeze response.

Again, it is critical to bear in mind the adaptive bi-directional functional integration of our central stress response system (limbic hypothalamus. pituitary, adrenal axis, LHPA) which bi-directionally connects with our autonomic nervous system (the ventral vagus and the dorsal vagus) and at each and every moment regulates our affective arousal (mood) states during positive or negative affect social-emotional engagement (observed emergent behaviors, such as calm and availability for engagement; aggression or fight/flight responses or shutdown/freeze responses or dissociation). withdrawal). With regards to our neuroendocrine system or HPA axis this includes alongside the activation of our ventral vagus complex, our mammalian social-emotional autonomic nervous system with the down-regulating of sympathetic-adrenal stress flight, fight responses an accompanied reduction of stress related hormones, such as testosterone, epinephrine, vasopressin, dynorphin and cortisol or conversely a positive increase in hormones, such as dopamine, endorphins, serotonin and oxytocin. As previously indicated, as an integral part of our neurophysiological regulation and neuroanatomy, it can be further viewed and understood with respect to our most primitive wired connections in terms of the seven core part affective instinctual drive system (e.g., seeking, nurturance, lust, fear, rage panic/anxiety and play). See, Panksepp, J, 1994 Affective Neuroscience.

We can clearly see with children with constitutional challenges beginning in utero, for example, immune or endocrine system compromises by the mother’s exposure during pregnancy to neurotoxins that can result in an array of heterogeneous affect neurodevelopmental challenges, such as autism spectrum or related developmental challenges. Now, what needs to be clearly understood is that children who present with such comorbid constitutional histories similarly present with disproportionate physiological state regulation challenges, autonomic fight/flight or withdrawal/freeze responses, as we separately see with individuals with unhealthy attachment histories and subsequently with complex post-traumatic stress. Many identical overactive subcortical regions and associated physiological state regulation (i.e., individuals with ASD and complex PTSD) have been found although with differing origins and etiologies to be similarly and adversely affected (e.g., right anterior cingulate cortex, hippocampus, right orbital prefrontal cortex, and the right dorsolateral limbic hypothalamus pituitary adrenal axis, our central stress response system). As previously mentioned (in both ASD and complex PTSD) this neurophysiologically results in rapid and adaptive shifts depending upon the individual’s sense of perceived safety, not safety or perceived or actual life-threat

Separately, it is important to note, autism spectrum challenges are not typically accompanied (contrary to decades of persistent myth) by primary cognitive skills and expressive/verbal language deficit. These are second tier symptomatology. The primary core challenges are the earlier preverbal affective-regulatory based challenges in maintaining a continuous flow of simple to complex back and forth social-emotional engagement. The child’s behaviors (typical or non-neurotypical) are always adaptive and emerging properties reflecting the child’s physiological state regulation organized by perceived cues of safety vs. non-safety. Also, as previously noted, this is further exacerbated by sensory over, under or mixed responsivities across one or more primary sensory domains and expressed in terms of autonomic fight, flight or freeze/withdrawal responses during interactions with others.

This is internally (interoceptively) registered/felt by the child (or adult) as unsafe to engage or maintain typical social-emotional reciprocal engagement. Therefore, what then too often appears upon initial clinical assessment of the child as, “deficits across cognitive and functional social-pragmatic language domains" (comorbidities once accounted for put aside), are actually being driven (80% bottom/up) by the child's physiological state (e.g., overactive right brain subcortical circuits LHPA axis into our autonomic sympathetic and parasympathetic nervous system which dynamically, bi-directionally connects with higher cortical functions and adaptively manifests in terms of safe to engage and access to executive functioning or fight. flight or withdrawal/dissociated responses.

To put it simply, the child or older does not feel safe with others and surroundings and thus finds it immensely difficult to maintain a continuous flow of social-emotional co-regulated affective interactions, which includes because of that child hypervigilant or hypoactive state to distinguish or filter out background noise (e.g., low frequency sounds which signals on an ancient primitive level threat or predator) from the rhythm, modulation and pitch of the bandwidth of human voices. Thus, the unavailability of the child's executive functioning (i.e., successive ideation, planning and sequencing of actions and emergence of expressive language) is actually in fact not due to (what appears to be upon most educational and psychological assessments) primary cognitive and language deficits but rather the child's adaptive physiological state regulation resulting in a phylogenetic shift to the recruited responses of the child's earlier dominating subcortical limbic regions (i.e., fight, flight or withdrawal/freeze) which then acts to inhibit or suppress executive functioning (e.g., organizing, planning and sequencing) including both receptive and expressive communication/language.

Again, although, in neurodevelopmental challenges, such as autism spectrum challenges, we can clearly identify or strongly indicate a separate set of constitutional factors (e.g., enlargement of the amygdala, reduced brain volume; including reduced volume of specific neurons in the anterior cingulate and over connectivity and underconnectivity of particular regions; see Schore 2014} resulting in neurophysiological traumatic stress,, what should be understood is that irrespective of insecure avoidant or disorganized attachment, i.e., neglect and abuse, or separately, atypical biological/ constitutional challenges that begin in utero and can later result in a diagnosis of autism spectrum disorder, we often nonetheless see very similar downstream biopsychosocial etiologies.

For example, vagus nerve auditory attunement or auditory shut down with respect to being able to register the full normative prosodic range of human voices; reduced functional-emotional expressive use of facial, bodily gestural reciprocity or a flat affect and the ability or challenges in optimally regulating the laryngeal and pharyngeal muscles required for vocalization, including the receptive and expressive varied inflected emotional or prosodic elements of speech which comprises 93% of spoken language. A. Schore 2014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184129/

A new understanding of the evolutionary significance of this highly myelinated vagus branch (e.g., striated facial, middle ear, ocular, vocalization) represented a huge paradigm shift towards a much more nuanced understanding of how social-emotional engagement came to serve a new and hierarchical transformational role in regulating our social-emotional engagement capacity or lack of accessibility. As stated previously unfolds in a phylogenetic hierarchy beginning with the evolution of the earliest parasympathetic metabolic shut down, feigned death or immobilization response in the reptilian brain to the fight/flight and newer and more myelinated parasympathetic vagus response (rest and restoration) in the mammalian brain and how each of these features are hierarchical structured (primitive, limbic, neocortex) in our own phylogeny and either optimally regulated (e.g., calm, well-regulated deepening back and-forth social-emotional engagement, including complex ideation and expressive language - that is core human executive functioning) or circumvented and recruited to primitive or regressive functioning (e.g., fight, flight or withdrawal/immobilization) by these two contiguous but evolutionary distinct parasympathetic vagus nerve pathways.

All of the above is extraordinarily important to understand in order to transform our deleterious educational systems to our therapeutic practices, from birth through the lifespan, with respect to understanding a child’s, “behaviors” not in the antiquated, simplistic sense as “willful” or “appropriate versus inappropriate behaviors” or “poorly learned coping mechanisms” which can be modified vis a vis operant conditioning (e.g., changing a set of antecedents and/or modifying a set of consequences) through applied schedules of reinforcement. “Behaviors", as now understood from a biopsychosocial perspective (and a paradigm shift which has emerged) are not about reinforcing in the child a new set of robotically trained responses (the view of the child as tabula rasa) but are now understood as adaptive and emergent properties directly connected to the child’s state regulation (primitive limbic, brain stem and socially evolved interconnected autonomic nervous systems). Hence, the absolute necessity to understand “behaviors”, first and foremost as adaptive shifts in physiological state regulation which are instantaneously (i.e., neuroceptively, beneath conscious awareness) recruited in accordance to our perceived “feelings of safety with others” or in various states of defense (i.e., fight, flight and withdrawal).

Hence, the emergent properties of our evolved mammalian visual-facial, auditory-prosodic, tactile-gestural and olfactory faculties do not fall under the absurdities of learned training, reinforced environmental contingencies, memorization or antecedent conditioning. Of course, indeed one can train a child to, "Look at me" through repetitive drilling and the adult reinforcement by deploying an automaton disbursement of carrots and sticks. However, what you cannot do and seems to elude the behaviorists thinking, you cannot train a child in rapid shifts of pleasurable affective co-referencing. Engagement is an affectively-driven, intersubjective and dynamic relational based process. It is not a series of discrete acts performed on cue, which is then simply stored and dedicated to memorized or declarative recall (e.g., Child: "I do' X' in 'X' situation). Biopsychosocial growth, learning and development are never a trained or general recitation of parsed out, circumscribed or selectively identified cognitive tasks (e.g. identifying colors, letters, numbers and shapes, labeling pictures or signifiers and actions or, in accordance to the absurdities of the verbal behavior school of thought, chopping up and deconstructing language into tacts, mands echoic and intraverbals). Hence, the continued to be widely emphasized mechanist- reductionist absurd and, dare we say, diseased interpretation at this point in time (e.g., in our societal educational and psychosocial dynamic practices) in contrast to what we now conclusively know from the perspective of Developmental Affect Neuroscience and imaging studies with respect to how All children learn, grow and develop and how the earlier to later parts of the brain become available and are connected, not just maturationally or automatically, but epigenetically through moment to moment rich child/parent dynamic affective( emotional) interactions is not just simply wrong but destructive!

Its persistence nonetheless, continues to be egregiously portrayed by a never ending onslaught of educators and behaviorists . For example, we commonly and readily see this on a daily basis when we talk about the child on the spectrum with his/her avoidance of eye contact, touching inappropriately and not following directions. The latter are essentially all equated as “non-compliant” or “inappropriate behaviors” which can be systematically and readily modified through ABA methodologies with its applied schedules of behavioral reinforcement and rote memorization of the child. Rather, “behaviors” again are an integral part of the child’s underlying neurobiological foundations (i.e., socially adaptive autonomic nervous system functioning) and are facilitated through healthy and reassuring social-emotional psychobiologically attuned nurturing relationships from birth and throughout the lifespan.

In that regard, it should be noted that systematic and comprehensive developmentally oriented biopsychosocial approaches, such as DIR/Floortime, is a highly-structured affect-developmental process of wooing the child into engagement, whereas ABA methodologies (more or less) is a process of essentially using various metaphorical hammers and chisels from the outside (i.e. Learning Theory) to sculpt the child into forms of compliance in order to largely produce for testing conformity to a generic status quo and funding purposes a checklist of verifiable and essentially emotionally bankrupt results.

See, Porges, S. 1995. The Polyvagal Theory).*  Dr. Stephen Porges: 2014 Human Nature and Early Experience https://www.youtube.com/watch?v=SRTkkYjQ_HU Porges, S. 2009 The Polyvagal Theory: New Insights of Adaptive Actions of the Autonomic Nervous System https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108032/ S. Porges, S. Furman 2011 The Early Development of the Autonomic Nervous System Provides a Neural Platform for Social Behavior, A Polyvagal Perspecive. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079208/2002 The Vagus: A Mediator of Physiologic and Behavioral Features Associated with Autism https://7296bf3b-bc0e-449f-a441-30606dc45d47.filesusr.com/ugd/5504d5_587eee4489574db99ec606336308a02c.pdf

Regarding stress-activation systems in children and adolescents, see, Rothenberg; McGrath, 2016 , Inter-Relation Between Autonomic and HPA Axis Activity in Children And Adolescents https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731846/

Neurotypical Development, The Maturation Of Our Social-Emotional Brain:  In Utero Through Year Three

The neuroscientific evidence over the last several decades clearly demonstrates a direct correlation between forming healthy neuronal patterns of connectivity and child/primary caregiver nurturance based practices (and as noted brain stem and autonomic nervous system regulation): The nature of child/caregiver deepening affect reciprocal attachment and complex two-way reciprocal emotional problem solving (e.g., back and forth co-referencing with visual-facial, auditory prosodic and tactile gestural exchanges) with respect to building the right hemispheric emotional foundations of the child's healthy core "sense of self" and correspondingly the child's intact, integrated and healthy emerging developmental capacities (i.e., social-emotional relating, thinking and social pragmatic communication) have been well established in the fields of attachment theory, Interpersonal neurobiology, Infant and child mental health, developmental psychotherapy and psychoanalysis.

Since the 1990's this has been corroborated by extensive neuroscientific research that clearly demonstrates that the healthy integration of each infant's sensory and motor connections and how these inchoate connections beginning in infancy turn on or off gene expression, produce proteins and form into complex synaptic patterns (the maturation of the wiring of the subcortical and prefrontal areas) including the maintenance of healthy vagal tone (i.e., respiratory sinus arrhythmia as a dynamic measure of heart rate variability of the nucleus ambiguous). This is directly dependent upon highly emotionally attuned and responsive primary caregiver interactions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318551/ 

For the seminal ground breaking work that began to transform neuroanatomy, neurobiology, early infant child mental health, psychoanalysis, family law and Developmental psychology into a new understanding and synthesis, an over-arching theoretical framework and a new foundation for Affect Developmental evidenced based treatment practice see, Schore, Allan, 1994, Affect Regulation and the Origin of Self: The Neurobiology of Emotional Development.

Absolutely brilliant presentations by Allan Schore, 2017, The First 1000 Days of Life: A Critical Period For Shaping Our Emotional Selves and Brains: https://www.youtube.com/watch?v=lY7XOu0yi-E&t=6s

Allan Schore, 2017, The Development Of The Right Brain Across the Lifespan. What’s Love Got to do With It? https://www.youtube.com/watch?v=u_B6WekX75s&t=5030s

The understanding of this fundamental and highly nuanced child/primary caregiver dyadic, triadic and multi-social framework (indeed, if we look at the extended family system) can be correctly conceived of in terms of a significant paradigm shift or the bridging of the fields of Developmental psychology and neurobiology with respect to a new and comprehensive understanding of formerly compartmentalized biological, psychological-and-social components. This critically encompasses the relationship (epigenetic factors) of early infant/toddler/primary caregiver secure or insecure attachment practices that significantly determines the trajectory of what and when genes turn on and off, produce proteins and form and maintain healthy or unhealthy synaptic formation and interconnectivity (what internationally renowned attachment researcher and psychiatrist, Dr. Dan Siegal defined as,, “Interpersonal Neurobiology”).

Justifiably, this is now conceptualized as the underlying foundation of developmental social pragmatic evidenced based treatment practices, such as DIR/Floortime, with respect to understanding and guiding primary caregivers in facilitating and maintaining healthy dyadic affect reciprocal emotional relationships in early infant and childhood mental health as well as treating children with autism spectrum challenges. The latter is a fundamental move away from the past traditional cognitive dissonance of brain treated apart from body (e.g., the continuing traditional educational practices of treating cognitive, language, arousal, autonomic and sensory motor functions as separate components or as in applied behavioral analysis (ABA), a focus on targeting “selective behaviors and tasks ”) toward a truly integrated biopsychosocial mind-brain-body approach in accordance to the last twenty-five years of research in Developmental Affect Neuroscience.

Due to the advances in PET scams over the last twenty-five years we can now more accurately measure our data (i.e., adult-child inter-brain communications and how the subcortical and cortical areas of the brain in infant and toddler development epigenetically begin to form in real-time. We can specifically show a direct correlation between epigenetic connections (e.g., how subcortical to prefrontal neural connections are formed in real-time) during healthy child/caregiver nurturance or conversely impaired neuronal activity due to unhealthy nurturance practices. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968319/  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181066

I have provided at the end of this section several additional links to some audio and video discussions for families and clinicians working in the field on what actually constitutes the healthy affective basis of childhood development (i.e., the roots of emotional intelligence). Now, given a child's healthy underlying biological and immune system, the perennial question prior to 1990's was, "What is it that brings the early developing parts of the infant's brain (primitive reflexes, senses and emotions: heart rate variability, breathing, blinking, sensations to sense of touch warmth; auditory, soothing or alarming voice, vision, etc.) into organized and meaningful affective patterns of simple reciprocal co-regulated engagement (optimal arousal for attending, relating and engaging)?" The answer given by Developmental affect neuroscience is the co-regulated partner(s) or "adult higher brain(s)" (the primary caregivers) with the prenatal and postnatal newly forming brain of the child. This is the foundational social-emotional symbiotic relationship absolutely critical for all infant/toddler social-emotional-cognitive and expressive language development.

Again, what is required to bring the emerging "social brain" of the infant/toddler online with respect to basic executive functioning from simple to increasingly complex engagement with others (e.g., regulated/co-regulated sensory-affect-motor ideation, sequencing and engagement) is the more experienced or higher brain of the primary caregiver or more specifically the child/primary caregiver dyad,  Every human infant is born with approximately 84 billion neurons. The human infant is born biologically equipped with a set of basic reflexes. senses and primitive emotional responses. However, the vast majority of neurons that will form into synapses hooking up these complex neuronal pathways (sensory-affect-motor) while intact are highly malleable and only loosely interconnected at birth and only begin to increasingly coalesce into complex neural networks during the first year of life.

The brain is experience-user/interdependent. The strength of the connectivity and resiliency of the brain's foundations (primitive, limbic and neocortex) are directly co-determined or co-regulated by the "higher brain" of the parent or the child/primary caregiver dyad. This necessitates for optimal integration and resiliency secure based attachment, attunement and reciprocal back and forth emotional social engagement (e.g., beginning from birth with the simplest wooing/pleasurable back and forth emotional signaling between parent and child, connecting, breaking and re-connecting child/parent affect-facial expressions, smiles, frown, grimaces; games as simple as "peek-a-boo", etc.), all of which help co-structure for the child internally well-regulated biopsychosocial patterns with respect to his/her physiological state regulation and increased executive functioning.

Again, this must begin with healthy child/parent dyad of secure based attachment and deepening expanded attunement by up-regulating joyful states through play and down-regulating stressful states through soothing. The latter creates the interpersonal neurobiological foundations for increased optimally regulated and not just malleable (which all brain pathways are) but resilient complex emotional signaling (e.g., co-emotional gestures, primitive co-prosodic vocalizations, sensory integration, simple to expanded ideation and social-pragmatic expressive language).

The following absolutely brilliant presentation addresses the emotional basis of attachment, affect regulation and cognition, which biopsychosocially exponentially forms during the last trimester into the end of the second to third year of life and which constitutes the unfolding nature and degree of empathy and resiliency of the primary Functional-Emotional Developmental milestones beginning in infancy throughout the lifespan.

Dr. Allan Schore, Modern Attachment Theory: The Enduring Impact of Early Right Brain Development on Affect Regulation, 2012 . https://www.youtube.com/watch?v=c0sKY86Qmzo

Dr. Allan Schore, The Neurobiology And Neuroendocrinology Of Boys At Risk, 2017. https://www.youtube.com/watch?v=P451kiWSBic&t=12s

2018, Dr. David Willis, Reflections on Dr. Allan Schore’s presentation above: https://www.youtube.com/watch?v=qkJe1dwmbM4

Dr. Allan Schore: The Neurobiology of Attachment, 2013 (brief clip on explanation of Nurture and Nature; Parent/Child interactive regulation which is crucial in turning on genes to produce proteins which help construct and maintain healthy synaptic growth and development.)

https://www.youtube.com/watch?v=0RGWjs7SIfw

Autism Spectrum And Related Biological-Psychological-Social Developmental Challenges.

What has been far too long ignored in practice by special educators and other clinicians working with children with autism spectrum and other related challenges and too often if at all conveyed to parents (e.g., at the start of early intervention) is the neuroscientific evidence that it is precisely these same principles of healthy nurturance based practices - necessary and indeed critical for each child's core functional emotional developmental milestones (i.e., calm, attentiveness, co-regulated patterns of back and forth emotional regulation, playfulness, ideation) when applied in a therapeutic context (i.e., adjusted or tailored to each child's functional emotional developmental and processing biological based constitutional challenges) that does in fact significantly help rebuild and strengthen new healthy integrated neuronal pathways in the brain.

Because of the paradigmatic shift in our understanding the immense and critical role of epigenetics (synaptic growth and structuring of the autonomic nervous system as experience dependent), the field of psychology and treatment both in autism spectrum and other related typical and non-neurotypical challenges has now shifted from attachment theory as as an ethological-behavioral theory in the 1960's to cognitive theory 1980's/90's to now affect-based regulation theory or an understanding of the critical role of the emotions, particularly in infant/mother dyads but throughout the lifespan.

Guided pleasurable and affectively engaging relationships not just with infants and toddlers but with older children with mild to more involved autism spectrum challenges (due to the brain's enormous neuroplasticity) can not only help facilitate but again as the neuroscientific evidence clearly demonstrates actually re-wire the brain, that is build, strengthen and expand healthy neural pathways (e.g., improved connectivity between the prefrontal cortex and subcortical functioning and overall integrated sensory-affect-motor functioning - where simple to complex social-emotional affective engagement and pragmatic language development, beginning from the emotional right subcortical to linguistic left prefrontal cortex can begin to re-build and strengthen synaptic connections). An expanding database of evidence over the last decade on neuroplasticity is increasingly demonstrating the ability for individuals to re-construct new neuronal connections throughout the lifespan.  

The following is an extremely enlightening discussion with regards to much of what I have discussed above with Dr. Stuart Shanker, Distinguished Research Professor of Philosophy and Psychology at York University, entitled Babies, Brain, Nature and Nurture.

https://www.youtube.com/watch?v=5bi6x-4aNmM

Stuart Shanker 2016, Todd Ouida Children Foundation Conference, Attuning The Mind Body Spirit, Recognizing Stress and Protecting the Spirit in Infants, Toddlers and Children.

https://www.youtube.com/watch?v=vXNWYoKuVS8

Below is a presentation by Dr. Beatrice Bebee, world renowned attachment researcher and psychoanalyst. This includes a video second to second microanalysis of the mother/infant dyad with respect to co-creating the earliest foundations for deepening emotional reciprocal attachment and attunement that engenders secure attachment or insecure ambivalent and insecure disorganized attachment and thus setting the Developmental, emotional-cognitive and linguistic trajectories throughout the lifespan https://www.youtube.com/watch?v=0yVU2lmlMdk

American Academy of Pediatrics, August 2018 Clinical Report on Play http://pediatrics.aappublications.org/content/early/2018/08/16/peds.2018-2058

The following is a brief but essential overview of the six core strengths necessary for healthy child development by Dr. Bruce Perry, American psychiatrist, currently the Senior Fellow of the Child Trauma Academy in Houston, Texas and an Adjunct Professor of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine in Chicago, Illinois,

https://www.youtube.com/watch?v=skaYWKC6iD4

The Root of Empathy Symposium: 2017 . Dr. Bruce Perry, Born For Love: Why Empathy Is Essential And Endangered

https://www.youtube.com/watch?v=5gU1wXbs5mc&t=9s

The following is an extraordinarily important video clip with regards to a well-known experiment by internationally acclaimed, Developmental psychologist, Edward Tronick, Director of Child Development Unity and Distinguished Professor at University Massachusetts, Boston. He is a research associate in Newborn Medicine, a lecturer at Harvard Medical School. He is well known for his research on infant/child caregiver dyadic attachment and what transpires when that emotional connection is disrupted or withdrawn: The Still Face Paradigm:

 https://www.youtube.com/watch?v=bG89Qxw30BM

https://www.youtube.com/watch?v=apzXGEbZht0

The following video clip, "Attunement and Why It Matters", by David E. Arrendondo, M.D., briefly illustrates what happens between infant/primary caregiver with respect to neuronal connectivity and attunement during deepening reciprocal attachment and emerging co-emotional signaling.

https://www.youtube.com/watch?v=UHYaF8EHzVw

Below is one of the most important seminal papers written in 2004 by the late Stanley Greenspan, M.D. and co-founder of DIR/Floortime with respect to the role of affect (or the emotions) constituting typical and non-typical developmental pathways. It is absolutely critical reading: "Developmental Pathways To and From Autism: The Role of Emotions in the Core Deficit in Autistic Spectrum Disorders-- The Affect Diathesis Hypothesis."

https://drive.google.com/file/d/0B4eYdf4hpBzyRi12eWp5OWx5NE0/view

Below are two very brief video clip introductions on the "Mirror Neuron System", by Dr. Dan Siegal, Distinguished Fellow of the American Psychiatric Association and is the Executive Director of the Mindsight Institute. Founding Co-Director of the UCLA Mindful Awareness Research Center. He serves as the Medical Director of the Lifespan Learning Institute. The mirror neuron system is largely regarded as challenged with many individuals diagnosed with ASD. It is part of the brain directly responsible for the ability of individuals to empathically identify, register, interpret, understand and predict the "intentionality" of another's action or what has been traditionally referred to as "Theory of Mind." 

https://www.youtube.com/watch?v=24fITRNWh1k&list=PLDCtwyPSjhlNEz4xuzxt6Tdsnyt2vChiB&index=8

https://www.youtube.com/watch?v=Tq1-ZxV9Dc4&list=PLDCtwyPSjhlNEz4xuzxt6Tdsnyt2vChiB&index=7

Dr. Dan Siegal presents below an in-depth discussion on interpersonal neurobiology, "The Neurological Basis of Behavior, the Mind, the Brain and Human Relationships." 

https://www.youtube.com/watch?v=B7kBgaZLHaA

***Dr. Dan Siegal, Roots of Empathy: Research Symposium, 2016. An Interpersonal Neurobiology Approach to Resilience and the Development of Empathy.

https://www.youtube.com/watch?v=2dmX6XBZ1GY

Dr. Allan Schore: 2014 The Most Important Years of Our Life: Our Beginnings https://www.youtube.com/watch?v=KW-S4cyEFCc&t=752s

Dr. Allan Schore. Roors of Empathy: Research Symposium, 2016.: Modern Attachment: The impact of Right Brain Development on Affect Regulation

https://www.youtube.com/watch?v=c0sKY86Qmzo

*The Polyvagal theory first introduced by Stephen Porges, M.D., in 1995 provided a new and transformative neuroanatomical and neurophysiological understanding of our autonomic nervous system with respect to our central nervous system as not peripheral but as a single integrated socially adaptive system, regulated by two phylogenetic branches of the vagus, one an older unmyelinated parasympathetic vagus nerve dominant in reptiles (i.e., breathing, ingesting and shut down/immobilization under threat) and a newer myelinated parasympathetic vagus nerve that emerged in our evolutionary transition from reptiles to mammals. (i.e., our social engagement system, which is connected by visceromotor pathways from the sinoatrial node of the heart or the central pacemaker of the heart and the bronchi that forms as a single column in the brain stem to the striated facial muscles, auditory system and vocal system)

The Polyvagal Theory, 2009: New insights into the adaptive reactions of the autonomic nervous system, Stephen W, Porges, M.D.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108032/

The Polyvagal Perspective, 2007, Stephen Porges, M.D.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868418/

Steven Porges, M.D., Human Nature and Early Experience (an in-depth discussion on the neurophysiological correlates that constitute the foundation for a biopsychosocial understanding on how typical and non-typical infants begin to learn, grow and thrive.)

 https://www.youtube.com/watch?v=SRTkkYjQ_HU

Stephen Porges, MD., The Neuroscience and the Power of Safe Relationships                

https://www.youtube.com/watch?v=3pbVTla932Y

Stephen Porges, M.D., Polyvagal Theory: Co-Regulation in Therapy

https://www.youtube.com/watch?v=ivLEAlhBHPM

Stephen Porges, M.D.,, "The Polyvagal Theory."

https://www.youtube.com/watch?v=8tz146HQotY   

Stephen Porges, M.D., 2011, Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation.

https://books.google.com/books?hl=en&lr=&id=0-nxBGHj36oC&oi=fnd&pg=PR9&dq=definition+neurobiology+and+neurophysiology&ots=tfqEfhr6hn&sig=dzaQxjEPy9u4bY_wDZ2PCB_HyYg#v=onepage&q=definition%20neurobiology%20and%20neurophysiology&f=false

Dr. Stephen Porges: Discussion on "Misophonia."

https://www.youtube.com/watch?v=nB3nS4Gh_9k&t=7s

Colwyn Trevarthen, 2014 Pathways to Child Flourishing: The Love of Special Companions and the Importance Of Play. What is it Being Human and How Can It Survive?

https://www.youtube.com/watch?v=IYXAU2Bvfbw

Daniel Stern, 2010, A Developmental Perspective From Birth On. (a discussion on the synthesis of psychoanalysis and the developmental model)

https://www.youtube.com/watch?v=N_j4q45GHDY

Dr. Stuart Shanker: Self-Regulation: Roots of Empathy Symposium 2014

https://www.youtube.com/watch?v=84GHcfzXsmw

*General Psychiatry: published. online 2018, Oct. 31: Factors Associated with Parent Engagement in DIR/Floortime Treatment of Children with Autism Spectrum Disorder:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234967/

**The following is an extremely important link for all primary caregivers and clinicians with respect to advocacy for their children, intervention guidance, ,public policy, insurance coverage and the adjoining supportive research evidence for a comprehensive Developmental Relationship based approach such as DIR/Floortime, as well as included are answers to common questions from families on ABA which is distortedly presented as the only evidenced-based treatment approach for children with ASD and related challenges.

http://www.icdl.com/advocacy