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 THE JOURNAL OF DEVELOPMENTAL PROCESSES

Volume 3, Issue 1 Spring 2008

CONTENTS

Editorial: Igniting the Spark: High Tech High and Beyond—Barbara J. King 1

Still-Face Paradigm for Young Children:

21/2 year-old Children’s Reactions to Maternal Unavailability during the Still-Face—
M. Katherine Weinberg, Marjorie Beeghly, Karen L. Olson, and Ed Tronick 4

JDP Forum

In Search of the Pathways that Lead to Mentally Healthy Children—

Stuart G. Shanker 22

Dynamic Systems Theory and the Promotion of Children’s Mental Health—

Erika S. Lunkenheimer 34

Contemporary Perspectives on Facilitating Language Acquisition for Children

on the Autistic Spectrum: Engaging the Parent and the Child—
Susan Longtin and Sima Gerber 38

Differential Treatment of Toddlers with Sensory Processing Disorders in

Relation to Their Temperament and Sensory Profile—
Pnina S. Klein, Renat Laish-Mishali, and Nurit Jaegermann 52

Book Essays

Bipolar Children: Cutting-Edge Controversy, Insights, and Research—

Ira Glovinsky 60

Dangerous and Daring Books for Boys and Girls: Artifacts of the
Changing State of Childhood—
Dorothy Justus Sluss 66

Bethesda, Maryland Copyright © 2008

 The Journal of Developmental Processes
Editor-in-Chief
Stanley I. Greenspan
Chairman, Interdisciplinary Council for Developmental and Learning Disorders
Departments of Psychiatry, Behavioral Sciences, and Pediatrics
George Washington University Medical School
Washington, DC, USA
StanleyGreenspanMD@comcast.net

Editor Associate Editor

Barbara J. King Ira Glovinsky
Department of Anthropology The Interdisciplinary Center for the Family
College of William and Mary West Bloomfield, Michigan, USA
Williamsburg, Virginia, USA ira1834@sbcglobal.net
bjking@wm.edu
Administrative Editor
Jane Mild LaRoque
Associate Editor-in-Chief
Lexington, Massachusetts, USA
Serena Wieder
jmlaroque@rcn.com
Interdisciplinary Council on Developmental
and Learning Disorders Editorial Assistant
Bethesda, Maryland, USA Jennifer Camp
swieder@erols.com College of William and Mary
Williamsburg, Virginia, USA
jdpstaff@gmail.com

JDP Editorial Board

Margaret Bauman Robert Lickliter

The Ladders Program Department of Psychology
Harvard University Florida International University
Wellesley, Massachusetts, USA Miami, Florida, USA
Leon Cytryn Pedro Reygadas
Departments of Psychiatry, Behavioral Sciences, Department of Anthropology
and Pediatrics El Colegio de San Luis
George Washington University San Luis Potosí, Mexico
Washington, DC, USA Ricki G. Robinson
Alan Fogel Descanso Medical Center for Development
Department of Psychology & Learning
University of Utah University of Southern California
Salt Lake City, Utah, USA La Canada, California, USA
Gil Foley Rebecca Shahmoon Shanok
Department of Psychology Jewish Board of Family Services
Ferkauf Graduate School Child Development Center
Yeshiva University New York, New York, USA
Bronx, New York, USA Stuart Shanker
Sima Gerber Department of Philosophy and Psychology
Department of Linguistics and Communication Disorders The Milton and Ethel Harris Research
Queens College, CUNY Initiative
Flushing, New York, USA York University
Toronto, Canada
Morton Ann Gernsbacher
Department of Psychology Barbara Smuts
University of Wisconsin-Madison Department of Psychology
Madison, Wisconsin, USA University of Michigan
Ann Arbor, Michigan, USA
Barbara Kalmanson
Clinical Psychologist Richard Solomon
San Francisco, California, USA Ann Arbor Center for Developmental
and Behavioral Pediatrics
Pnina Klein
Ann Arbor, Michigan
School of Education
Bar-Ilan University Christina Toren
Ramat-Gan, Israel School of Social Anthropology
University of St. Andrews
Marc Lewis
St. Andrews, Scotland
Department of Human Development and Applied Psychology
University of Toronto
Canada

The Journal gratefully acknowledges the financial support of the Milton and Ethel Harris Research Initiative (MEHRI),York University, Toronto,
Canada. For more information, please see www.MEHRI.com.
Editorial:
Igniting the Spark: High Tech High and Beyond
Barbara J. King
Department of Anthropology
College of William and Mary
bjking@wm.edu
Often in these pages I write about a book, or a newspaper
or magazine article that makes me think differently about
children, or the intertwining of biology and culture, or the
connection among all species in the natural world. I love
doing that: the vast and deep sea of human experience
captured in fiction or journalism so often reflects aspects
of our scientific interest in developmental processes. This
time, I want to tell you about two books that are steeped
in science in a double-edged and unique way.
Perspectives of San Diego Bay: A Field Guide and
San Diego Bay: A Story of Exploitation and Restoration
are remarkable volumes. The cover of each proclaims the
authors to be “the students of Gary and Jerri-Ann Jacobs
High Tech High” (HTH). According to its website, “High
Tech High began in 2000 as a single charter high school
launched by a coalition of San Diego business leaders
and educators,” and has since expanded.
The story of these books shows what happens when
the spark of engagement and empowerment is brought to
young people. The whole thing started, in a way, with
Jane Goodall, the world-famous chimpanzee researcher.
Years ago, Goodall founded Roots & Shoots, which, as
she puts it in the field guide’s foreword, is a “conserva-
tion and humanitarian education program for youth.” The
Roots & Shoots students at HTH, led by teachers Jay
Vavra, Tom Fehrenbacher, and Rodrigo Buenviaje, took
on the project of researching and writing the material for
these two books.
Perspectives, the field guide, will inhabit my suitcase
the next time I fly to southern California. Divided into
sections on fauna, biodiversity, and biogeography, places
and spaces, and summative analysis, it teems with infor-
mation that brings the natural world of the region alive. In
the best way, I got lost in the text, wandering from section
to section, dipping in here and there. I found myself want-
ing to search the intertidal zone for burrowing anemones
1
and giant sea stars; to hear the long-billed curlew’s song;
and to watch the interactions between the pelicans and the
fishermen at Shelter Island (the humans benefit from the
pelicans’ keen eye for locating fish in the water). I love
that Canis lupus familiaris and Homo sapiens were in-
cluded in the section on mammals! (I have to take issue,
though, with “Humans are currently the only animals that
walk completely upright.” Tell that to a penguin!)
Both books include reflections as well as data gath-
ered by the students. San Diego’s Boat Channel moved
Merlin Gunn-Cicero to write a paragraph including: “The
wake of a boat occasionally breaks against the shore, dis-
turbing the dull silence. I enjoy the break in the monot-
ony for a moment, until the sky splits in half from the
sound of the jet turbines screaming overhead. I can’t stay
up here any longer; I’m dying to dunk my head below the
surface of the water to chat with the fishes.” Me, I’d head
for the Octopus Garden; the Boat Channel, I learned, is
filled with octopus dens.
San Diego Bay opens with a discussion of Native
American hunting and gathering, which made this an-
thropologist feel right at home. Humans arrived at this
coastal area 8,000 to 12,000 years ago and made a good
living from the sea. From this launching point, the book
devotes most of its chapters to local resources, ranging
from tuna to kelp additives to salt. Salt? Who knew a re-
port on the impact of the salt industry on the San Diego
region’s fauna could make good reading?
Both books are well illustrated, with photos, time-
lines, and the like. There’s science everywhere in these
volumes. We learn what we can all do to work toward a
cleaner, better environment in San Diego and elsewhere;
on a different layer, the science of human dynamic pro-
cess shines through. These books reveal what may hap-
pen when adults and children spark each other’s talents.
Pay it forward!
2 BARBARA J. KING
This Issue
This issue begins with an article on the still-face ex-
periment. In a fascinating departure from the usual focus
on infants’ response, Katherine Weinberg, Marjorie
Beeghly, Karen L. Olson, and Ed Tronick report what
happens when toddlers encounter a totally (if briefly)
non-responsive mom and then reunite with a “normal”
mom. Qualitative and quantitative data show that tod-
dlers use a wider array of responses and reactions than
infants do when trying to make sense of these situations.
Attempts to initiate joint attention and repetitions of
verbal utterances were frequent strategies by these 21⁄2
year olds. Like adults, children struggle in creative ways
to make meaning in a world that includes unexpected
events.
In the JDP Forum, Stuart Shanker combines analysis
of cutting-edge research in psychology and neurobiology
with themes in the history of philosophy to explore the
development of healthy minds in children. For Shanker,
what’s to be avoided is any assumption of linear relation-
ship between where a child is right now and what she
may become five years down the road. Developmental
trajectories are not fixed, and well-tailored treatment
methods may rechannel the course a child is on. The chal-
lenge is to conceptualize how to do the science, for exam-
ple the science of ADHD and autism, without falling
back on old nature/nurture-type dichotomies. Shanker of-
fers concrete examples of how this approach may work.
Change is at the heart of the dynamic-systems ap-
proach that animates both Shanker’s and Erika Lunk-
heimer’s work. Lunkheimer responds to Shanker, and
recognizes the challenge of dynamic-system science
when she remarks that “The child is a moving target.”
Lunkheimer urges this emerging field to embrace the
study of normative as well as non-normative develop-
ment, and discontinuous as well as stable processes. She
suggests that the role of families and schools in develop-
mental intervention should now come front and center.
The role of the family in developmental process is the
heart of Susan Longtin and Sima Gerber’s article, which
centers on language learning in children diagnosed with
Autism Spectrum Disorder (ASD). Longtin and Gerber
offer a detailed comparison of three parent-based pro-
grams that aim to increase the communicative and lin-
guistic skills of ASD children. A model that gives pri-
macy to social-emotional engagement (which provides
the motivation to learn) and cognitive effort (which chal-
lenges a child’s resources) is, the authors believe, key to
evaluating parent-based programs. It also may aid the
therapist’s—especially the speech-language therapist’s—
own process in working to improve children’s lives.
In the final article, we return to the realm of toddlers’
behavior. Pnina S. Klein, Renat Laish-Mishali, and Nurit
Jaegermann investigate whether mothers modify the ways
they guide and teach their children about the world in
clear relation to their children’s temperament and sensory-
processing behaviors. Among the findings with poten-
tially significant implications is that children who have
high neurological thresholds (“sensory seekers”) receive
quite different maternal behaviors than do children who
are highly reactive to and uneasy around certain stimuli,
even though these two groups of children tend to be
highly active. As the authors point out, even mothers who
are highly sensitive to their children’s specific circum-
stances may be unaware of their own behavioral tenden-
cies in this regard.
In a pair of essays, books of keen interest to JDP
readers are critically examined. Ira Glovinsky takes issue
with the ways Bipolar Children: Cutting-Edge Contro-
versy, Insights, and Research, edited by Sharna Olfman,
approaches the phenomenon of pediatric bipolar disorder.
Glovinsky finds the book to be simplistic and riddled
with misconceptions that may harm families who consult
it for help.
The Dangerous Book for Boys and The Daring Book
for Girls have become publishing phenomena in the last
year. Dorothy Sluss explores the play activities offered to
boys or girls included in, as well as left out of, these
books, and asks to what degree the books are as gendered
as their titles suggest. (Because the JDP is multi-species
in orientation, we toyed with, but eventually dropped, the
idea of sending Sluss a third book to review: the new
Dangerous Book for Dogs. Stay tuned to see what animal
comes next in the series.)
An Editorial Transition
I have made no secret of how much I love reading and
writing. After a three-year term as JDP Editor, I’m step-
ping down in order to have more time to pursue writing
about science for the public.
Of course, I’m committed to my “day job” at the Col-
lege of William & Mary, teaching undergraduates who
are as stimulating daily companions as the students of
High Tech High must be—but that’s the thing. Teaching
in the university and talking with the public “out there”
should be, I believe, seamless—one big holistic activity
with the same end: to share and to exchange and to ex-
pand knowledge. It’s a lot of fun and I always learn a
great deal. Right now, I’m working to finish my book on
animal-human relationships in evolutionary perspective,
and I’m starting to publish some magazine articles too.
 Editiorial: Igniting the Spark: High Tech High and Beyond
I want to express heartfelt thanks to everyone who has
gotten the JDP off to such a good start: Dr. Stanley
Greenspan, Dr. Serena Wieder and the staff in Bethesda
at www.icdl.com; the JDP Board, with special thanks to
Alan Fogel and Stuart Shanker; and my Associate Editor
Dr. Ira Glovinsky. Personally, the day-to-day activities
became immeasurably more efficient, professional, and
fun because of my good fortune to work long-distance
with copyeditor Jane Mild LaRoque, and here in
Williamsburg, with William & Mary graduate students
Megan Habas Siudzinski and Jennifer Camp.
It’s my pleasure to announce that, by the time this
issue reaches you, JDP’s new editor will be in place. Gail
Melson is Professor Emerita in the Department of Child
Development and Family Studies at Purdue University.
Her book Why the Wild Things Are: Animals in the Lives
of Children has deeply influenced my own understanding
of the connections that form between children and ani-
mals, and the significance of those bonds for healthy
child development.
3
The JDP’s next issue will be a unique King-Melson
hybrid product! I have invited a number of authors to
contribute to a special issue on serious challenges facing
children around the world. I aimed to go beyond our typ-
ical focus on the US, Canada, and Western Europe. It’s
easy for me to say that every child’s spark should be ig-
nited; it’s something else again to take a hard look at
what some children face in order to get an education,
stay healthy, or in certain cases, just survive in the first
place (and of course, these same challenges do occur in
the US, Canada, and Western Europe). Hardest of all can
be to know how to help. Please look for the special
issue, which Gail Melson will edit, in late 2008, and
read about the work of some of the people who are mak-
ing a difference.
What is the best way to welcome Gail Melson to the
JDP? Greet her with your own difference-making behav-
ior: your articles, your books for review, your ideas and
your comments should now go to gmelson@purdue.edu.
Gail, it’s all yours!
A Still-face Paradigm for Young Children:
21/2 Year-olds’ Reactions to Maternal Unavailability during the Still-face

M. Katherine Weinberg
Harvard Medical School
Children’s Hospital, Boston, MA

Marjorie Beeghly
Harvard Medical School
Children’s Hospital, Boston, MA
Wayne State University, Detroit

Karen L. Olson
Harvard Medical School
Children’s Hospital, Boston, MA

Ed Tronick (Corresponding author)

Harvard Medical School
University of Massachusetts at Boston
Children’s Hospital, Boston, MA
ed.tronick@childrens.harvard.edu

Abstract: This study evaluated similarities and differences Introduction

in 21⁄2 year-old children’s reactions to maternal unavailabil-
ity during a brief still-face episode and subsequent resump-
tion of social interaction during a reunion episode. Seventy
mothers and children were videotaped in the Toddler Still-
Face paradigm (T-SF), an age appropriate adaptation of the
Face-to-Face Still-Face paradigm. Similar to their younger
counterparts, 21⁄2 year-olds displayed the traditional “still-
face effect,” including an increase in negative affect, gaze
aversion, and a wide array of behaviors indicative of prox-
imity seeking to the mother, solicitation of her attention, and
avoidance and a “reunion effect,” characterized by a carry-
over of negative affect and avoidance behavior (e.g., mov-
ing away from the mother) from the still-face episode to the
reunion play episode. However, differences in toddlers’ be-
haviors during the still-face and reunion episodes were also
observed, which highlight age-related changes in the tod-
dlers’ ability to cope with the stress of maternal unavaila-
bility during the still-face during the third year of life. Con-
trary to reports for younger infants, few gender differences
were found in toddlers’ reactions to the still-face. The find-
ings support the hypothesis that the toddlers are attempting
to make meaning out of an unexpected and senseless event.
Note: First author position is equally shared by Katherine Weinberg
and Marjorie Beeghly.
Several similar and generally accepted interpretations
have been advanced to account for the still-face effect
(Adamson & Frick, in press; Tronick, Als, Adamson,
Wise, & Brazelton, 1978; Weinberg & Tronick, 1996).
First, the still-faced mother violates the infant’s expecta-
tion for a normal interaction (Tronick et al., 1978). Sec-
ond, by withdrawing all forms of interaction with the in-
fant, the mother no longer provides the infant with the
regulatory scaffolding often needed for the infant to main-
tain an organized social and affective state (Beeghly &
Tronick, 1994; Stack & Muir, 1990; Weinberg & Tronick,
1996). And third, the mother’s lack of responsiveness dis-
rupts the infant’s goal for social engagement and connect-
edness with her (Tronick et al., 1978) and the contingency
between the infant’s and mother’s behaviors (Gergely &
Watson, 1999; Rochat, Neisser, & Marian, 1998).
Tronick (2004, 2007) has integrated these interpreta-
tions in his dyadic expansion of psychobiological states
of consciousness hypothesis. Following Bruner (Bruner,
1990) Tronick has argued that humans are meaning-
makers. They make meaning to gain a sense of the self in
relation to itself and to the world of things and other peo-

4
 A Still-face Paradigm for Young Children: 21⁄2 Year-olds’ Reactions to Maternal Unavailability during the Still-face
ple. Moreover, with development, meaning-making ca-
pacities change qualitatively and the meanings that are
made change as a consequence. For example, infants
make meanings that are sensori-motor (Piaget, 1952) and
sensori-affective (Stechler & Latz, 1966) in nature,
whereas toddlers make meanings that utilize their bur-
geoning representational and locomotor skills (Piaget,
1962; Beeghly, 1997; Bretherton & Beeghly, 1982).
Moreover, meanings and meaning-making systems are
polymorphic and include physiologic, behavioral,
speech, representational, and cognitive components
(Tronick, 2007).
Meanings are both self-organized (regulated inter-
nally and private) and also dyadically organized (regu-
lated with others and shared). When meanings are dyadi-
cally organized, a dyadic state of consciousness emerges
between the individuals—something akin to Vygotsky’s
zone of proximal development (Vygotsky, 1967). These
dyadically organized meanings contain new co-created
meanings that, in turn, can be appropriated by each indi-
vidual into his own private state of consciousness. Suc-
cessful self- or dyadic creation of new meanings leads to
an expansion of the complexity and coherence of the in-
dividual’s state of consciousness. The still-face in this
view is a situation that challenges children’s meaning-
making capacities and already existing meanings about
the mother, including their expectations, implicit know-
ing, and representations.
To examine meaning-making capacities in infants is
difficult because of their lack of speech. Inferences about
their intentions and representations are based on observa-
tions of their dynamic expressive and communicative ac-
tions including gestures, facial expressions, vocaliza-
tions, and posture (Fogel, Nelson-Goens, Hsu, &
Shapiro, 2000; Hsu & Fogel, 2003; Meltzoff & Gopnik,
1993). For example, Weinberg and Tronick (1994) argued
that infants’ expressive behaviors form coherently organ-
ized configurations that convey meanings such as “con-
tinue” or “stop” and that these meanings are related to
context (e.g., normal interaction versus the still-face).
Bruner (1990) has argued that infants’ intentionality can
be seen in their actions, such as reaching for an object,
and the change in their actions when they succeed in ful-
filling their intentions. Spitz (1965) has made a similar
argument. However, although watching preverbal infants
react to the still-face is compelling, inferences of inten-
tionality and meaning-making must be cautiously as-
serted, given their lack of speech. Thus, in this study our
goal was to examine the meaning-making capacities of
21⁄2 year-olds and how they make meaning of the still-face
with their more advanced developmental capacities in-
cluding speech and nonverbal representational capacities.
5
Over the past 25 years, hundreds of infants have been
videotaped in the Face-to-Face Still-Face paradigm
(Tronick et al., 1978). This paradigm has proven to be a
particularly fruitful methodological tool for evaluating
young infants’ socio-emotional, regulatory, and coping
abilities (see Adamson & Frick, 2003a, for a review).
However, with the exception of two studies with autistic
children (Escalona et al., 2002; Nadel et al., 2000), no
study to date has examined toddlers’ reactions to this per-
turbation in maternal interactive behavior during the
third year of life. Thus, in this study we wanted to eval-
uate 21⁄2 year-old children’s reactions to maternal unavail-
ability during the still-face and the subsequent resump-
tion of maternal availability during the reunion episode
of an age-appropriate adaptation of the Face-to-Face
Still-Face paradigm—the Toddler Still-Face (T-SF). We
expected that the way in which toddlers reacted and
coped with this social stressor would reveal their under-
lying meaning-making processes at this age.
The classic Face-to-Face Still-Face paradigm con-
fronts young infants with three successive interactive
contexts: 1) a “normal” face-to-face caregiver-infant so-
cial interaction during which the caregivers are asked to
play with their infants in a normal manner, followed by
2) a still-face episode during which caregivers are in-
structed to keep an unresponsive poker face and not to
smile, touch, or talk to their infants, followed by 3) a re-
union episode during which the caregivers and infants re-
sume normal face-to-face social interaction. Each
episode typically lasts 2–3 minutes with 2 minutes being
the modal length. The paradigm has been used with in-
fants ranging in age from 2–12 months with a mean age
of 5.2 months (Adamson & Frick, 2003b).
Infants typically respond to the still-face with what
has come to be called the “still-face effect.” In study
after study, infants react to the still-face with a signature
increase in gaze aversion and a decrease in positive affect
(Adamson & Frick, 2003b; Cole, Martin, & Dennis,
2004). In studies that have used microanalytic scoring
systems, infants in addition react to the still-face with an
increase in negative affect, visual scanning, pick-me-up
gestures, distancing behavior such as twisting and turning
in their seat, autonomic behavioral stress indicators such
as spitting up (Toda & Fogel, 1993; Weinberg & Tronick,
1996; Weinberg, Tronick, Cohn, & Olson, 1999) and
pyschophysiologic stress indicators, such as heart, respi-
ratory sinus arrhythmia, skin conductance, and cortisol
changes (Gunnar & Davis, 2003; Haley & Stansbury,
2003; Ramsay & Lewis, 2003; Stansbury & Gunnar,
1994).
Although the powerful effect of the still-face is well
established and extensively described, the reunion episode
6 M. KATHERINE WEINBERG, MARJORIE BEEGHLY, KAREN L. OLSON AND ED TRONICK
that follows the still-face has received relatively scant at-
tention. Though a carry-over effect of negative affect was
found in an early study of the still-face (Tronick et al.,
1978), until recently researchers have not empirically fo-
cused on the reunion episode as a regulatory challenge for
infants and caregivers (Kogan & Carter, 1996; Rosen-
blum, McDonough, Muzik, Miller, & Sameroff, 2002;
Weinberg & Tronick, 1996; Weinberg, Olson, Beeghly, &
Tronick, 2006). These authors have described a “reunion
effect” on infants ranging in age from 3 to 7 months that
consists of increased negativity (i.e., facial expression of
anger and sadness, fussing, and crying), gaze aversion,
and object focus and, at least in infants aged 6 months or
older, a rebound of positive affect to levels close to or be-
yond those observed in the first play. The reunion episode
is thought to be stressful for dyads because the mothers
and children must re-establish and repair the interaction
following the still-face. The reunion episode therefore
presents dyads with an affectively complex and demand-
ing regulatory meaning-making task of coming to a re-
newed shared meaning about what they are doing to-
gether. Infants must simultaneously cope with the
resumption of maternal behavior and with the intra- and
interpersonal carry-over of negative affect and stress from
the still-face that was generated by the senselessness of
the mother’s unresponsive behavior during the still-face.
In some studies, gender differences have been found
in young infants’ reactions to both the still-face and the
reunion episode. We (Weinberg et al., 1999) found that
male infants have more difficulty than female infants in
maintaining affective regulation. In both the still-face and
the reunion episodes, boys were more likely than girls to
show facial expressions of anger, to fuss, to gesture to be
picked up, and to try to get away by turning and twist-
ing in the infant seat. Boys were also more socially ori-
ented than girls and thus more likely than girls to look
at the mother, smile, and vocalize. Girls, on the other
hand, spent substantially more time exploring objects
and showing facial expressions of interest. We hypothe-
sized that boys and girls may use different types of self-
regulatory strategies. Whereas female infants use visual
attention to objects as a form of regulation (perhaps as a
result of their greater developmental maturation), male
infants need more regulatory support from a caregiver. As
a consequence, much of boys’ expressive behavior (both
positive and negative) is directed toward the caregiver
and may serve the function of communicating to the care-
giver their greater need for external regulation.
Compared to infants, it is likely that toddlers’ experi-
ence of and strategies of coping with the still-face and re-
union are even more complex phenomena reflecting their
more advanced social, emotional, cognitive, and motor
capacities (Kagan, 1998; Kopp & Neufeld, 2003; Thomp-
son, 1994). For instance, by 21⁄2 years of age, toddlers are
beginning to understand social standards and to be con-
cerned about the regulation of their and others’ behavior
around these standards (Kagan, 1998; Kopp, 1982; Kopp
& Neufeld, 2003; Sroufe, 1996). The still-faced and so-
cially unavailable mother violates social standards for ap-
propriate maternal behavior, and toddlers are forced to
cope with the notion that this is not the way that their
mother should behave (Kagan & Lamb, 1987). Toddlers
also have to determine whether to respond to the still-
faced mother in a way that is concordant with the social
standards that they are beginning to internalize. For ex-
ample, a child may be confronted with the dilemma of
yelling at the mother or asking questions to elicit infor-
mation about what is happening. Obviously these issues
of meaning-making are not relevant to infants.
The still-faced mother also violates toddlers’ repre-
sentations of the mother-child relationship (Weinberg &
Tronick, 1996). Based on months of prior interaction
with the mother, toddlers know that this is not the way
their mother typically behaves. The mother’s still-faced
countenance and unavailability for social interaction vio-
lates children’s implicit as well as explicit knowledge
of what they normally do together (Adamson & Frick,
2003b; Muir & Hains, 1993; Shapiro, Fagen, Prigot, Car-
roll, & Shalan, 1998). It also disrupts children’s need for
social connection and may stress their sense of security.
As is the case for infants, toddlers may attempt to repair
this interactive perturbation and re-engage the mother.
However, toddlers are likely to do so in more complex
ways that reflect their greater developmental maturity
and self-regulatory skills. For instance, toddlers may try
to regain connection with the mother by seeking physical
proximity to her, soliciting her attention (e.g., asking
questions or showing her a toy), or attempting to re-
engage her in the same play activities they had engaged
in prior to the still-face. Toddlers may also turn away and
avoid the mother (perhaps in an effort to self-regulate) or
they may become dysregulated (e.g., throw toys) and ex-
hibit negative behavior (e.g., cry, whine, or yell in anger).
Younger infants also experience this violation but they do
not have the same extended history with the mother as
toddlers do, and their representational capacities are dif-
ferent and more limited.
Another significant developmental difference be-
tween infants and toddlers is that, during the second and
third years of life, toddlers are beginning to acquire a
rudimentary and possibly explicit understanding of the
emotional states and intentions of other people (Beeghly
& Cicchetti, 1994; Bretherton, 1991; Bretherton &
Beeghly, 1982; Trevarthen, 1980; Wellman, 1993). Dur-
 A Still-face Paradigm for Young Children: 21⁄2 Year-olds’ Reactions to Maternal Unavailability during the Still-face
ing the still-face, toddlers may make implicit or even ex-
plicit explanations for their mother’s sudden unrespon-
sivity. For example, children may think that the mother
did not hear them and make repeated requests for interac-
tion or information that escalate in volume and intensity.
Or they may attribute the mother’s behavior to a change
in her physiological state such as her being tired. Analytic
theory would suggest that the maternal still-face may also
force children to question whether the mother’s changed
behavior is their fault or caused by their behavior, e.g.,
“Why is she doing this to me?” and “Did I do something
to cause this?” (Emde, 1983; Winnicott, 1964). While
these questions are difficult to answer at any age, young
children’s answers may reflect the history of the mother-
child relationship (“Mommy, are you sad?”), children’s
tendency to attribute explanations that are internal or ex-
ternal to them (e.g., “I was bad” versus “Mommy is tired
and needs a rest”), and/or children’s history of coping
with problems successfully or unsuccessfully (“I can
cope with this” versus “I can’t deal with this”).
The present study addresses three primary questions:
1) Do 21⁄2 year-old toddlers exhibit a similar still-face ef-
fect during the T-SF as has been consistently reported for
young infants in the Face-to-Face Still-Face paradigm?
What differences, if any, can be observed? 2) Do 21⁄2 year-
old toddlers exhibit a similar reunion effect during the
T-SF as has been reported for young infants in the Face-
to-Face Still-Face paradigm? It seems likely that toddlers
(like infants) would be affected by the breaking of the in-
teractive connection with the mother and attempt to re-
establish that connection, but given their greater devel-
opmental maturity, it is unclear how specifically they will
react and deploy their actions and coping behaviors. And,
3) Are there gender differences in toddlers’ affective and
behavioral reactions during the still-face and reunion
episodes of the T-SF, and, if so, how do these differences
correspond to or contrast with those reported for younger
infants during the Face-to-Face Still-Face paradigm? We
expected that maternal unavailability during the still-face
episode and the subsequent resumption of normal inter-
action in the reunion episode would be a powerful and
age-appropriate social stressor at age 21⁄2 years that would
elicit a variety of regulatory strategies in children to help
them cope with this unexpected violation in social inter-
action. Specifically, we expected that toddlers would
show both a still-face and a reunion effect as has been re-
ported for young infants, but they would manifest these
effects in age-appropriate ways that reflect their more
mature representational, motor, and self-regulatory skills.
We also anticipated that toddlers’ behaviors during the
still-face and reunion episodes would reflect an intention
to reconnect and maintain an engagement with the
7
mother, as observed in a heightened prevalence of re-
quests for joint attention, information, or social interac-
tion, proximity seeking, and verbal repetitions. More-
over, we expected that “better coping” at 21⁄2 years during
both the still-face and reunion episodes would reflect a
greater ability to maintain emotional self-regulation and
to avoid becoming distressed or behaviorally dysregu-
lated (e.g., crying, yelling, hitting the mother, or throwing
toys). Based on the infancy literature, we also expected
that boys would have greater difficulty than girls regulat-
ing their affect and behavior in both the still-face and re-
union episodes at age 21⁄2 years.
Methods
Subjects
Seventy mothers and their 21⁄2 year-old children (34
boys and 36 girls) participated in this study (M child
age = 31 months, SD = 1.7 months). On average, moth-
ers were 36 years old (SD = 3.5) and had achieved 16
years of education (SD = 1.6, range = 12 to 23 years).
Subjects were recruited from a larger pool of 109 moth-
ers and infants who had participated in a larger and lon-
gitudinal study of mother-child social interaction.
At the time of recruitment, the original sample met a
set of low risk social and medical inclusion criteria. The
mothers were healthy, married or living with the infant’s
father, 21 to 40 years of age, and had completed at least
12 years of education (high school diploma or equiva-
lent). Recruited families ranged in socio-economic status
(SES) from working class to upper-middle class, as
measured by Hollingshead’s Four-Factor Index of Social
Status (Hollingshead, 1979). Although mother-infant
dyads were recruited regardless of race or ethnic back-
ground, all but one was Caucasian. The infants were all
full-term and healthy at birth as determined by pediatric
examination in the newborn period.
Of the 109 mother-infant dyads that had been part of
the infancy study, 70 (64%) were recruited to participate
in an additional single laboratory visit when the children
were 21⁄2 years old. The 70 participants did not differ sig-
nificantly from the 39 non-participants on any infant bio-
logic or maternal socio-demographic variable. Most non-
participants were lost to follow-up (i.e., moved or could
not be located) or had children who were too old by the
time the present study began. A few families were no
longer interested in participating, or no longer met our in-
clusion criteria due to health reasons (e.g., two dyads
were excluded because the children had been diagnosed
with an autism spectrum disorder).
8 M. KATHERINE WEINBERG, MARJORIE BEEGHLY, KAREN L. OLSON AND ED TRONICK
At the time of the toddler visit, all 70 mothers and chil-
dren were healthy and the children were developing nor-
mally. Two of the 70 mothers (3%) had separated from the
children’s fathers. Study families varied in the number of
children living in the household. Forty percent had just the
target 21⁄2 year-old, 51% had two children in the household
(including the target child), and 9% had three or more
children. Mothers also varied in employment status. Fifty-
four percent had returned to work by the 21⁄2 year observa-
tion, whereas 46% were full-time homemakers.
Procedures
The 21⁄2-year visit took place in a laboratory playroom
at Children’s Hospital, Boston. All mothers signed an in-
formed consent form at the start of the visit, and were
given the option of shortening or terminating the video-
taped interactions including the still-face at any time, if
they so desired. None of the mothers chose to do so. The
Institutional Review Board (IRB) at Children’s Hospital
of Boston approved all procedures.
Toddler Still-Face Paradigm (T-SF). Following the
informed consent procedures, mother-child dyads were
videotaped during the T-SF, an age-appropriate adapta-
tion of the Face-to-Face Still-Face paradigm. Similar to
the infancy paradigm, the T-SF consisted of three 2-
minute episodes: 1) normal play with the mother, 2) still-
face, and 3) resumption of normal play with the mother
(reunion). However, unlike the infancy paradigm, the
toddler paradigm took place in the middle of a longer
mother-child free play session, during which dyads
played on the floor with a standard set of assorted toys
appropriate for toddlers. During the first play and the re-
union play episodes, the mothers were instructed to play
with their children as they normally would at home. Dur-
ing the still-face episode, the mothers were instructed to
remain on the floor and maintain a neutral “poker” or
still-face and to refrain from talking, smiling, nodding, or
touching the child. They were also instructed not to ac-
cept or give toys to the child.
The T-SF was videotaped from behind a one-way mir-
ror using two cameras. To facilitate later coding, the exper-
imenter selected the view that maximized full-frontal or 3/4
frontal views of the child and mother. Videotapes were also
initialized with computer-readable time code (SEMPTE).
Coding of Videotapes
In order to mimic the infant Face-to-Face Still-Face
procedure, coding was based on the last two minutes of
mother-child free play prior to the still-face (play 1), the
two-minute still-face episode, and the first two minutes
of free play following the still-face (reunion episode).
The children’s affect and behavior during each episode
were scored from videotapes using the child codes from
the Child and Caregiver Mutual Regulation (CCMR)
scoring system (Weinberg, Beeghly, & Tronick, 2003),
which are presented in the appendix. The CCMR was
specifically designed for this study to capture the wide
repertoire of regulatory strategies that toddlers may de-
ploy in response to maternal unavailability during the
still-face. Coding was accomplished using the Action
Analysis Coding and Training system (AACT, 1996),
which provided computer-assisted observational coding.
The computer directly controlled the S-VHS machine
and video monitor and allowed single frame accuracy in
coding and automatic time code capture. The AACT sys-
tem permitted on-line continuous coding of variables of
interest. Coders typically viewed videotapes in real time
but replayed segments, used slow motion, and edited
their coding as needed.
In the first coding pass, coders focused on scoring
the children’s negative, positive, or neutral affect. The af-
fect codes were based on facial expressions (e.g., smiles,
frowns) and vocalizations with affective tone or con-
tent (e.g., crying, squealing in enthusiasm). “Negative af-
fect” included facial expressions of anger, sadness, fear,
subdued/withdrawn, or puzzled/concerned affect, and
negative vocalizations such as crying, whining, com-
plaining, frustration, irritation, annoyance, or impatience.
“Neutral affect” included facial expressions of interest
and vocalizations characterized by a normal conversa-
tional tone. “Positive affect” included facial expressions
of joy (e.g., smiling, laughing) and positive vocalizations
such as exuberance, and enthusiasm. In addition, a code
for nonscorable affect was included in case the child was
not visible momentarily because of problematic camera
angles. The affect codes were coded continuously, and
every change in the children’s affect was recorded. In ad-
dition, the affect codes were mutually exclusive so that
the occurrence of one affect code terminated the previous
affect code.
In a second coding pass, coders scored specific child
behaviors. The specific child actions included verbal
and nonverbal initiations (e.g., verbal requests, show-
ing mother a toy, pointing to an object), disruptive/
aggressive acts (e.g., yelling, throw a toy, hitting the
mother), proximity/contact seeking (e.g., moving closer
to the mother, touching or hugging the mother), avoid-
ance behavior (e.g., turning the back to the mother), self-
comforting behaviors (e.g., sucking on a thumb or fin-
ger), verbal explanation (e.g., the child provides an
 A Still-face Paradigm for Young Children: 21⁄2 Year-olds’ Reactions to Maternal Unavailability during the Still-face 9

explanation or rationalization for the still-face, “Mommy
is tired” or “Wake up!”), and self-evaluations (e.g., “I
can’t do it”). These codes were coded on a frequency
(rate per minute) basis. However, the duration of some
of these codes (e.g., child’s back turned to mother, touch,
hug/cling, and self-comforting) was also captured, as in-
dicated in the appendix.
The videotapes were coded by independent teams of
two coders masked to toddlers’ and mothers’ background
information and the study’s hypotheses. In pilot work with
the CCMR, we found that coders were better able to cap-
ture all the child’s behaviors accurately if they coded in
teams of two. For reliability, teams of two coders independ-
ently double-coded 20% of the videotapes. Reliability was
evaluated in two ways. First, percent agreement between
teams was assessed using the formula: (agreements /
(agreements + disagreements)) × 100 = % correct agree-
ments. Mean percent agreement overall was high
(96.18%). The Cohen Kappa statistic was also applied to
the codes to correct for chance agreements. Mean kappa
was 0.63, indicating good overall reliability.
comforting. For affect, mean percent time in negative,
positive, and neutral/interest was calculated. 2) Mean
rate per minute (RPM) was calculated for CCMR codes
that were scored on a frequency basis. Mean rate per
minute was also calculated for the codes of touch,
hug/cling, and back turned to mom.
Univariate and bivariate analyses were used to pro-
vide descriptive statistics for variables derived from the
CCMR. Several codes were excluded because they did
not occur with sufficient frequency to be included in the
analyses. These included the codes for tantrum, running
around the room, pleading, physical requests (e.g.,
pulling mom’s hand), and crying (no child cried during
the T–SF).
To evaluate the primary objectives of the study, a 2
(gender) × 3 (episode: first play, still-face, reunion)
ANOVA with repeated measures (SAS 9.1 proc mixed),
including the two-way interaction, was conducted, with
episode as the repeated measure. Any significant episode
effects were further evaluated using simulated based post
hoc tests.

Analytic Plan Results

In the Results section, findings from quantitative
analyses addressing the study’s three questions are pre-
sented first. These are followed by transcribed excerpts
of three toddlers’ behavior during the T-SF.
In the quantitative analyses, two types of dependent
variables were derived from the CCMR for analytic pur-
poses in the present study: 1) Mean percent time was
calculated for the CCMR codes for which duration
was available. These included the affect codes and the
codes of touch, hug/cling, back turned to mom, and self-
Quantitative Analyses
Do 21⁄2 year-olds exhibit a still-face effect?
Descriptive statistics and ANOVA results for the
CCMR variables are provided in Tables 1 and 2. Table 1
lists means and standard deviations for the CCMR dura-
tion codes (i.e., the percent time measures for the sum-
mary CCMR categories of negative, neutral/interest, and
positive affect, and for touch, hug/cling, back turned to
mother, and self-comfort codes). Table 2 presents means

Table 1.
Descriptive statistics for percent time CCMR (duration) codes during the episodes of the Toddler Still-Face paradigm (N = 70)
Play 1 Still-Face Reunion Play F(df = 2,67)
Affect/
Behavior n/I M SD n/I M SD n/I M SD Episode

Positive affect 49 6.04 9.13 43 3.81 5.48 52 4.42 8.40 2.35

Neutral/interest 70 93.31 9.23 70 92.54 11.78 70 94.17 10.15 0.43
Negative affect 10 0.64a 2.52 17 3.65b 11.12 12 1.42a,b 4.06 3.56*
Touch 14 2.14a 8.43 34 11.07b 23.29 26 6.60a,b 19.17 4.56*
Hug/cling 1 0.07 0.56 11 3.05 12.98 4 2.22 12.53 1.89
Back to mom 19 1.94a 5.46 35 9.48b 21.81 24 4.29a,b 13.85 4.76*
Self-comfort 10 0.32 1.16 18 2.07 11.98 14 0.50 1.25 1.06
n/I = number of individual children exhibiting a particular code in each episode (out of 70);
M = arithmetic mean; SD = standard deviation
* p < 0.05, ** p < 0.01, *** p < 0.000.
Note: Means with differing superscripts are significantly different from each other as assessed using simulation based post hoc tests at p < 0.05.
10 M. KATHERINE WEINBERG, MARJORIE BEEGHLY, KAREN L. OLSON AND ED TRONICK

Table 2.
Descriptive statistics for rate per minute (RPM) CCMR behavioral (frequency) codes during the episodes of the Toddler Still-Face paradigm
Play 1 Still-Face Reunion F(df = 2,67)

Behavior n/I M SD n/I M SD n/I M SD Episode

Verbal requests 28 0.43a 0.70 52 1.46b 2.13 35 0.46a 0.59 8.80***

Requests for info 35 0.67 1.06 44 0.98 1.34 42 0.81 1.12 1.93
Requests to leave 1 0.02 0.18 1 0.01 0.06 2 0.04 0.21 0.71
Show toy 36 0.69a 1.10 53 1.19b 1.21 39 0.71a 1.08 5.00**
Repetitions 22 0.24a 0.42 60 2.68b 2.94 24 0.32a 0.59 23.31***
Escalation 5 0.04a 0.13 19 0.30b 0.69 4 0.04a 0.16 4.95**
Seeks proximity 32 0.45a 0.62 48 0.79b 0.82 32 0.54a 0.78 6.09**
Touch mom 14 0.22a 0.57 34 0.55b 0.80 26 0.31a 0.57 5.38**
Hug/cling to mom 1 0.01a 0.06 11 0.11b 0.29 4 0.02a 0.13 5.21**
Turn back to mom 19 0.23a 0.52 35 0.44b 0.64 24 0.25a 0.47 3.78*
Move away 3 0.41a 0.55 40 0.63b 0.77 35 0.52a,b 0.70 3.15*
Disruptive actions 18 0.25 0.51 19 0.31 0.74 22 0.33 0.73 0.37
Explanations 3 0.04 0.18 3 0.05 0.26 2 0.01 0.09 1.98
Self-evaluations 2 0.01 0.08 1 0.01 0.06 2 0.03 0.19 0.56
n/I = number of individual children exhibiting a particular code in each episode (out of 70);
M = arithmetic mean; SD = standard deviation
* p < 0.05, ** p < 0.01, *** p < 0.000.
Note: Means with differing superscripts are significantly different from each other as assessed using simulation based post hoc tests at p < 0.05.

and standard deviations for the rate per minute (RPM)
CCMR behavioral (frequency) codes. In both tables, the
number of individual children (out of 70) who exhibited
each CCMR code is also indicated for each episode.
As seen in Table 1, there were several significant
episode effects for the duration CCMR codes. A signifi-
cant main effect of episode for negative affect indicated
that children showed significantly more negative affect
during the still-face episode than they did during the first
play episode. Children also spent significantly more time
with their back turned to the mother and touching the
mother during the still-face than in the first play. Although
not statistically significant, there was also a trend for
positive affect to decrease from the first play to the still-
face episode (p = 0.10). In contrast, the duration of self-
comforting behaviors was statistically equivalent during
each of the three episodes (first play, still-face, reunion).
As seen in Table 2, a larger number of significant
episode effects were observed for the RPM variables de-
rived from the behavioral frequency codes. Children were
more likely to make verbal requests and to show a toy to
the mother during the still-face than during either the first
play or the reunion play. They were also significantly
more likely to repeat verbal utterances and to exhibit es-
calating behavior (i.e., by making increasingly loud and
insistent vocalizations) during the still-face as compared
to the first play or the reunion play. Furthermore, the chil-
dren were more likely to seek proximity to the mother, to
touch the mother, and to hug/cling to the mother during
the still-face than during either of the two play episodes.
They were also more likely to turn their back to the
mother and to move away from the mother during the
still-face. In contrast, contrary to our expectations, chil-
dren were not more likely to provide explanations for
maternal behavior, self-evaluations, or engage in disrup-
tive actions such as yelling, throwing toys, or hitting the
mom during the still-face than during either of the first
play or reunion play episodes.
Do 21⁄2 year-olds show a reunion effect?
Results provided evidence for a reunion effect, al-
though this was less striking than the evidence for a still-
face effect at this age. As seen in Table 1, the rise in chil-
dren’s negative affect, touching the mother, and turning
their back to the mother that was observed in the still-face
did not significantly abate during the reunion play. As
seen in Table 2, the children were also equally likely to
move away from the mother during the reunion episode
as they had been in the still-face episode.
Are there gender effects in toddlers’ reactions during
the still-face and reunion episodes?
Contrary to our expectations, only two significant
main effects for gender were observed. The first indicated
that girls were more likely than boys to initiate joint at-
tention and social interaction with the mother using non-
verbal means, by either showing her a toy, handing her a
toy, pointing to a toy, or putting a toy in the mother’s
 A Still-face Paradigm for Young Children: 21⁄2 Year-olds’ Reactions to Maternal Unavailability during the Still-face
face/line of vision (M RPM for boy s= 0.67, SD = 0.89;
M RPM for girls = 1.04, SD = 1.32, F (df = 1,68) = 4.60,
p = 0.035). The second main effect indicated that boys
were significantly more likely than girls to elicit the
mother’s attention via physical touch (M RPM for boys =
0.47, SD = 0.78; M RPM for girls = 0.26, SD = 0.52,
F(df = 1,68) = 4.35, p = 0.041). There were no significant
episode x gender interactions.
Qualitative Results
To illustrate the quantitative results described above,
transcribed excerpts of the verbal and behavioral reac-
tions of three toddlers (two boys and one girl) during the
T-SF are now provided.
Transcript 1: Alligator Boy Transcript (3m 08s)
Play Episode (30s)
Child: (leans to mom) Baby (toy) can go right here (a toy
bathtub).
Mother: Oh, you think she’s warm?
Child: (reaches for baby) No, she’s cold. We have to wrap
her up (wraps baby doll in a towel).
Mother: (leans closer and looks) Nice.
Child: And this alligator (reaches for alligator toy with
his right hand) he’s gonna bite the baby (moves alli-
gator toward baby, for whom he reaches with his left
hand).
Mother: (gasps) Uh oh, uh oh.
Child: (moves alligator to “bite” the baby and then looks
at mom).
Mother: Where’s the baby’s mommy?
Child: (plays with baby).
Mother: (feigned anxiety) That baby needs a mother to
help.
Child: Help the... (incomprehensible; mom interrupts and
starts talking; child is playing with baby doll and toy
schoolhouse).
Mother: (interrupts and speaks in a frightened voice for the
baby) Help me, help me. That alligator is biting me.
Child: (puts the doll back in bathtub and looks at mom)
Oh look, no alligator is biting you.
Still Face Episode
Child: (immediately looks at mom and holds alligator) No
alligator, no alligator. He’s in the cage (voice rising).
Child: (looks at mom and moves alligator as if he were
walking) He’s in the cage (louder).
Child: (moves toward mom, looks at her and speaks with
an escalated tone) He’s in the cage.
Child: (continues to move toward mom) No alligator.
Child: (continues to move toward mom) No alligator.
11
Child: (sits, looks at mom and speaks with a slightly
more escalated tone) No alligator.
Child: (looks a mom and speaks with the same tone) No
alligator.
Child: (looks at mom, shakes head “no,” and speaks with
the same tone) No alligator.
Child: (moves away from mom, sits near schoolhouse
and speaks with initial tone) No more alligator.
Child: (plays with school house for approximately five
seconds, then looks at mom and speaks matter-of-
factly) There is no more alligator.
Child: (looks at mom intensely, moves hand and points)
They’re over here, Mom.
Child: (looks at mom and speaks with the same tone
which escalates as he picks up a toy pickle) No more
alligator. He needs a pickle.
Child: (looks at mom, speaks with the same tone and em-
phasizes each word) Mom, he needs (looks down),
Mom, (looks up at mom again, speaks with an esca-
lated tone and scowls) he needs a pickle.
Child: (looks down and frowns, approximately three sec-
onds later he looks at mom and speaks with the same
tone) Mom, he needs a pickle.
Child: (looks away and tone returns to initial intensity)
He needs a pickle.
Child: (looks around and speaks quietly) He needs a
pickle.
Child: (continues to look around, speaks too quietly to
comprehend and then looks away from mom).
Child: (reaches for an object and holds it out to mom,
looks at her, and speaks with original tone intensity,
but words are incomprehensible)
Child: (leans closer to mom and speaks with a slightly
more escalated tone, holding a toy potato chip) For
alligator.
Child: (looks away from mom and tone returns to initial
intensity) For alligator.
Child: (reaches for potato chip and gives it to mom, looks
at her and speaks with same tone) Chip for alligator.
Child: (looks at mom, leans closer, continues to hand her
the same chip and speaks with a slightly more esca-
lated tone) Chip for alligator.
Child: (looks at mom, holds the chip at mom’s eye level
and speaks with a slightly more escalated tone, em-
phasizing each word) Chip for alligator.
Child: (places chip on mom’s knee).
Child: (returns to normal sitting position and speaks with
original tone intensity) Chip for alligator.
Child: (looks at mom) Chip for alligator.
Child: (points at chip, looks at mom and speaks with a
slightly more escalated tone, emphasizing each word)
Chip for alligator.
12 M. KATHERINE WEINBERG, MARJORIE BEEGHLY, KAREN L. OLSON AND ED TRONICK
Child: (looks away from mom, plays with schoolhouse
and speaks with the same tone, emphasizing each
word) Chip for alligator.
Child: (becomes more engaged with the school house and
tone returns to initial intensity) Chip for alligator.
Child: (plays with schoolhouse for thirty-five seconds,
does not look at mom or say anything).
Reunion Episode
Mother: (leans in and touches toy in schoolhouse) Let’s
see if we can do that.
Child: (moves back from schoolhouse, but still keeps
eyes on the schoolhouse).
Mother: Oh boy, want to have the girl throw it again?
Child: (reaches for small figures in schoolhouse, no eye
contact with mom)
Mother: (leans in to play with the same toys as child)
Have the girl throw it again.
Child: (moves back from schoolhouse, turns body away
from mom to reach for toy and then begins to play
with the schoolhouse again) Almost.
Mother: Almost. See if that person can throw better.
Child: (looks at toy) This one?
Mother: Yea.
Child: (plays with the new toy).
Mother: (reaches for the same toy as the child in the
schoolhouse) Oh.
Child: (leans in and plays with the schoolhouse for ap-
proximately five seconds and speaks with original
tone intensity) Almost.
Transcript 2: Alligator Girl Transcript (3m 31s)
Play Episode (30s)
Mother: (grabs baby doll and toy bathtub) I’m going to
give the baby a bath.
Child: (watches mom).
Mother: (grabs towel) I’m going to wash the baby nice
and clean in the baby bathtub. Then I’m going to wrap
the baby up in the towel, dry the baby’s hair. Rub, rub,
rub, rub, rub (carries out each action she describes).
Child: (laughs and shows alligator to mom) Mom, I got
an alligator.
Child: (laughs) I got a snake.
Child: (turns back to mom and speaks incomprehensibly
with alligator in hand, then turns back to mom and sits
next to her).
Child: (looks at mom) I put a giraffe in the bath.
Mother: A giraffe? I think that’s an alligator (looks at al-
ligator and touches it, while daughter holds it) or a
lizard or something.
Child: (grabs alligator and puts it in mom’s face).
Mother: It’s not a giraffe (mom pretends to scream).
Child: (still holds alligator in mom’s face and laughs and
speaks incomprehensibly).
Mother: (moves alligator away from face and smiles) I
think he wants to eat a hotdog (turns body away from
daughter to get a toy hotdog and gives it to daughter)
Yum, yum, yum.
Child: (takes hotdog from mom’s hand) I’ll give him one.
Mother: You give him the hotdog.
Child: (pretends to feed alligator for and looks at mom)
Yum, yum.
Mother: Yum, yum.
Child: (pretends to feed alligator, hears a knock on the
observational window signaling the start of the still-
face and looks at mom) What was that, Momma?
(looks back at alligator).
Child: (puts alligator down and looks at mom) I think that
was a banging noise.
Mother: (looks away from daughter) No, that wasn’t a
banging noise. That’s okay.
Child: (walks around behind mom, but stops when she
hears a second knock on the window, looks up and
then looks back to mom) I hear noise.
Still Face Episode
Child: (bends down to pick up a toy, turns to face mom,
speaks incomprehensibly, picks up towel and moves
to sit near toy bathtub, speaks incomprehensibly and
looks at bathtub).
Child: I give baby a bath. Will you give her a bath? (im-
mediately after speaking she picks up a gorilla, looks
at it, and holds it in front of mom’s face and makes a
growling noise and smiles).
Child: (moves gorilla closer to mom’s face).
Child: (takes gorilla back, looks at it, and then tries to
give it back to mom) Momma, momma (holds alliga-
tor in front of mom’s face).
Child: Momma, (turns back to mom, bends down to pick
up alligator then turns back to mom, smiles and puts
alligator in mom’s face) Big alligator.
Child: (smiles and holds alligator in front of mom).
Child: (waves alligator in front of mom’s face and speaks
with a slightly escalated tone) Momma.
Child: (holds alligator steady in front of mom’s face and
speaks with the same tone) Momma.
Child: (moves alligator away from mom, looks at mom
and speaks with an escalated tone) Momma!
Child: (moves alligator in front of mom’s face and speaks
with the same tone) Momma!
Child: (tone returns to original intensity) Momma,
Momma, there you go. (moves alligator closer to
mom’s face, alligator touches mom’s nose).
Mother: (turns head away from daughter).
 A Still-face Paradigm for Young Children: 21⁄2 Year-olds’ Reactions to Maternal Unavailability during the Still-face
Child: (turns slightly away from mom, sits down and
looks at baby doll and bathtub) Here, let’s give baby
a bath. You give baby a bath.
Child: (plays with baby doll and bathtub for approxi-
mately seven seconds, does not make any eye contact
with mom).
Child: (plays with toys and speaks with a slightly esca-
lated tone, but does not make eye contact with mom)
You give the baby a bath. You give the baby a bath.
You give the baby a bath.
Child: (looks at mom and speaks with a slightly escalated
tone) You give the baby a bath.
Child: (looks down at toys, then looks up at mom quickly
and then back down to play with toys and speaks with
initial intensity) Will you give baby a bath?
Child: (continues to play with toys, keeps head down and
speaks quietly) Momma, will you give baby a bath
right now?
Child: (still looks at toys and speaks with a slightly esca-
lated tone) You give (looks at mom and stops playing
with toys) baby a bath.
Child: (looks around briefly and speaks with the same
tone) Momma, (looks down, plays with toys and
speaks with original intensity) will you give baby a
bath? Can you give her a bath, Momma?
Child: (smiles and tries to give mom alligator) Here comes
a snake, Momma.
Child: (moves alligator away from mom, hears knock on
the observational window and looks at mom) I don’t
know what that was, Momma.
Reunion Episode
Mother: (looks at daughter and shakes head no) That was
nothing.
Child: (looks away from mom) What was that?
Mother: (looks at daughter) That was nothing, honey.
Child: (looks at mom when mom is speaking, then looks
away, rests head against fist and speaks) What was
that?
Mother: Huh?
Child: (looks down at the ground) I want to see . . .
(incomprehensible).
Mother: (plays with toys while speaking) That was
just, that was just a, that was just a noise. Somebody
in the other room hit the wall. (looks at daughter)
You know how Christopher hits the wall with the
powder?
Child: (looks at toy) Yeah.
Mother: (looks at daughter) Yeah, somebody in the next
room hit the wall by accident.
Child: (looks at toys) I don’t want to bang.
Mother: (shakes head no and turns away to grab cook-
ing utensils) Okay, they won’t bang. (turns back to
13
daughter and shows her cooking utensils) Want to
cook?
Child: (looks at cooking utensils and smiles) Yeah.
Transcript 3: Cuddling Boy (3m 05s)
Play Episode (30s)
Child: (sits with back against mom, leaning on her and
playing with toys).
Mother: (reaches out to son with cup in hand and
watches son’s actions) Here’s your juice. Here you
go (smiles).
Child: (pretends to have dinosaur drink from cup).
Mother: Oh, the dinosaur is going to drink the juice?
Child: (turns head slightly toward mom) Mmm.
Mother: (nods head in agreement) Mmm.
Child: Mmm.
Mother: (smiles and laughs) Good.
Child: (turns head back to toys and puts dinosaur in alli-
gator’s mouth).
Mother: Oh no, the alligator is going to eat the dinosaur
(speaks in a scared voice). Help!
Child: (kisses dinosaur twice) Mwa, mwa.
Mother: (plays with toy truck and speaks) Oh, you gave
the dinosaur a kiss? That’s nice.
Child: (turns head up toward mom nods head in agree-
ment and smiles, then turns head back toward toys).
Still Face Episode
Child: (puts dinosaur in alligator’s mouth and speaks in-
comprehensibly, then turns head back toward mom
and looks at her).
Child: (turns head back towards alligator and continues
to speak incomprehensibly).
Child: (turns head and looks at mom quickly, then turns
back toward toys and speaks incomprehensibly).
Child: (puts dinosaur in mouth, removes it, puts dinosaur
in the alligator’s mouth and speaks incomprehensibly).
Child: (looks down at toys on ground, takes two deep
breaths and yawns).
Child: (speaks incomprehensibly, picks up dinosaur,
turns toward mom, looks at her, holds alligator up to
her face and speaks) Dinosaur. Dinosaur.
Child: (moves dinosaur away from mom, turns away and
looks down at ground) Dinosaur. Dinosaur.
Child: (turns toward mom and holds dinosaur up to
mom’s face) Dinosaur. Dinosaur.
Child: (moves dinosaur away from mom, turns away and
looks down at ground) Dinosaur.
Child: (turns toward mom and holds dinosaur up to
mom’s face) Dinosaur. Dinosaur.
Child: (turns around so that his entire body is facing
mom, has dinosaur in one hand, alligator in the other
14 M. KATHERINE WEINBERG, MARJORIE BEEGHLY, KAREN L. OLSON AND ED TRONICK
and holds them up to mom’s face) Dinosaur. Dino-
saur. Dinosaur. Dinosaur.
Child: (continues to hold alligator and dinosaur close to
mom’s face, looks at mom, remains quiet, then
speaks) Dinosaur.
Child: (moves alligator and dinosaur away from mom’s
face) Dinosaur.
Child: (holds alligator up to mom’s face, looks at mom
and speaks quietly) Dinosaur. Dinosaur. Dinosaur.
Child: (turns head away from mom, then turns back to-
ward her and holds dinosaur close to mom’s face).
Child: (speaks quietly) Dinosaur. Dinosaur. Dinosaur.
Child: (looks down at ground and continues to speak qui-
etly) Dinosaur. Dinosaur.
Child: (places head against mom’s chest and speaks with
original intensity) Dinosaur. Dinosaur.
Child: (moves head away from mom’s chest and looks up
at her) Dinosaur. Dinosaur. Dinosaur. (holds dinosaur
up to mom’s face and continues speaking) Dinosaur.
Dinosaur. Dinosaur.
Child: (moves dinosaur away from mom’s face, puts head
on mom’s chest and speaks with a sad tone). Di-
nosaur. Dinosaur. Dinosaur.
Child: (keeps head on mom’s chest, but turns away so he
is no longer facing her, he also holds dinosaur and al-
ligator close to his body).
Child: (keeps head against mom’s chest, turns back to-
ward her and speaks in a sad tone) Dinosaur. Di-
nosaur. Dinosaur.
Child: (rubs head against mom’s chest and continues to
speak with the same tone) Dinosaur. Dinosaur.
Child: (keeps head against mom’s chest, looks up at
her face and then moves head off mom’s chest up to-
wards mom’s face and speaks in a sad tone) Mommy,
Mommy.
Child: (puts head back against mom’s chest and whim-
pers). I gotta pee.
Child: (moves alligator away from body, turns toward al-
ligator and speaks incomprehensibly).
Child: (holds alligator up to mom’s face and speaks qui-
etly) Alligator.
Child: (moves head off of mom’s chest and speaks with
original intensity) Alligator. Roarrr!
Child: (moves alligator away from mom’s face, looks at
mom and continues speaking with the same tone)
Mommy. Mommy. Mommy. Mommy (each time his
voice becomes quieter).
Child: (turns head away from mom, stands up, looks at
mom, smiles and sits back down on mom’s lap).
Reunion Episode
Mother: (wraps arms around son, smiles and speaks with
positive vocal tone) Hi (child’s name). Are you play-
ing with that toy?
Child: (turns toward mom, holds alligator up to mom’s
face and speaks with initial intensity) Alligator. Alli-
gator. Alligator.
Mother: (reaches for alligator and looks at son) The alli-
gator, what does the alligator do?
Child: It goes mwa. (kisses alligator and smiles).
Mother: Oh, we’ll give him a kiss. Mwa. (kisses alligator).
Child: (smiles and gets off mom’s lap).
Mother: (reaches for toys) What can we make?
Child: (walks toward toys mom is holding, bends down
near her and speaks incomprehensibly).
Mother: Oh, you want to play basketball?
Discussion
This study evaluated similarities and differences in 21⁄2
year-old children’s reactions to the still-face and reunion
episodes of the Toddler Still-Face paradigm (T-SF), com-
pared to those reported for young infants during the Face-
to-Face Still-Face paradigm. Three empirical questions
were addressed that have been evaluated in the infancy
literature but not beyond that age: Is there a still-face ef-
fect, is there a reunion effect, and are there gender differ-
ences in 21⁄2 year-old children’s reactions to the still-face
and reunion episodes of the T-SF? Results confirmed that
the 21⁄2 year-olds displayed the “still-face effect” and that
their behavior during the still-face episode was similar in
several respects to that observed for younger infants.
These results also show that older, more developmentally
mature toddlers continue to react in dramatic ways to
even a brief period of maternal unavailability such as that
afforded by the still-face, and that the still-face continues
to be a powerful and age-appropriate stressor at this age,
one that elicits a variety of affective reactions, regulatory
coping behaviors, and meaning-making.
The infancy literature indicates that young infants
typically react to the still-face with a signature decrease
in positive affect, increase in negative affect, and gaze
aversion, as well as pick-me-up gestures, distancing be-
haviors, and autonomic stress indicators (Adamson &
Frick, 2003b; Toda & Fogel, 1993; Weinberg & Tronick,
1996; Weinberg et al., 1999). In this study, the 21⁄2 year-
olds appeared to be acutely aware that their mother was
not behaving the way she typically behaves. Like their
younger counterparts, the toddlers reacted to the still-face
with an increase in negative affect and gaze aversion as
 A Still-face Paradigm for Young Children: 21⁄2 Year-olds’ Reactions to Maternal Unavailability during the Still-face
indicated by turning their back to the mother. They also
displayed a trend toward a decrease in positive affect
from the first play to the still-face episode. Furthermore,
they displayed a wide array of behaviors indicative of
proximity seeking to the mother, solicitation of her atten-
tion, and avoidance. All in all, a remarkable number of
parallels between young infants’ reactions to the still-face
and toddlers’ reactions to the still-face were observed.
At the same time, toddlers displayed a wider array of
responses and reactions than their younger counterparts,
which reflects the advances in the older children’s social,
cognitive, emotional, and motor development that have
taken place by the third year of life. When confronted
with unexpected maternal unavailability during the still-
face episode, most of the toddlers worked effortfully to
re-establish a connection with the mother (Kopp, 1989).
The majority tried to regain her attention by initiating
joint attention or social interaction with her (e.g., by
showing toys, making verbal requests for action, and re-
peating verbal utterances, which became increasingly
loud and more insistent when the mother did not re-
spond). Repetition of verbal utterances in particular was
a powerful and common reaction during the still-face
episode among these children. Metaphorically, it was as
if the children made sense of their mothers’ sudden un-
availability by assuming their mother didn’t hear them
and that, if they repeated themselves often enough and at
a sufficiently loud volume, the mother would eventually
hear them and respond. The children also moved physi-
cally closer to the mother, touched her, and hugged and
clung to her. Perhaps several of these actions reflected
their need for a feeling of security given that more com-
plex emotional and affective sharing was not possible.
Contrary to our expectations, only a few toddlers pro-
vided verbal explanations for the mother’s behavior dur-
ing the still-face. Understandably these explanations were
based on concrete, direct observations of the mother
rather than on internal self-reflections. The most common
were questions focused on the mother’s presumed physi-
ological state (e.g., sleep/wake state, level of fatigue) such
as “Mom, are you awake?” or “Are you tired?” Rarely ob-
served were self-evaluative explanations that were attrib-
utable to themselves or their prior actions, such as “Did I
do something to cause this?” or “It is my fault.” These re-
sults are consistent with prior reports indicating that while
children in the third year of life read intentions, they are
just beginning to understand the reasons for changes in the
intentions, emotional states, and state of mind of other
people (Bretherton, 1991; Bretherton & Beeghly, 1982).
As has been reported for younger infants, the 21⁄2 year-
olds in this study displayed both approach and avoidance
15
behaviors to the mother during the still-face. On the one
hand, they sought physical proximity to the mother,
touched the mother, and hugged and clung to the mother
during the still-face episode. On the other hand, they also
moved away from the mother and turned their back to her
during the still-face. It is possible that these conflicting
reactions reflect the child’s relationship history with the
mother and that the still-face stressed the child’s sense of
security. In future research it will be important to exam-
ine the relation between the children’s attachment classi-
fications and their reactions to unexpected maternal un-
availability during the still-face episode of the T-SF. In
the infancy literature, significant associations between
infant behavior during the still-face and subsequent at-
tachment classifications have been reported (Braungart-
Reiker, Garwood, Powers, & Wang, 2001; Cohn, Camp-
bell, & Ross, 1991; Kogan & Carter, 1996).
Alternatively, it is possible that maternal unavailabil-
ity during the still-face episode elicits ambivalent reac-
tions in children that may or may not be attributable to
their relationship history. Tronick and colleagues have ar-
gued that the maternal still-face presents the child with a
prolonged mismatch or interactive error that cannot be
repaired by the young child (Tronick, 1989; Tronick
& Cohn, 1989; Tronick & Gianino, 1986; Weinberg &
Tronick, 1996). That is, it is difficult for the toddlers to
make meaning out of what the mother is doing in a con-
sistent way that would give directional intentionality to
their behavior. Thus at one moment, they approach and
try to solicit the mother’s attention, but when it fails, they
withdraw. It appears that they oscillate between making
sense of what she is doing as available and then as un-
available. As such, they are trapped between these two
meanings. Therefore, children may have both a goal of
repairing the interaction and playing (making meaning)
with the mother and a conflicting goal of withdrawing
and avoiding connecting to her. Were the meaning-
making chronically unsuccessful, that is, taking the form
of an entrapment, it would seem to speak to an experien-
tial process that could generate a disorganized attachment
style, which at its core is characterized by children’s fail-
ure to be able to give sustained directional intentionality
to their behavior.
Despite the increase in negative affect (e.g., sad or
angry-toned vocalizations) during the still-face episode,
none of the children cried, although a few showed ag-
gressive or dysregulated behavior such as yelling, hitting
the mom, throwing toys, or engaging in tantrum behavior.
This indicates that the 21⁄2 year-old children in this study
managed to maintain an organized state during the still-
face episode, even though the mother had withdrawn all
16 M. KATHERINE WEINBERG, MARJORIE BEEGHLY, KAREN L. OLSON AND ED TRONICK
forms of regulatory support. These findings indicate just
how much self-regulatory capacity these children have.
This was the case even for the boys who were expected
to show greater dysregulation than girls based on the in-
fancy literature (Weinberg et al., 1999). In addition the
findings showing a low incidence of aggressiveness (e.g.,
hitting mom, throwing toys) and yelling provide some
general support for the idea that typically developing 21⁄2
year-olds are beginning to behave in a manner that is con-
cordant with internalized social standards (Kagan &
Lamb, 1987).
The results of this study also indicate that 21⁄2 year-
olds show a reunion effect following the still-face. Simi-
lar to their younger counterparts, toddlers’ negative affect
increased during the still-face and did not significantly
abate during the subsequent reunion play episode. Fur-
thermore, the rise in the percentage of time they spent
touching the mother and turning their back to the mother,
as well as the frequency of moving away from the mother
during the still-face, did not significantly diminish during
the reunion episodes. In contrast, many other behaviors
that peaked during the still-face returned to first play
(baseline) levels during the reunion episode, including
verbal requests, showing toys to mom, repetition and
escalation of verbal utterances, proximity seeking, and
hugging/clinging to the mother.
These reunion findings are similar to those observed
among young infants (Kogan & Carter, 1996; Rosenblum
et al., 2002; Weinberg & Tronick, 1996; Weinberg et al.,
2006). The findings replicate the oft-observed carryover
effect of negative affect from the still-face to the reunion.
The data also suggest that infants and toddlers alike must
cope with the simultaneous return of maternal interactive
behavior and the negative intra- and interpersonal after-
math of the still-face. In particular, they may have to con-
front a new and confusing situation in which their mother
is now acting normally but was just prior to that acting in
a senseless way. Again, chronic experience with this type
of inconsistency in maternal emotional availability would
likely generate chronic confusion and disrupt children’s
engagement with things and people. The reunion episode
therefore presents researchers with an excellent opportu-
nity to observe the child’s regulatory behavior and ability
to re-negotiate the interaction after the stress and disrup-
tion of the still-face.
Unlike prior reports for infants, and contrary to our
expectations, there were few gender differences in the
toddlers’ reactions to the T-SF. The hypothesis that boys
would show greater dysregulation than girls during the
still-face and reunion episodes was not supported. Rather,
boys and girls were equally likely to show an increase in
negative affect, although very few of either gender exhib-
ited more extreme behaviors such as yelling or hitting.
The gender differences that were observed, however,
were in line with the infancy findings. Across all episodes
of the paradigm, girls were more likely than boys to try
to initiate joint attention with the mother’s attention using
nonverbal means (by showing or giving her a toy), which
is consistent with the younger female infants’ use of ob-
ject engagement as a coping strategy during the Face-to-
Face Still-Face paradigm. In turn, boys were more likely
than girls to elicit social interaction with the mother by
physically touching the mother, which is consistent with
the younger male infants’ greater tendency to elicit the
mother’s attention directly. These differences in the way
the genders attempt to re-connect with the mother are
likely to reflect a complex and dynamic interaction be-
tween genetics and relational history.
These findings also suggest that, by the third year of
life, 21⁄2 year-old boys compared to younger male infants
have become better at regulating their affect and less de-
pendent on the mother as an external source of regula-
tion. Alternatively, it is possible that the still-face is not
sufficiently stressful to elicit greater dysregulation in
boys at this age. A longer duration of the still-face or
other stressful situations focused on age-appropriate de-
velopmental tasks such as autonomy and exploration
(e.g., coping when physical movement is restricted, or
with trying to master a challenging or frustrating toy),
might reveal gender differences at this age.
There are several limitations to this study. First, the
sample consisted only of adult healthy (as opposed to
adolescent or chronically ill) mothers from mostly intact,
middle-class families, and their healthy, typically devel-
oping children. Generalizability of the data is therefore
limited to samples at low medical and socio-demographic
risk status. Future studies on the still-face at older ages
should include more diverse samples of mothers and chil-
dren from different racial and ethnic backgrounds and
with varying social, psychiatric, and medical risk status.
Second, although the sample size is relatively large, the
sample size may have limited the study’s statistical power
to identify gender-related effects on children’s reactions
to the still-face and reunion episodes during the T-SF. The
study also did not examine whether broader child (e.g.,
difficult temperament) or maternal psychosocial factors
(e.g., maternal depression) are associated with individual
differences in boys’ and girls’ reactions during this para-
digm. Finally, the study did not evaluate longitudinal
changes in children’s reactions to the still-face and re-
union episodes over time. It will be important in future
work to assess more specifically the developmental
processes underlying children’s reactions to the still-face
and how toddlers’ coping strategies change over time.
 A Still-face Paradigm for Young Children: 21⁄2 Year-olds’ Reactions to Maternal Unavailability during the Still-face
Despite these limitations, the results from this study
point to how important social and emotional connections
with others continue to be for toddlers during the third
year of life, as has been shown in prior research with
young infants. The data also suggest that the still-face
paradigm, such as the T-SF or other variations of it, may
be a valid and interesting tool to evaluate social connect-
edness beyond infancy. The quantitative findings as well
as the descriptions of toddlers’ reactions to the T-SF sup-
port Tronick’s (2007) hypothesis that the toddlers are at-
tempting to make coherent and complex sense of their
self in relation to others, what he calls a “dyadic biopsy-
chological state of consciousness.” In normal interac-
tions, the meaning is made (co-created) with the partner.
During the still-face, dyadic meaning-making is pre-
vented and the toddler must try to make sense of what is
happening on his or her own. Unlike infants, for whom
the meaning-making must be inferred, toddlers’ meaning
and meaning-making are more explicit. As expressed in
their words, actions, and prosodic vocal changes, the tod-
dlers in a very real sense seem genuinely confused by the
still-face and struggle to make sense of what their moth-
ers are doing. They ask questions and make commands
coordinated with expressive behaviors. These actions are
what Bruner (1990) would call “acts of meaning” or what
Searle (Searle, 1983) might call “speech acts.” They indi-
cate the child’s need to do something together with the
mother in order to feel connected.
Although caution in interpretation of the findings is
warranted, the similarity of the toddlers’ reactions (espe-
cially their non-speech acts of meaning) to younger in-
fants’ meaning-conveying acts support the hypothesis
that infants too are trying to make sense of the maternal
still-face. Of course, the infants are doing it with their
limited developmental capacities that do not include
speech. Furthermore, the similarity of their communica-
tive actions suggests that toddlers conserve as well as
elaborate the meaning-making capacities of infants dur-
ing the still-face. Emde (1984) and Ekman and Oster
(1979) have argued that emotional expressions are con-
served over the entire course of development and suggest
that they may be a universal form of communication that
operates across cultures. We would extend this hypothe-
sis in two ways. We would suggest that there are mean-
ings expressed in emotional displays as well as in other
actions and behaviors, and that this polymorphic array of
meanings and meaning-making systems bridges the de-
velopmental gap between infants and adults, making co-
ordinated action and social connectedness possible
(Fogel, 1993; Fogel et al., 1992).
At the core, our findings regarding toddlers’ reactions
to the still-face demonstrate that they view it as a pertur-
17
bated, senseless situation. As such, its senselessness re-
veals the strategies children use to make sense of it. Just
as importantly, by disrupting meaning-making and seeing
its effects, we become aware of the normal continuous
moment-by-moment process of meaning-making en-
gaged in by all humans—infants, children, adults—as
they attempt to make more sense of the world and them-
selves. Future research focusing more explicitly on the
developmental evolution of children’s meanings and
meaning-making capacities during the still-face from in-
fancy to older ages may provide a fascinating glimpse
into the polymorphic meanings children hold in their
states of consciousness at different ages.
Acknowledgments
Support for this research or manuscript preparation
was provided by grants from the National Institute of
Child Health and Human Development (RO1 HD39737,
RO1 HD048841) and the National Science Foundation
(SBR-9514495). The authors wish to thank the mothers
and children who made this research possible and grate-
fully acknowledge the valuable research assistance of
Henrietta Kernan, Joan Riley Driscoll, Laura Rose, Sarah
Rabbitt, Michelle Burke, Elizabeth Nelson, Regina
Epperhart, and Sarah Partridge. Correspondence con-
cerning this article should be addressed to Ed Tronick,
Child Development Unit, Children’s Hospital, 1295
Boylston Street, Suite 320, Boston, MA 02215; email:
ed.tronick@childrens.harvard.edu.
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20 M. KATHERINE WEINBERG, MARJORIE BEEGHLY, KAREN L. OLSON AND ED TRONICK

Appendix
The Child and Caregiver Mutual Regulation Scoring System (CCMR)
Weinberg, Beeghly, & Tronick, 2003

CHILD AFFECT (all duration codes)

Negative
• Facial expressions of anger, sadness, fear / subdued/withdrawn countenance / puzzled/concerned affect /
negatively toned vocalizations such as crying, whining, complaining, frustration, irritation, annoyance, or
impatience
Interest
• Facial expressions of interest / neutral affect /normal conversational tone of voice
Positive
• Facial expressions of joy (smiling) / positively toned vocalizations (laughing, exuberant squealing, enthusiasm)
• Nonscorable affect: Scored when the child cannot be seen or heard on the video

CHILD ACTIONS (these codes are coded on a frequency basis unless otherwise specified)
Requests
1. Verbal Request: Child requests an action or attention verbally (e.g., child asks mother to play with a toy or to
watch him/her do something “Hey Mommy, watch!” or “Play with me?”)
2. Physical Request: Child requests an action or attention physically (e.g., child pulls mom’s hand,
moves/manipulates her face during the still-face, looks at mom for help)
3. Request Information: Child requests information about a toy, how to do something, or why something is
happening (e.g., “What’s this thing?” or “Mommy, what’s the matter? What’s wrong?”)
4. Request to Leave: Child requests to leave the laboratory room or to go home (e.g., “Mommy, I need to go
potty,” “I want to go home”)
5. Show Toy: Child points to a toy, shows or gives the mother a toy, or puts a toy in the mother’s face/line of
vision
6. Plead: Child pleads with mom to do or stop something (e.g., “Please, Mommy, play with me.”)
7. Repetition: Child repeats verbal utterances. The utterance must occur at least twice (e.g., “Mommy, look at me.
Mommy, look at me”). In this example, the first utterance is coded as a verbal request, and the second as a
Repetition.
8. Escalation: Child exhibits escalating behavior. That is, the child sounds increasingly upset, loud, or insistent.
Explanation
The child provides an explanation or rationalization for why the mother is behaving in a particular manner. For
example: “Mommy, are you tired?” or “Are you awake”?
Active disruptive/aggressive actions
1. Yell: The child yells at the mother or in general.
2. Hit mom: The child throws a toy at the mother or hits the mother.
3. Throw toy: The child throws a toy against the wall, hits toys against each other, or stomps on a toy.
4. Prohibits mom: The child does not want to share, does not want the mother to participate or play with him, or
do something. The child forbids the mother to do something verbally (e.g., “You can’t play with the alligator.
I had it first”; “No”) or non-verbally (e.g., the child shakes his head NO; pulls a toy away from mom).
5. Run Around: The child runs around the laboratory and is not focused on the task at hand.
6. Tantrum: The child exhibits tantrum behavior (e.g., throws herself on floor). This code is often double coded
with other active/disruptive/aggressive codes.
 A Still-face Paradigm for Young Children: 21⁄2 Year-olds’ Reactions to Maternal Unavailability during the Still-face 21

Proximity/contact seeking or avoiding behavior

1. Seeks proximity: The child moves closer to the mother.
2. Touch mom (duration code): The child touches the caregiver or caresses the caregiver in an affectionate manner.
3. Hug/cling (duration code): The child clings to the mother, sits on the mother’s lap, or hugs the mother.
4. Kiss: The child kisses the caregiver. Code any kiss to the caregiver’s body.
5. Turn back to mom (duration code): The child has or turns his back to the caregiver.
6. Moves away: The child moves away from the caregiver or gets off the caregiver’s lap.
7. Leave room: The child goes to the door or tries to open the door.
Self-comforting (duration code)
The child sucks on a thumb or finger(s) or the child rubs her face or twirls her hair.
Self-evaluations
1. Positive evaluation: The child believes that he can do something or expresses pride in an achievement (e.g., the
child claps hands at his own achievement, statements such as “I can do it,” “I did it,” “It’s ok”).
2. Negative evaluation: The child expresses self-doubt, or self-criticism, or believes she cannot do something
(“I cannot do it,” “I cannot deal with this”).

Note. Only the child part of the CCMR is presented here. The entire system is available upon request.

Maternal procedure violations during the toddler still-face paradigm

1. Smile: The mother smiles or laughs during the still-face.
2. Nod: The mother nods or shakes her head during the still-face.
3. Use Toy: The mother accepts or hands a toy to the child during the still-face.
4. Touch: The mother touches the child during the still-face.
5. Talk: The mother talks to the child during the still-face.

As in previous infancy studies, the mothers were coded during the still-face to evaluate whether they violated the
instructions of the still-face. Examples of violations included talking to or touching the child, any affect other than
neutral, and accepting or giving toys.
JDP FORUM
In Search of the Pathways that Lead to Mentally Healthy Children
Stuart G. Shanker
The Milton and Ethel Harris Research Initiative
York University
Toronto, Ontario, Canada
shanker@yorku.ca
A Dynamic Systems Approach
to the Mind/Brain Debate
At the Milton and Ethel Harris Research Initiative, in
York University, we are studying the processes that pro-
mote the development of a healthy mind in young chil-
dren. We look at this issue at both the psychological and
the neurobiological level, and the complex interactions
that take place between the two. This research provides
us with a unique opportunity to explore both sides in the
nature/nurture debate, but given that our mandate is to
benefit children in very practical ways, we can never
allow ourselves to get lost in the thickets of this inter-
minable philosophical debate. Our goal is to understand
the interaction between psychological and neurobiologi-
cal processes in order to identify and mitigate potential
problems as early as possible, and to enhance the devel-
opment of healthy minds in all children.
Whenever one encounters a protracted philosophical
debate that periodically swings from one polarity to an-
other, one can be fairly certain that the problem is not that
both sides are wrong but rather, that both are partially
right. The challenge is, of course, to find some way of
reconciling and assimilating these competing views. But
until a new framework emerges that is capable of such a
feat, calls for a synthesis are doomed to remain at the
level of rhetoric.
There is no end of examples of this Hegelian scenario
in the human sciences, but none more telling than the
mind/brain debate, which has dominated Western think-
ing about human functioning since the writings of Plato.
To be sure, the technical details have grown considerably
more sophisticated, but the fundamental issue has re-
mained the same from the time of the ancient Greeks:
either, as Plato argued, the mind shapes the brain, or, as
Hippocrates insisted, the brain shapes the mind.
22
Such problems are the special province of philoso-
phy, and for that reason alone, a source of unease
amongst some scientists. From the very beginning the
worry has been expressed—not infrequently by philoso-
phers themselves—that the resolution of these problems
will amount to little more than an “idle tea-time amuse-
ment” (Russell, 1957). But these problems can have
enormously important practical as well as theoretical
consequences.
For example, the mind/brain debate has profound im-
plications for how developmental disorders are treated.
Whereas those who accentuate the nurturing side of child
development tend to dwell on the possibility of tailoring
a child’s experiences in such a way as to restore a mal-
functioning neural system, those who place the emphasis
on the child’s biological heritage often focus on the need
for medications or other prosthetics and see the role of in-
tervention as that of recruiting some different part of the
brain to perform (as best it can) an operation that has
been compromised by a defective neural system. These
different attitudes not only have a significant impact on
the child and her family, but indeed, on the scientific
view of the possibility of mitigating, and perhaps one day
preventing, a broad range of developmental, psychologi-
cal, and behavioral disorders.
There is a growing sense today, however, that we
have finally seen the emergence of a framework that is
indeed capable of synthesizing both sides in the mind/
brain debate: of understanding how psychological and
neurobiological processes influence each other, and how
the relationship between them grows over time (Fogel,
1993). Broadly speaking, the new framework is that of
dynamic systems theory, which, in place of linear models
that postulate a direct relationship between cause and ef-
fect, looks at how multiple factors affect each other in
mutual and simultaneous ways, looking, in particular, at
 In Search of the Pathways that Lead to Mentally Healthy Children
the relationship between elements in a system and how
that relationship changes over time (Fogel, King, &
Shanker, 2008).
How does one apply this paradigm to the mind/brain
problem? Does it simply mean that mind is situated at
one level in a developmental system and brain at another,
alongside other levels such as family, community, and
culture? If that were the case, then one would still be left
with the age-old problem, so conspicuous in Descartes’
famous musings about the role of the pineal gland, of ex-
plaining exactly how the two levels actually interact
when they are supposed to belong to different ontological
domains.
An important step forward in answering this question
was taken with the advent of epigenetics: the biological
theory that there is a control system of switches that turn
genes on or off. The basic idea here is that early social ex-
periences can control these switches and cause heritable
effects in humans (Weaver et al., 2004). Dynamic sys-
tems theorists working in molecular biology then took
this idea a critical step further with the argument that “At
each level of the developmental system, the effect of any
level of influence is dependent on the rest of the system,
making all factors potentially interdependent and mutu-
ally constraining.” Hence “The minimum unit for devel-
opmental analysis must be the developmental system,
comprised of both the organism and the set of physical,
biological, and social factors with which it interacts over
the course of development” (Gottlieb, Wahlsten, & Lick-
liter, 1998).
For those working in the area of abnormal develop-
ment, the most important implication of this argument is
that children are not born with a developmental or psy-
chological disorder: i.e., there is not an ADHD or an
autism gene, in the way that generative linguists once
speculated that there might be a language gene (Shanker,
2002). Nor can one trace these disorders back to a single
episode or event, such as a genetic mutation, or a gene
being “turned off” by adverse experiences, or an inocula-
tion or infection. Rather, ADHD and autism are seen as
complex downstream disorders, the result of initial neu-
rogenetic and/or epigenetic factors that set the child on a
developmental trajectory leading towards the disorder.
Herein lies the basic picture that underlies the manner
in which we designed MEHRI, with half of our resources
devoted to studying the effects of early intervention on a
child’s psychological development and half of our re-
sources looking simultaneously at the development of the
child’s brain. (For a fuller description of our studies, see
www.mehri.ca.) Our thinking is grounded in a develop-
mental pathways model, whose basic principle, as we
shall see in more detail below, is that initial neurobiolog-
23
ical deficits—which might be the result of genetic and/or
social-environmental factors—can strongly influence the
kinds of interactive experiences that a child seeks out or
to which she is receptive, which in turn can have a dra-
matic impact on the development of increasingly special-
ized neural systems.
What we are studying at MEHRI, therefore, is how
the synthesis of social-emotional experience and neurobi-
ology leads to a developmental trajectory that becomes
ever more entrenched, so that by the time a child enters
school it can be difficult to alter. The better we can iden-
tify the steps involved in these trajectories the better we
can design treatment methods that promote mental health
and help mitigate the disorder by addressing, and we
hope reducing, the child’s and/or caregiver’s maladaptive
strategies. Similarly, the better we can understand the
pathways that lead to enhanced attention, concentration,
self-regulation, social understanding, and empathy, the
better we can tailor a child’s individual experiences to
maximize his or her development of these and related
capacities.
Understanding “Healthy Mental Functioning”
As mentioned earlier, we are primarily interested in
the capacities that children need in order to flourish in a
modern school environment; what sorts of experiences
promote the development of these capacities; what sorts
of biological and/or social factors can undermine or im-
pede these experiences; and the extent to which such
deficits or constrictions can be mitigated and the child re-
turned to a healthier developmental trajectory. But before
one can begin to study these processes one first has to
clarify what one understands by a healthy mind, which, to
say the least, is a challenging matter.
One problem is simply that what constitutes “healthy
mental functioning” might vary according to the contin-
gencies of the environment. For example, we now know
that elevated levels of cortisol early in life contribute to
poor physical and mental health in adulthood (Flinn &
Leone, 2006; Gunnar, 2007). Yet one can imagine situa-
tions in which elevated cortisol levels in the early years
might be adaptive, given the nature of the environment
into which the child is born (see Ledoux & Phelps, 2000).
If one of the defining features of health is simply what-
ever is conducive to survival, then it might well be the
case that mechanisms that promote the survival of the
young with potentially negative physical and/or mental
consequences later in life would be deemed healthy.
Another problem is that some of the children that we
see have enhanced abilities in a selected area. In some
24 STUART G. SHANKER
circumstances such an island of expertise might be highly
valued, yet such heightened abilities can also lead to
undesirable consequences in the child’s overall mental
functioning (Howe, 1989). For example, some children
with autism have a heightened ability to match and dis-
criminate stimuli, but this can cause problems in how
they form categories: especially if it leads them to con-
struct overly narrow categories, which can, for example,
disrupt their ability to make sense out of the variability
inherent in the speech stream.
The problem becomes even more serious if the skill in
question should happen to be one that caregivers value
above all other aspects of the child’s well-being. The ex-
ample of the castrati immediately comes to mind: i.e., the
practice of castrating young boys before puberty in 18th
century Italy in order to preserve their ability to sing so-
prano or mezzo-soprano. But perhaps similar forms of
abuse are evident in young children today who demon-
strate a precocious musical or athletic talent and are im-
mediately subjected to a training regimen that sacrifices
crucial aspects of the child’s overall social and emotional
functioning.
In more general terms, we are confronted here with
the problem that the manner in which one conceptualizes
a healthy mind is inextricably bound up with one’s social
values. For example, one culture might prize the capac-
ity to repress one’s emotions, whereas another might
value their expression. One culture might stress the im-
portance of empathy, while another see this as a symp-
tom of moral weakness (Harkness et al., 2007). One cul-
ture might embrace as one of its defining values that no
child should be left behind, while another might adopt a
social Darwinist program of educational streaming based
on natural selection.
Many of these problems are really a version of the
classical dilemma that has plagued cultural anthropology
from its inception: namely, whether there are any univer-
sals of healthy mental functioning. Closely related is the
objection, made famous by R.D. Laing, that even to speak
of a healthy mind is to imply that there is such a thing as
a diseased mind, as opposed to the much more anodyne
claim that there are simply different kinds of minds.
Laing was, of course, concerned with the manner in
which individuals diagnosed with a mental disorder are
stigmatized as ill simply because their behavior departs
from a society’s accepted norms of behavior. It is hard
not to be sympathetic with the humanist animus inspiring
this argument, especially in light of the further entrench-
ment of the medical model of mental illness that has
taken place since the publication of The Divided Self
(see PDM Task Force, 2006). But given our mandate at
MEHRI to help children—all children—flourish in
school, we have set out to identify the pathways that lead
to their cognitive, communicative, social, emotional, and
physical well-being when they enter this challenging en-
vironment; the factors that impede or cause deviations
from these pathways; and the experiences that can miti-
gate the developmental consequences of these deviations.
Plato and the Search for Eudaimonia
The very assumption that there is such a thing as a
healthy mind, and that it is in a society’s best interest to
study the ways it can best promote its development in
young children, is one of the oldest and, in some ways,
constitutive themes in Western thinking about the mind.
It dates back to the Ancient Greeks, and most notably,
Plato. Over and over Plato compared mental with physi-
cal health so as to question what would constitute mental
health and how one would attain such a state, which Plato
himself saw as one of balance (Cooper & Hutchinson,
1977). He argued that, just as someone who eats and ex-
ercises properly will experience “physical health,” so too
someone who tempers his appetites and desires, enjoys
relationships of social intimacy, and is unafraid of death,
will “flourish.”
At the heart of the psychological as well as philosoph-
ical revolution that Plato instituted was his attempt to for-
mulate a model for the development of a child’s mind
such as would lead to this overall state of health. Plato
was every bit as aware of the intimate relationship be-
tween physical and mental health as any contemporary
scientist writing on the subject (see Cotman, Berchtold,
& Christie, 2007; Cotman & Berchtold, 2002; Brene et
al., 2007). Indeed, Plato was perhaps the first to examine
the complex interplay between innate character traits and
the effects of different types of caregiving practices on
such a temperament (cf. Kagan, 1994), where the ulti-
mate goal is to understand which type of upbringing is
best suited to which type of personality in order to maxi-
mize that individual’s capacity to enjoy a state of eudai-
monia: of flourishing or happiness.
Over the past two millennia there have been endless
debates as to how to define eudaimonia. However much
one might wish to avoid being dragged into this philo-
sophical quagmire, the reality is that one cannot begin to
study the processes that promote the development of a
healthy mind without having formed some position on
this foundational issue. So while we were developing our
psychological and neuroscientific tools at MEHRI, we
found ourselves engaged in a classic philosophical in-
 In Search of the Pathways that Lead to Mentally Healthy Children
quiry into what sorts of capacities constitute healthy
mental functioning, within the parameters of modern
post-industrial society.
The notion of functional/emotional capacities is cen-
tral to our view of healthy mental functioning (Greenspan
& Shanker, 2004). The capacities that we have in mind are
those that enable a child to master her emotions and thus
attend to the world (i.e., those that are grouped together
under the rubrics of emotion- and self-regulation and ex-
ecutive functioning); to form a strong attachment with her
primary caregivers; to engage in back-and-forth commu-
nicative interactions with her caregivers, which involves
the development of intentional or purposeful behavior; to
engage in sustained, joint problem-solving with her care-
givers; and then, to develop symbolic and language capac-
ities and the capacity to think logically and reflectively.
Accordingly, we are not so much interested in how many
facts a child might have memorized when she enters
school, or even in a number of specific skills that can be
formally measured, but rather, in her capacity to rise to the
challenges to which she will be exposed (see Kirp, 2007).
To understand the importance of this point, one need
only consider the pace at which technology is evolving.
For example, the speed at which information is now dis-
seminated and becomes outmoded may seriously test the
limits of a mind that is capable of coping with simpler
processing demands. Whereas an earlier culture might
have focused on developing memorization skills, it now
seems imperative to develop more creative “tools of
mind” (to use Vygotsky’s term) to deal with the chal-
lenges of the future. But then, the import of this last point
is that we should indeed be more concerned with devel-
oping the whole child and not some narrow aspect of the
child’s academic performance such as can be easily
measured by formal testing. This, we came to believe,
was Plato’s greatest insight when he came to focus on the
importance of eudaimonia: the capacity to rise to the
challenges that one will be faced with, which, in the mod-
ern world, are changing at a pace that even a generation
ago could scarcely have been envisaged.
The Capacities That a Child Needs
in Order to Flourish Today
Over the past century, there has been a massive shift
in developed nations from rural to urban living. There is
a growing concern amongst scientists studying this phe-
nomenon that such a transformation brings with it all
sorts of challenges that test a mind that might have coped
fairly well in a more rustic setting, but is stressed by an
25
urban environment.1 Those studying the impact of these
changes on children in Canada and the US have ex-
pressed concerns for example, over the number of visual,
auditory, social stressors in cities (see Field, 2007); by the
shortage of green spaces and nature-based experiences
(see Kahn & Kellert, 2002); by the decline in exercise as
it becomes problematic for children to walk to school, or
to exercise while at school (see Franco et al., 2007); by
changing family and social patterns (see Mustard, Mc-
Cain, & Shanker, 2007); changing leisure pursuits, eating
and sleeping patterns (Olfman, 2005); and so on.
The important point to bear in mind here is that these
challenges that the child must deal with range across a
number of domains, many of which are easy to overlook
if one’s focus is too narrowly cognitive. For example, one
of the hardest challenges many children experience is the
first day of school. Accustomed to the security of being
alone with their primary caregiver, or in a small group
setting, the child suddenly finds herself thrust into a room
filled with noisy children, many of whom are feeling
equally overwhelmed. Children vary in all sorts of ways
and have all sorts of sensory likes and dislikes, all sorts
of interaction preferences and aversions. If the child has
come from a nurturing environment, her parents have
learned what sorts of experiences best help her to stay
regulated. The transition from this warm and highly
personalized environment to a classroom can be quite
overwhelming.
Not only must the child quickly adjust to these new
surroundings, but she must also become attached to an
adult that, whether we acknowledge the point or not, is
now going to play the role of surrogate parent for a sig-
nificant proportion of the child’s weekday life. Even in
the best of circumstances the child can only expect to get
a fraction of her teacher’s attention. Meanwhile, she is
expected to understand and conform to the rules of class-
room behavior, all the while attempting to master myriad
new concepts and skills that many of those around her
may seem to acquire with ease.
In order to be able to rise to such challenges, the child
has to be able to maintain a calm and regulated state in
different environments and to settle herself when she be-
comes anxious or frightened. She needs to learn how to
1. We can get some idea of these trends from the latest Government of
Canada Report (2006) on “The Well Being of Canada’s Young Children.”
In 2002/2003, 16.7% of Canada’s children 2–5 years of age displayed signs
associated with emotional problems. This is up from 13.8% in the year
1998/1999. In 2002/2003, 12.7% of children 2–5 years living in rural areas
were reported to have emotional problems, versus 17.2% of children in
urban centers. In 2002/2003, 7.7% of male children living in urban centers
were reported to display signs of hyperactivity and inattention versus 5.15
of rural males.
26 STUART G. SHANKER
control her emotional outbursts, and if she is to mix com-
fortably with other children and take an active role in so-
cial interactions, she needs to understand what they are
thinking and feeling.
These “mindreading” abilities are clearly not innate;
nor are they simply a function of social/cognitive de-
velopment (Legerstee, 2005). To be capable of acting in
a warm and empathetic manner with her peers, a child
needs to experience such warmth and empathy, and she
needs to confront a broad range of new emotions. All
young children find certain emotions frightening or
overpowering, depending on the circumstances of their
upbringing. For example, a single or sheltered child who
has never had to deal with competition or aggression
finds herself on a steep learning curve as she struggles to
navigate her way through the minefields of playground
politics.
In the classroom proper the child needs to be able to
attend to a lesson for a relatively long period of time and
inhibit distractions, of which there are likely to be far
more than to which he is accustomed. The child can’t be
self-absorbed or retreat into some private interest, like a
Gameboy, that keeps him quiet for hours on end. Further-
more, he has to be able to recognize patterns and solve
problems in different domains, and to sequence his
thoughts and remember what he has learned. He also
needs to be able to work independently, deal with frustra-
tion, and above all, be curious and eager to acquire new
information and develop new interests.
In the area of language development, the child should
be able to understand and use a broad range of nonverbal
affect signals (e.g., facial expressions, gestures, posture),
and be competent in more formal areas, such as using and
understanding sentences that include subordinate clauses,
passive constructions, and inflectional endings. She has
to be able to ask appropriate “wh” questions, and not only
respond appropriately to what others say, but most impor-
tantly, initiate conversations and express, report, de-
scribe, etc., her intentions, desires, beliefs. It is also vital
that she is able to engage in a reciprocal flow of conver-
sation and know the basic principles of repair strategies.
There has been a tendency, when looking at a child’s
cognitive development at school-entry, to focus on very
concrete skills, such as the number of color words that
the child has mastered; or whether she is starting to count
and to understand the simple application of numbers; or
to read and write simple words. But when one is thinking
of the development of the whole child, there are a num-
ber of foundational cognitive skills that are absolutely
vital. For example, the child should be able to focus on a
problem, restrain his impulses, form a step-by-step solu-
tion and stick to it; he should be able to build logical
bridges between ideas; he should be engaging in complex
symbolic play; and he should be able to distinguish be-
tween fantasy and reality.
And, of course, Plato was right: one cannot ignore the
physical dimension in all this. The child has to be able to
deal with the physical demands of a school day and the
inner resources necessary to spend so much time on her
own in the equally demanding contexts of the classroom
and the playground. The child needs to be developing
both her fine and gross motor skills, and, as a number of
studies have established, she should have developed good
sleep, hygiene, exercise, and eating habits. The child also
needs to learn how to deal with frustration and to develop
a strong sense of working cooperatively with others,
skills that are in part developed through sports. It is no
surprise that those societies that have laid the greatest
stress on communal forms of physical activity have also
seen the greatest successes in the language, cognitive,
and social development of their children (e.g., Sweden
and Cuba are two outstanding examples of this point: see
Lagerberg, 2005).
In Pursuit of a Normative Model
of Healthy Development
None of the capacities outlined above is a zero-sum
phenomenon, i.e., a matter of a child either having or not
having such-and-such a skill. Rather, a child’s capacities
vary in all sorts of subtle ways—both within and across
domains and according to different situations. Moreover,
the child’s capacities vary according to both endogenous
and exogenous factors: for example, how the child is
feeling; how well she has slept; whether she has had a nu-
tritious breakfast; the nature of the classroom environ-
ment; how warm and nurturing the teacher is; and so on.
For us, one of the most important points is simply that
the development of these abilities is not a maturational
phenomenon, even though, to be sure, genetic and bio-
logical factors play an enormously important role. But we
have learned from cases of extreme neglect that if a child
is deprived of warm, nurturing experiences in the early
years of life this can have a devastating effect on the
development of these core capacities (Greenspan &
Shanker, 2004). Furthermore, recent experiments with
rats and monkeys illustrate that early nurturing and stim-
ulation influence the expression of genes and can even
modify genetic codes that are passed along to the next
generation (Roma et al., 2006).
Nor does one want to say that there is some single or
genetically-controlled pathway to healthy mental func-
tioning. Children vary in myriad ways in terms of their
sensory and regulatory proclivities, or their individual
strengths and weaknesses in processing different kinds of
 In Search of the Pathways that Lead to Mentally Healthy Children
information. Hence even if we can identify milestones of
healthy mental functioning in a 5-year-old, children may
arrive at this state by a unique and highly idiosyncratic
manner, where the experiences that they undergo play a
pivotal role in the development of their cognitive, com-
municative, social, and emotional abilities.
This last point has profound implications for our ef-
forts to develop a normative model of healthy develop-
ment. It means that we must not assume that there is a
unilinear causal relationship between a psychological/
neurobiological state observed at, say, 18 months or in a
3-year-old, and the capacities that the child demonstrates
at 5 years of age, for the abilities of the 5-year-old are
downstream effects of her intervening experiences. To be
sure, certain biological factors may strongly influence the
kinds of experiences that the child undergoes; but by no
means is this trajectory inalterably fixed in advance. In-
deed, the whole point of trying to detect biological, so-
cial, and/or environmental factors that might compromise
healthy functioning as early as possible is to design treat-
ment methods that restore a child to a healthy develop-
mental trajectory.
And that raises a crucial question in its own right—
namely, how exactly can we conceptualize the relation-
ship between the development of the mind and the devel-
opment of the brain so that we avoid falling back into all
the old patterns of thinking about the interaction between
nature and nurture? We know that neurobiological pro-
cesses and structures strongly influence our mental de-
velopment (Tucker, 2007; Kagan & Herschkowitz,
2005). But we also know that a child’s growing levels of
consciousness cannot be explained by neurophysiologi-
cal processes alone, or as the result of a genetic blueprint;
for in a fundamental sense, the development of the child’s
mind is heavily influenced by her social-emotional inter-
actions (Greenspan & Shanker, in press).
One of the most important theoretical questions that
drive our research at MEHRI, therefore, is how these
social-emotional interactions that develop the mind
thereby affect the development of the brain, which is
forced to meet the demands of increasingly complex
social-emotional relations. After all, we may be the
species with the most developed prefrontal cortex, but
what make us human are the experiences that promote the
growth and functioning of this prefrontal cortex.
Developmental Pathways
As has been stressed throughout this article, MEHRI
has been designed in such a way as to study the pathways
that lead to mental health at both the psychological and
the neurobiological level. The purpose here is not to look
27
for correlations between these two levels but rather, inter-
actions between them. In recent years developmental
neuroscientists have been exploring the notion of “cas-
cading constraints” as a means of understanding this
interaction. The idea here is that some biological event
during a sensitive period modifies brain circuits in funda-
mental ways, causing neural pathways to become highly
stable and thereafter difficult to change. These changes in
the cortex and subcortex are said to involve a loss of “de-
velopmental freedom,” and in that sense, “constrain” the
scope of future developmental possibilities (Lewis, 2005;
Knudsen, 2004).
Following a study by MEHRI’s Director of Neuro-
science, however, which showed that an intensive ther-
apy program on aggressive 8–12 year-olds produced
striking neurological changes in a significant number of
the subjects (Stieben et al., 2007), we have become very
mindful that to speak of “cascading constraints” is not at
all the same thing as to speak of “cascading closures.”
Granted, the more entrenched a neural pattern becomes,
the more effort required to promote a neural reorganiza-
tion. Yet, every day we are learning more about the on-
going plasticity of the brain and the kinds of experiences
that can tap into this potential (see Doidge, 2006).
It is for this reason that we were drawn to Peter
Mundy’s neurodevelopmental pathways model (Mundy
& Burnette, 2005). As noted earlier, the basic principle of
this model is that an initial biological event can have a
powerful effect on the kinds of social experiences that a
child is receptive to or seeks out, which may further re-
duce the input to certain neural systems whose develop-
ment hinges on these social experiences. That does not
mean that it is impossible for the child to engage in the
sorts of experiences that provide these neural systems
with the needed input.
To take a case in point, and something that we study
closely at MEHRI, there is a part of the brain, the
fusiform gyrus, which is critically involved in our ability
to read facial expressions of emotion. Not surprisingly,
when imaging studies were conducted on adult subjects
with autism, it was discovered that there was a striking
lack of activity in this part of the brain. This led re-
searchers to question whether autism was somehow the
result of a genetic malfunction in the fusiform gyrus or
some lower system feeding into the fusiform gyrus
(Baron-Cohen, 1995). A dramatic discovery by Morton
Gernsbacher and her colleagues at the University of Min-
nesota revealed a more complex developmental picture
(Gernsbacher et al., 2003).
Adults with autism were shown photographs of actors
displaying happiness, anger, or fear. Half of the photo-
graphs had the agent’s eyes looking straight ahead and
half had their eyes averted. There was indeed a significant
28
Dynamic Systems Developmental Neurological Model of ASD
(e.g., Amygdala and faces)
0-6 months
Social
Neurological
Orienting
Deficit/
- Reading emotions
Neural Joint Attention/initiation
Development deficit
Upstream
deficits
6-12 months
(e.g., social communication)
Closed windows of opportunity lead to strengthening of the disorder
diminishment in the activation of their right fusiform
gyrus, along with a significant increase in the activation of
centers involved in conflict monitoring and the detection
of threat, when these subjects viewed the eyes-straight-
ahead photographs. But there was no comparable effect
when the subjects viewed the photographs in which the
actors’ eyes were averted. Thus, the Gernsbacher study
suggests that subjects with autism avert their gaze in order
to reduce the stress that is created in direct social encoun-
ters. That is, the explanation for this behavior would
appear to lie in sensory over-reactivity to social/visual
stimuli, not in a genetic malfunction of a dedicated face-
processing system.
The upshot of this way of thinking, then, is that an ini-
tial neurological deficit constrains the child’s dyadic in-
teractions, which results in reduced social input and
thence decreased activation of specialized systems for
functions like face processing, reading emotions, social
orienting, and social motivation, which in turn constrains
the child’s capacity to engage in these very social interac-
tions and has other measurable effects on brain develop-
ment.2 We have shown elsewhere (Greenspan & Shanker,
2004) how these dyadic interactions are critical for the
development of the neurobiological systems that under-
pin a child’s social, emotional, cognitive, and commu-
2. Adapting the model from Mundy & Burnette (2005), Jim Stieben,
Director of Neuroscience at MEHRI, has developed the above flow chart to
depict this model.
STUART G. SHANKER
“Downstream” Neurobehavioral Disorganization
Decreased specialization/activation of
n eural areas for:
Face processing
Reduced Social orienting/Joint attention
Social Reward systems
input Social motivation (approach - social initiations)
Less Greater brain
Neural Pruning/ Volume?
connectivity
Core Deficit Model (adapted from Mundy et al., 2005)
nicative development. A neurobiological deficit at birth
or in the early years that obstructs these interactive expe-
riences can result in a reduction of the input on which the
development of these systems depends. If these neural
systems are deprived of the input needed for their devel-
opment, this can further impinge on the child’s willing-
ness or ability to engage in the necessary social experi-
ences, resulting in a further constriction in the network of
capacities necessary for healthy development (Sega-
lowitz & Schmidt, 2007).
Understanding the Causes
of ADHD and Autism
Recent advances in the study of ADHD and Autism
Spectrum Disorders (ASD) provide vivid examples of the
promise that the developmental pathways approach holds
out for the early identification and mitigation of these dis-
orders. It is important to begin any such discussion with
a note of caution, however, given that we are dealing with
spectrum disorders that range from the moderate to the
severe and can have quite different symptomologies. This
heterogeneity not only makes it difficult to conduct accu-
rate prevalence studies, but further complicates any at-
tempt to develop a unitary causal model of the disorder.
Furthermore, there is always the concern that we might
be “over-pathologizing” some cases, i.e., treating as a
 In Search of the Pathways that Lead to Mentally Healthy Children
medical condition what might, in some instances, be a
fairly common behavior that only becomes problematic
because of current social conditions or demands. This is
a particularly worrying issue with children diagnosed as
having ADHD when their restlessness may in large part
be due to a lack of physical activity and the strain of sit-
ting for too long in a classroom (see Louv, 2005).
When one speaks about the causes of ADHD or
autism, therefore, one may only be referring to a subset
of the large number of children diagnosed with these dis-
orders (currently estimated to be between 7–12% in the
case of ADHD and .66%–1% for autism). Children who
are prone to risk taking and impulsivity tend to be under-
reactive to sensations of touch and sound and thus crave
a lot of sensations in order to obtain more feeling tone in
their bodies. These children often have problems with
motor planning and sequencing. That is, they can’t se-
quence many actions in a row and they might have a hard
time sequencing their thoughts.
Sagvolden has recently postulated that a shortage of
dopamine—a neurohormone that supports the ability to
wait for a reward—might also be a critical factor in the
development of ADHD (Sagvolden, Johansen, Aase, &
Russell, 2005). Sagvolden’s model has stimulated con-
siderable interest in the question whether, if a child is
born with a short version of the genes involved in the pro-
duction of dopamine, there is a heightened risk that these
might be turned off (e.g., by heightened stress), with the
result that the child has a shortage of dopamine and thus
experiences delay as aversive (see Rueda, Rothbart, Mc-
Candliss, Saccomanno, & Posner, 2007). Such a child
would then be prone to engage in behaviors that favor im-
mediate reward, leading ultimately to the symptoms that
characterize ADHD.
As Sagvolden himself stresses, the challenge that we
face here from a dynamic systems perspective is that we
do not allow this hypothesis to relapse into a mode of lin-
ear causal thinking. What Sagvolden’s “hypo-dopamine”
hypothesis draws attention to is how an early biological
factor can have an enormous impact on child-caregiver
interactions. If no effort is made to lengthen the time-
frame in which a reward must be delivered in order for it
to be associated with a behavior, or to help the child deal
with distractions, or to help the child develop the capac-
ity to self-organize and see a task through to completion,
then the child’s craving for instant gratification could
well result in a lack of input to the parts of the brain reg-
ulating attentional control. This outcome might be espe-
cially true in the case of a highly anxious caregiver who
perhaps himself suffers from a shortage of dopamine and
thus responds to his child’s delay aversion by constantly
catering to the child’s need for rapid gratification, thereby
29
exacerbating the under-development of the parts of the
brain that help regulate the time window in which a be-
havior can be associated with a reward.
A comparable scenario applies to autism. A child
who, for example, is hypersensitive to visual and audi-
tory stimuli may find dyadic interactions highly stressful,
even aversive, and withdraw into himself in order to
avoid the very interactions that are so critical for the de-
velopment of his so-called social brain. For example, as
indicated earlier, the child may gaze-avert to reduce the
stress of social encounters, thereby depriving circuits that
comprise the social brain of the input they need to func-
tion automatically, beneath the threshold of conscious re-
flection (Ledoux, 1996). A child may also perseverate on
an action, or engage in self-stimulatory behaviors in an
attempt to reduce his anxiety. Such children are not born
with autism, therefore, but one can certainly see how a
serious biological deficit can significantly constrain the
child’s social experiences and thereby lead to a reduced
input of the information that is necessary for activation of
the neural areas involved in face processing, reading
emotions, social orienting, and social motivation.
The fact that a pronounced dopamine deficit or prob-
lems in sensory regulation can have a profound effect on
the child’s interactive experiences hardly entails, how-
ever, that a biological event early in life sets the child on
an unalterable developmental trajectory. The important
point here is that these biological conditions impinge on,
but they do not prohibit, the sorts of social interactions
that are so critical for the development of the mind and of
the brain, as we are learning from recent advances in the
treatment of developmental disorders. For example,
Adele Diamond reported in Science (Diamond, 2007)
that a preschool program that uses dramatic play, visual
aids, and peer interaction during reading and math in-
struction to teach children with ADHD important cogni-
tive and social-emotional skills had a powerful effect on
enhancing their ability to screen out distractions, to resist
responding impulsively to a question, and to think cre-
atively and reflectively (Diamond, Barnett, Thomas, &
Munro, 2007; see also Rueda, Rothbart, McCandliss,
Saccomanno, & Posner, 2005; Kerns, Esso, & Thomp-
son, 1999). Similarly, the therapists working with young
children with autism at MEHRI are exploring whether,
through heightened affect, and working within the child’s
zone of proximal development, it is possible to woo a
child who finds social interaction stressful into engaging
in these interactions, with the result that the systems com-
prising the social brain begin to acquire their necessary
inputs and the child attends to the world around them.
Furthermore, it turns out that affect plays a critical
intermediary role between these different levels. At any
30 STUART G. SHANKER
given point of development, the child’s brain may con-
strain what is possible in her zone of proximal develop-
ment, but it is the child’s motivation, interest, curiosity,
pleasure, etc. that enable her to exert the effort required
for that next step in development, which in turn forces her
brain to develop the new connections needed for the task
at hand. The hope here is that even a child who starts out
life with a severe biological impairment can, if wooed
into the experiences necessary for the growth of the mind,
begin to attend to her caregiver and the world, regulate
her own emotions and arousal state, form warm affective
relationships, engage in back-and-forth interactions and
social problem-solving, master symbols and words, and
begin to think logically (i.e., go through the stages of
healthy mental development that are needed to provide
the various parts of the brain involved in these tasks with
the input that lays down the connections that will open up
her universe of future developmental possibilities).
A further note of caution follows from all this. It has
become commonplace for epidemiologists who are inter-
ested in the effects of epigenetic events on a child’s de-
velopmental trajectory to speak about a child being “at
greater risk” for such-and-such an outcome should such-
and-such a gene be turned off or on. The reason for this
cautious language is that these studies are performed on
large populations in which one is looking for correlations
between a biological marker and a mental or physical
health outcome. But for a developmental scientist, the
devil lies in the details: not in an intervening variable, but
in the child’s intervening life experiences.
An important example of this point can be found in a
ground-breaking study by Avshalom Caspi, who discov-
ered a significant correlation in the Dunedin birth cohort3
between the short gene for serotonin production and an
increased risk of adult depression (Caspi et al., 2003).
But as Caspi and his colleagues were careful to warn, we
cannot jump from this discovery to the conclusion that
there is a linear relationship between this early genetic
event and the adult’s mental health; for one thing, the
child’s nurturing experiences clearly have a critical role
on his resilience and his later susceptibility to depression.
What we need to understand, then, is the relationship
between early biological states and how they may influ-
ence or constrain the kinds of social experiences that the
child undergoes. Herein lies the basic point that tends to
get lost in all the talk about how a child with such-and-
such a short allele is at greater risk for such-and-such an
3. The Dunedin Longitudinal Study began with a study of 1037 peo-
ple born in Dunedin New Zealand between 1972 and 1973. Some of the
major findings from this ongoing study were published in From Child to
Adult: Dunedin Multidisciplinary Health and Development Study (1996).
outcome; for what this qualifier really means is that be-
tween an epigenetic event and a downstream outcome are
countless interactions that enhance or inhibit the develop-
ment of those neural systems that, in adults suffering
from some disorder, are seen to be under-developed or
hypo-functioning.
The Implications of the Developmental
Pathways Model for Evolutionary Psychology
Despite our promise to avoid straying too far down
the path of philosophical controversy, there was one
temptation that proved too strong to resist: the debate
over the modularity view that “the evolved structure of
the human mind is adapted to the way of life of Pleis-
tocene hunter-gatherers” (Barkow, Cosmides, & Tooby,
1992). The discovery of structural/ functional regularities
in the brains of subjects with developmental disorders
seemed, at first, to provide compelling evidence for the
idea that dedicated modules were selected at the dawn of
our evolutionary history to perform quite specific cogni-
tive, communicative, and social tasks (Pinker, 1994). But
invariably such imaging studies were performed on adult
subjects with the disorder, raising the question of whether
the regularity observed was the effect of the social inter-
actions that the child has experienced or the cause.
For example, as Joel Nigg points out in his recent sur-
vey of What Causes ADHD (Nigg, 2006), our under-
standing of the neural systems implicated in ADHD is en-
tirely derived from imaging performed on adult subjects.
There are clearly regularities in the systems affected in
adults with ADHD, although these can be extremely
complex and subtle. But these regularities must be
viewed in developmental time, and not as somehow static
phenomena.
Furthermore, developmental neuroscientists have
begun to document how different kinds of cells in differ-
ent neural systems seem to be better suited for specific
kinds of tasks (see Mareschal et al., 2007). So, for exam-
ple, to return to the case that we have touched on here, it
would seem that the cells in the fusiform gyrus are partic-
ularly well-suited for the kind of rapid processing in-
volved in analyzing facial expressions (see Karmiloff-
Smith, 1998). Hence what we really seem to be
confronted with here is not the result of predetermined
processing modules but rather, what Karmiloff-Smith
refers to as the “progressive modularization of face pro-
cessing in typically developing infants over developmen-
tal time” (Karmiloff-Smith et al., 2004).
Indeed, Karmiloff-Smith has produced compelling
evidence to show that what we see in developmental dis-
 In Search of the Pathways that Lead to Mentally Healthy Children
orders is the exact opposite from what evolutionary psy-
chologists proposed: namely, a lack of modularization, of
the increasing segregation and specialization of neural
systems that is seen in typically developing infants.
Rather, what we see in children with developmental dis-
orders is less synaptic pruning in the first year of life and,
as a result, more cortical interconnection: i.e., more wide-
spread cortical activity in performing tasks which, in typ-
ically developing children, are increasingly performed by
a specific neural system (Karmiloff-Smith, in press). The
deeper implication of this point is that the differentiation
of cortical systems is bound up with very specific types
of interactive affective experiences that involve the suc-
cessive transformations of emotional experience and that
are the product of cultural practices as well as our biol-
ogy (see Greenspan & Shanker, 2004).
MEHRI’s Platonic Mission
We have touched on Plato’s influence on the mind/
body and nature/nurture debates in Western thought here,
not simply to illustrate how ancient these questions are,
but to raise what is perhaps the most important goal of
MEHRI. For Plato did not view these problems as simply
a philosophical exercise, in the way, say, that Milton
mocks when he describes, at the beginning of Book II of
Paradise Lost, how a group of devils
. . . sat on a Hill retir’d,
In thoughts more elevate, and reason’d high
Of Providence, Foreknowledge, Will, and Fate,
Fixt Fate, free will, foreknowledge absolute,
And found no end, in wandring mazes lost.
Of good and evil much they argu’d then,
Of happiness and final misery,
Passion and Apathie, and glory and shame,
Vain wisdom all, and false Philosophie:
Yet with a pleasing sorcerie could charm
Pain for a while or anguish, and excite
Fallacious hope, or arm th’ obdured brest
With stubborn patience as with triple steel.
What drove Plato was the burning question (as Milton
would put it!) of how one creates a healthy/just society,
which, for Plato, amounted to one and the same thing.
Throughout his writings, we find Plato attacking the
Hippocratic tradition for what he saw as the logical fal-
lacy of seeking to reduce psychological concepts to bio-
logical processes. The reason Plato was so concerned
with this logical argument was because the reductionist
view of the mind does not explain why an individual suf-
31
fers from some disorder. Plato clearly accepted the signif-
icance of innate biological factors, but that, he argued,
creates all the more reason to study how such biological
factors influence the kinds of experiences that a child
seeks out, which are what mold his character. Plato’s ul-
timate goal was to understand how a temperament that
might lead a child along an unhealthy path could be nur-
tured so as to enable the individual to attain mental
health. Over and over he returns to the theme of how the
course of one’s life is not set in stone at one’s birth.
Rather, we have to study how we can maximize the de-
velopment of the individual, whatever his biological
starting point.
It would be fascinating at this point to digress into a
discussion of Plato’s view of the role that the properly
trained philosopher-physician has to play in this process,
alongside the medical doctor; for only the philosopher, he
felt, can bring an individual to want to adopt those ac-
tions that are necessary to achieve that state of balance
without which true health is impossible and medicine in-
effective (Cooper & Hutchinson, 1977). The history of
the field over the past two millennia might suggest that it
was Milton who had the more astute perception of the
philosopher’s capacity to enhance a nation’s mental
health. But there are larger themes in Plato’s writings on
this issue that demand our attention: the emphasis that he
placed on application as the driving impetus of theory;
his perception of the early social determinants of mental/
physical health; the analogy that he drew between the
health of the individual and the health of a society, and
accordingly, on universality (although, to be sure, his
views of social inclusion are rather disturbing).
The point is that it is one thing to demonstrate what
might be possible in the scientific understanding of the
pathways that lead to a child’s mental health, but quite
another to ensure that every single child receives the ben-
efits of these scientific breakthroughs. Ultimately
MEHRI was established to serve as a social as much as a
scientific catalyst—to understand what is becoming pos-
sible in the early detection and mitigation of develop-
mental, psychological, and behavioral problems in order
to fuel the political will needed to ensure that every child
benefits from these advances. All of the themes that we
have touched on here attest to the enormity of this chal-
lenge in a world in which family dynamics are rapidly
changing, resulting in a broad new range of social, psy-
chological, and biological stresses (Baker, Gruber, &
Milligan, 2005). The better we can understand the types
of family experiences and community processes that pro-
mote the healthy development of a child’s mind and
brain, the more motivated we must become to ensure that
every child receives those experiences.
32 STUART G. SHANKER
Acknowledgments
This paper and all of the research described in it are
the result of the late Milton Harris’ vision and Ethel Har-
ris’ determination to see his dream become a reality. In
addition to our debt to the Harris family, I am profoundly
indebted to all the scientists, staff, parents, and most of
all, the children, who have made the Milton and Ethel
Harris Research Initiative such an extraordinary center.
In addition, I would like to express my gratitude to an
anonymous reviewer for the Journal of Developmental
Processes and to its Editor, Barbara King, for their many
invaluable comments on an earlier draft of this paper. Fi-
nally, I must express my never-ending gratitude to Stan-
ley Greenspan, whose inspiration and friendship I cannot
hope to acknowledge adequately.
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JDP FORUM
Dynamic Systems Theory and the Promotion of
Children’s Mental Health
Erika S. Lunkenheimer
Child and Family Center
University of Oregon
elunk@uoregon.edu
The promotion of children’s mental health is a crucial
goal, one that is beset with many challenges that Stuart
Shanker has delineated well in his article, “In Search of the
Pathways that Lead to Mentally Healthy Children.” When
we study the etiology of a child’s developmental disorder,
or attempt to alter a developmental trajectory that has gone
awry, we face a complex playing field. The child is a mov-
ing target, one in which growth processes in real time (sec-
onds or hours) and developmental time (months or years)
are continually interacting and changing. We work with in-
dividual differences in children’s starting points and devel-
opmental timing, as well as differences in the environmen-
tal contingencies that shape these trajectories. We must
also account for how this dynamic interplay unfolds across
the child’s various developmental domains (e.g., social,
cognitive), relationships, and physical settings.
One could think these numerous processes are too
complicated to model adequately, let alone intervene
upon in a systematic way. However, dynamic systems
(DS) theory encompasses properties that allow for the
conceptualization and modeling of developmental
processes in both real and developmental time. These
properties can be used to describe the organization of in-
trapersonal and interpersonal patterns of interest to psy-
chologists. For example, an attractor is a pattern of inter-
actions between elements of a developmental system that
evolves into a stable behavioral state over developmental
time. Research by Dumas, Lemay, and Dauwalder (2001)
has illustrated group differences in the attractors of clini-
cally referred and typical mother-child dyads during real
time positive interactions. Unlike typical dyads that
showed expected sequences of parent control followed
by child compliance, clinically referred dyads showed at-
tractors of parent control coupled with child noncompli-
34
ance, even when parents preceded these attempts with
positive affect. This DS-based research illustrates an ex-
ample of how multiple behavioral dynamics in real time
can be encompassed into one analysis, which can then be
linked to developmental antecedents or growth trajecto-
ries, or compared across varying groups or contexts.
Despite the possibilities this framework offers, we are
still at the beginning of DS-based research in clinical psy-
chology and developmental psychopathology. If we are
truly concerned with facilitating children’s movement
into pathways of mental and developmental health and
maintaining those pathways over time, there are two
major emphases that should be pursued with respect to
the application of dynamic systems theory to research on
children’s mental health. First, we must rigorously apply
DS methods to the study of positive, adaptive, flexible,
and discontinuous psychological processes in the same
way we have applied them to pathological, maladaptive,
rigid, and stable processes. In order to directly promote
and maintain mental health, we need a strong empirical
understanding of how detrimental patterns in children’s
close relationships become optimal ones, or how discon-
tinuous transitions in real-time interactions provide op-
portunities for adaptive growth even in the presence of
neurobiological or environmental risk factors. Second,
we must apply DS theory and methods directly to the
study of the environmental contexts in which we wish to
implement intervention programs for promoting chil-
dren’s health (e.g., families and schools). If we do not un-
derstand the dynamic properties of the various contexts
involved in the child’s life and how these contexts influ-
ence pathways of children’s mental health over time, we
cannot build or implement the most effective prevention
and intervention programs for these contexts.
 Dynamic Systems Theory and the Promotion of Children’s Mental Health
DS Methods and Adaptive Change
As Shanker argued, DS offers a theoretical frame-
work with which to understand how nature and nurture
can interact to produce cascading constraints (Lewis,
1997) that influence the child’s long-term mental health.
Equally important may be how they interact to produce
the opposite—opportunities for adaptive change. The
theoretical argument that positive affect, flexibility, and
discontinuity are important scientific constructs for un-
derstanding child adaptation is not new. For example,
Granic has argued for the greater study of discontinuous
processes in developmental psychopathology research
(Granic, 2000). Her research on Parent Management
Training programs for parents of adolescents with exter-
nalizing behavior problems represents one of the only
programs of research to systematically apply DS meth-
ods to intervention effects with clinically referred chil-
dren. Specifically, Granic and colleagues have shown
that parent-child dyads that improve as a result of inter-
vention show increased dyadic flexibility in problem-
solving interactions from pre- to post-treatment, whereas
unimproved dyads show decreased flexibility (Granic,
O’Hara, Pepler, & Lewis, 2007).
However, this work is an exception, as little interven-
tion research has involved DS methods to date (see
Granic & Hollenstein, 2003 for an overview of DS meth-
ods). Further, we have not yet synthesized DS-based
methodologies with a prevention science and/or health
promotion approach (Lunkenheimer & Dishion, in
press). Many child clinicians and interventionists either
prescribe techniques for parents to act out with their
children, or directly alter and restructure real-time inter-
actions between caregivers and their children. Given that
many interventions aim ultimately to promote children’s
mental health, a better understanding of the dynamic
structure of adaptive interactions could allow us to repli-
cate these interactions in intervention.
In recent work, we have begun to apply a DS frame-
work to prevention research. The Family Check-Up
(FCU) is a brief, tailored, preventive intervention based
on an ecological assessment of the family that targets the
parents’ motivation to change (see Dishion & Stormshak,
2007). Initial research showed that targeted improve-
ments in positive, engaged parenting for families ran-
domly assigned to the FCU were related to reduced be-
havior problems (Dishion et al., in press) and increased
school readiness competencies (Lunkenheimer et al.,
2008) in young children at risk. We then followed up this
work with a DS approach using State Space Grids, a
graphical tool that quantifies observational data accord-
35
ing to two ordinal variables that define a range of behav-
iors or possible states for any particular system (see
Lewis, Lamey, & Douglas, 1999). We found that the FCU
contributed to improvements in positive-engaged attrac-
tors in parent-child interaction, which in turn predicted
growth in children’s self-regulation (Lunkenheimer,
Dishion, & Winter, 2008). Thus, adaptive parent-child
behavioral patterns assessed via DS methods promoted
needed developmental competencies for children in high-
risk families and acted as mechanisms of change in a uni-
versal, intent-to-treat prevention program.
By linking real-time adaptive processes to longitudi-
nal development, the use of DS methods may also impli-
cate ways to better tailor and optimize our intervention
efforts for certain developmental stages, transitions, and
skills. One skill or process of particular interest is that of
children’s self-regulation, because as Shanker and others
(e.g., Posner & Rothbart, 2000) have asserted, the child’s
ability to self-regulate or “rise to the challenges to which
she will be exposed” as Shanker describes it, is especially
important for his or her mental health. In recent work, we
examined whether DS properties of adaptive parent-child
interactions when children were age 3 predicted chil-
dren’s under-regulated (externalizing) behavior problems
after the transition to school (Lunkenheimer, Olson, &
Sameroff, 2008). We hypothesized that adaptive interac-
tions would be somewhat predictable, thereby modeling
regulatory patterns for the child and potentially protect-
ing the child from regulatory problems. We found both
main and interaction effects for unpredictability (i.e., en-
tropy; see Lunkenheimer & Dishion, in press, for a defi-
nition). Unpredictable parent-child interactions in pre-
school contributed to higher levels of later child behavior
problems as rated by mothers and teachers. Children
were at most risk when dyadic positive affect with par-
ents was also low. This sort of research on how dynamic
properties of real-time adaptive interactions relate to the
course of children’s mental health over time may help re-
searchers to tailor the content and timing of interventions
for specific problem behaviors. In this case, for example,
a clinician might target the increase of predictable,
scripted parent-child activities with a depressed mother
who is struggling to maintain positive affect in interac-
tions with her child.
DS Analysis of Environmental Contexts
In his article, Shanker makes two very interesting ar-
guments about the role of the environment in shaping
children’s mental health. One is that the child’s adaptation
36 ERIKA S. LUNKENHEIMER
to his or her environment is a crucial marker of health, but
that children today are required to adapt to an environ-
ment that is changing at a faster rate than in the past. The
shift from rural to urban living, technological advance-
ments that are introduced and quickly become obsolete,
and a large increase in visual, auditory, and social stres-
sors are just a few of the important ecological changes that
recent generations of children have encountered. Is it true
that children face greater challenges to their development
now than in prior generations? Are secular trends and eco-
logical changes at broader societal levels truly outpacing
those of children and their most proximal developmental
contexts such that children’s adaptation is threatened?
A DS theorist would tell us that this mismatch is en-
tirely possible. For example, a bifurcation is when a split
occurs in a given system, and the two systems that result
each evolve their own distinct dynamics or patterns
(Guastello & Leibovitch, in press). The end result is
greater levels of complexity and new forms of dynamical
states (Nicolis & Prigogine, 1989). For example, we have
evidence to suggest that climate change as a result of
global warming has outpaced many plant and animal
species’ capacity to adapt to it, perhaps due to a bifurca-
tion in our ecosystem driven by one variable or a group of
variables related to global warming (e.g., global depen-
dence upon oil, urban sprawl, weather patterns). Thus, in
DS terms, one could argue that a bifurcation has allowed
dynamics or patterns at broader levels of the ecological
context to outpace related proximal processes influencing
the child. For example, the economic and cultural shift to
dual-career families and subsequent changes to family
schedules may contribute to the reduction of structured
family meal times and correspondingly fewer opportuni-
ties for shared, scripted parent-child interactions.
A second argument Shanker makes about the role of
the environment is that interpersonal affective experiences
between children and those around them may help to
shape brain development, specifically the “increasing seg-
regation and specialization of neural systems” that corre-
spond with the processing of facial expressions. This ar-
gument is based on work by Karmiloff-Smith et al. (2004)
showing that children with developmental disorders do
not show the same degree of modularization or synaptic
pruning as typically developing infants. The consequence
is a higher degree of cortical interconnection than is opti-
mal, and reduced efficacy in information processing due
to the lack of specialized modules. Shanker concludes that
social interactions and the cultural values that drive them
may be playing a role in children’s brain development. I
would like to take this idea a step further and ask whether
the very nature of these neurobiological deficits could be
reflecting structural patterns in the environment. In refer-
ence to the prior example about family routines, might
there be ways in which secular trends toward the disman-
tling of more prescribed familial roles (e.g., changes in
traditional parenting roles and family structure) and the
blurring of family activities (e.g., watching television dur-
ing meals and family interactions) requires children to de-
velop in response to roles and environmental stimuli that
are overly “interconnected” as well? Is it possible that
self-regulation has become such an important construct
and disorders such as ADHD or depression so pervasive,
in part, because a lack of differentiation in roles and rou-
tines makes it difficult for children to learn to effectively
compartmentalize their thoughts, emotions, and skills?
In reading these arguments, I was struck by how little
we know about the dynamic patterns and properties of the
environmental settings and contexts that are most promi-
nent in shaping a child’s mental health. We do not know
how broader layers of the ecological context such as fam-
ilies, schools, neighborhoods, and cultures operate as dy-
namic systems in relation to individual differences in chil-
dren’s mental health, or how patterns and properties of
these systems have shaped the history and prevalence of
children’s developmental and mental disorders from an
etiological standpoint. More importantly, it is these con-
texts and others (e.g., community centers, clinics, hospi-
tals) that we rely so heavily upon when attempting to alter,
maintain, and promote child behavior towards pathways
of mental health. At the very least, we know that adaptive
changes in child behavior are more likely to be maintained
when multiple contexts and caregivers in the child’s life
are involved in supporting that change (Sheridan &
Kratchowill, 2007). A DS analysis of structural common-
alities and differences across contexts could be just one
way to assess and maximize consistency of intervention
efforts within the child’s support network. Through a bet-
ter understanding of the properties of these environmental
contexts as dynamic systems, we could create new oppor-
tunities to optimize intervention effects for children.
In summary, to appropriately address the power of a
DS framework to aid us in researching and promoting
children’s mental health, I agree with Shanker that we
must move towards treating the broader developmental
system as our unit of analysis (Gottlieb, Wahlsten &
Lickliter, 1998). To do so, we will need to analyze adap-
tive as well as maladaptive processes, and analyze envi-
ronmental contexts as well as individual and dyadic
processes. Until we begin to target a more inclusive sys-
tem and appropriately reflect in our analyses what we
know to be the complex properties of dynamic systems,
we are not making full use of what DS theory and meth-
ods offer us, nor optimizing our chances for improving
children’s mental health.
 Dynamic Systems Theory and the Promotion of Children’s Mental Health
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Contemporary Perspectives on Facilitating Language Acquisition for
Children on the Autistic Spectrum: Engaging the Parent and the Child
Susan Longtin
Department of Speech Communication Arts & Sciences
Brooklyn College
SLongtin@brooklyn.cuny.edu
Sima Gerber
Department of Linguistics and Communication Disorders
Queens College, City University of New York
“In order to develop normally, a child requires pro-
gressively more complex joint activity with one or more
adults who have an irrational emotional relationship with
the child. Somebody’s got to be crazy about that kid.
That’s number one. First, last, and always.” (Bronfen-
brenner, 1979).
Scenario One
A clinician sits with Max, a three-year-old boy diag-
nosed with autism. Max pushes a train back and forth at
the edge of a small table without referencing the thera-
pist. The clinician playfully joins Max with another car of
the train, gently bumping his train with hers. Max looks
at the clinician and smiles. The clinician smiles back and
says, “I bumped your train.” Max’s mother sits silently
off to the side watching the therapist engage her son with
the train that he often holds in his hand. Following this
session, the therapist encourages the mother to try simi-
lar activities and strategies at home.
Scenario Two
A clinician sits with Max, a three-year-old boy diag-
nosed with autism and his mother. Max pushes a train
back and forth at the edge of a small table without refer-
encing the clinician or his mother. The therapist suggests
that Max’s mother join him in his play with another car
of the train by gently bumping his train with hers. The
therapist encourages mom to try to catch Max’s gaze and
say “boom” as the train cars bump into each other. When
Max does not respond, the therapist suggests that mom
make highly intonated “choo-choo” noises as she bumps
the trains again. At this point Max looks briefly at mom,
smiles at her, and mom smiles back. Following this ses-
38
sion, the therapist and mom discuss the strategies that
were most successful in engaging Max as well as how
mom felt when he did and did not respond to her.
Due to the increase in the prevalence of children di-
agnosed with autistic spectrum disorder (ASD), profes-
sionals currently treat greater numbers of children with
this diagnosis than ever before (National Research Coun-
cil, 2001). Parents as well as clinicians and educators
working with children on the spectrum often look to the
speech-language pathologist (SLP) for direction on how
to address their child’s pervasive communication chal-
lenges (ASHA, 2006). The two scenarios above represent
different conceptualizations of the parent’s role in her
child’s therapy. These sessions differ on at least three
dimensions: 1) the parent’s participation during the in-
tervention (onlooker vs. interactant), 2) the nature of the
instruction with the parent (modeling vs. coaching), and
3) reflection on the parent’s feelings about the session
(overlooked vs. addressed).
Although many programs are available to address the
communication challenges of children on the autistic
spectrum, few are rooted in a developmental understand-
ing of what children know before they begin to talk and
how the relationship between the child and the caregiver
contributes to this knowing. The prevalence of programs
which do not reflect this developmental understanding,
such as those that are more behaviorally-based, is of con-
cern to many professionals. In current practice in New
York State, for example, parents of young children who
have recently been diagnosed with ASD are often advised
to initiate behavioral approaches and are given less infor-
mation about the kind of developmental relationship-
 Contemporary Perspectives on Facilitating Language Acquisition for Children on the Autistic Spectrum
based approach that will be discussed here (New York
State Department of Health, 1999). While behavioral ap-
proaches vary, their common characteristics include the
belief that children need to learn language in highly struc-
tured contexts, through the application of unidirectional
adult-directed operant conditioning procedures and re-
liance on preset curricula for all children (e.g., Lovaas,
1977). Behavioral approaches are often contrasted with
paradigms that are child-centered and social-interactionist
(Fey, 1986; McCauley & Fey, 2006). These perspectives
prioritize goals that are based on developmental se-
quences, use naturalistic contexts and everyday routines,
acknowledge that interactions are bi-directional with
partners mutually influencing one other, and recognize
and support individual variation among children.
Despite the fact that developmental programs reflect
contemporary thinking, parents are often not familiar
with this perspective and consequently, their implementa-
tion is the exception rather than the rule. Our review of
the chapters covering intervention approaches in a recent
handbook on ASD (Volkmar, Paul, Klin, & Cohen, 2005)
supports the prevalence of behaviorally-oriented pro-
grams. Our hope is that with greater awareness of de-
velopmental parent-based programs for language facili-
tation and with paradigm shifts in the training of
speech-language pathologists and other professionals,
more children on the autistic spectrum and their families
will be able to access these contemporary alternatives.
The purpose of this article is 1) to review three parent-
based programs which are grounded in the core belief
that the parent-child relationship is the primary context
for facilitating development, 2) to identify the common
threads and unique features of each of these child-
centered, social-interactionist programs and 3) to gener-
ate for professionals a composite of interdisciplinary
competencies which are necessary for our work with chil-
dren with ASD and their families.
To begin, best practices for the development of lan-
guage intervention programs should be rooted in the sci-
ence of child development and the science of language
acquisition. Reconsidering the core deficits of children
on the autistic spectrum underscores the importance of
understanding the process of typical development and the
origins of language and communication for each devel-
oping child. For example, challenges in engagement and
social communication are seen not only in children on the
autistic spectrum who are non-verbal, but also in children
who have well-developed linguistic systems (Prizant &
Wetherby, 1998). Prioritizing the social-communication
capacities that set the stage for the acquisition of lan-
guage and the ability to use language in interpersonal in-
39
teractions is central to developing intervention programs.
Similarly, understanding the interpersonal context in
which these social-communication capacities are typi-
cally nourished is central to determining who the partici-
pants will be during the intervention process. Finally, un-
derstanding the cognitive resources needed to learn
language will set the stage for developing strategies that
may simplify the task for children who are challenged in
these capacities.
Current thinking about the process of language acqui-
sition and the caregiver-child relationship can guide our
development of intervention programs for all children
with challenges, including those on the autistic spectrum.
In order to illustrate how the three programs reviewed
here meet this challenge, they are explored in light of a
contemporary model of language acquisition. By doing
this, we hope to highlight why these programs offer such
impressive alternatives to more structured product-based
approaches. It is our belief that the Bloom and Tinker
(2001) Intentionality Model offers a particularly helpful
conceptual framework for understanding the develop-
mental challenges of children on the autistic spectrum as
well as for generating the goals and strategies of interven-
tion. This model in combination with recent findings on
the power of the child’s early relationships sets the stage
for the review.
In Bloom and Tinker’s (2001) model (see Figure 1),
two aspects of the mental life of the young child—social
and emotional development (engagement) and cognitive
development (effort) are tied to the child’s acquisition of
language. Bloom and Lahey’s (1978) earlier conception of
language as the integration of form, content, and use is
now embedded in the context of early social-emotional in-
teractions and various processes of cognitive development
(Bloom & Tinker, 2001). With an understanding of en-
gagement and effort, the developmental integrity of the
three parent-based programs reviewed here is emphasized.
Engagement. The area of engagement can be under-
stood as the social and emotional motivation for learning
a language in the first place. Bloom and Tinker (2001) re-
iterate the widely accepted view that infants are respon-
sive to other persons from the beginning of their lives.
The intersubjectivity that develops between infant and
parent during the first year of life serves as the founda-
tion for the child’s social connectedness to other people
throughout life. “Engagement builds on the intersubjec-
tivity between the child and other persons, and on the re-
lationship between both the child and other persons to the
physical world” (Bloom & Tinker, 2001, p. 15). The no-
tion of engagement is a central organizing principle for
clinicians and parents who wish to facilitate language for
40 SUSAN LONGTIN AND SIMA GERBER

FIGURE 1. The Intentionality Model

From The Intentionality Model and Language Acquisition, by L. Bloom and E. Tinker,
2001, Monographs of the Society for Research in Child Development, 66(4, Serial No.
267), p. 14. Copyright 2001 by Blackwell Publishers. Reprinted with permission of the
author.

children with challenges in the social-emotional and af-
fective domains. In fact, it is the child’s connectedness to
his primary caregivers and all he learns from the “dance”
they engage in that sets the stage for the comprehension
and production of language. Children who are unable to
participate in the affective back and forth of interaction,
who have difficulty reading and producing non-verbal
signals, or are less active in communicating intentions,
are at risk for developing the form-meaning relationships
that define language.
Since engagement is both a process and a product of
early development, the role of the caregiver-child interac-
tion is key to describing what needs to be encouraged and
facilitated in atypical development. “The initial emotional
duet created by mother and baby—with their complemen-
tary interweaving of smiles, gestures, and animated vo-
calizations in social play—builds and strengthens brain
architecture and creates a relationship in which the baby’s
experiences are affirmed and new abilities are nurtured”
(National Scientific Council on the Developing Child,
2004, p 4). It is in the context of this caregiver-child rela-
tionship that the child’s emerging capacities are fostered,
setting the stage for development in every domain, in-
cluding language. The fact that family-centered service
delivery models were designed to capitalize on the power
of this relationship must be remembered as we review
parent-based intervention programs.
Effort. The Intentionality Model also includes the
component of effort, which “captures the cognitive pro-
cesses and the work it takes to learn a language” (Bloom
& Tinker, 2001, p.15). This component of the model con-
siders the limitations of the resources of the young child
and the demands of the processes of learning to interpret
and express language. These constructs have immediate
resonance for our thinking about children with ASD. For
them, the demands of learning to comprehend and produce
symbols are evident from their inability to do so easily. Al-
though it is not known whether the child with ASD has
problems in the mental representation of an intentional
state, the perception and memory required to develop the
intention, the association of the word with the intention,
and/or the encoding of the word, the work required to ac-
complish these processes is difficult for the child with
compromised resources. Intervention programs, which ad-
dress these processes at the same time that they maintain
the integrity of development, offer strategies and contexts
to help children learn language more easily.
Three programs are discussed in this article: More
than WordsTM (Sussman, 1999), Communicating Part-
ners (MacDonald, 2004) and the Developmental Individ-
ual Relationship-basedTM model (Greenspan & Wieder,
1997a). These parent-based programs are consistent with
current notions of best clinical practices for children on
the autistic spectrum (Girolametto, Sussman, & Weitz-
man, 2007; Kaiser, Hancock, & Nietfeld, 2000; Mahoney
& Perales, 2003; 2005; National Research Council, 2001)
and the family-centered mandate of early intervention. It
is our feeling that these three intervention paradigms are
consonant with the components of the Bloom and Tinker
(2001) Intentionality Model. Specifically, the children’s
 Contemporary Perspectives on Facilitating Language Acquisition for Children on the Autistic Spectrum
challenges in the social-emotional aspects of develop-
ment have been placed center stage and the role of the
parent has been prioritized. The notion that the young
child’s “relationships . . . incorporate the qualities that
best promote competence and well-being” is embedded
in this thinking (National Scientific Council on the De-
veloping Child, 2004, p.1). Further, an appreciation of the
resources and demands of learning language are reflected
in intervention strategies used to simplify the complex
process of language learning.
Program Descriptions
More than Words: The Hanen™ Program for Parents
of Children with Autistic Spectrum Disorders (MTW)
(Sussman, 1999) was developed by the Hanen Center, a
charitable organization based in Toronto, Canada which
was founded more than 30 years ago. An innovator in
family-centered early language intervention, the Hanen
Center provides services to children, develops resources
for professionals and parents, and conducts research.
MTW is one of several Hanen programs including
It Takes Two to Talk: The Hanen Program for Parents
(Manolson, 1992; Pepper & Weitzman, 2004) and Learn-
ing Language and Loving ItTM (Weitzman & Greenberg,
2002). Hanen programs empower parents to become their
child’s primary language facilitator, thus maximizing the
child’s opportunities for communication development in
everyday situations. MTW, developed specifically for
children on the autistic spectrum and their families, pro-
vides communication and language intervention, parent
education, and social support. The program teaches par-
ents how to promote their child’s social interaction, com-
munication, and play. In MTW, parents are educated
about their child’s level of development, individual learn-
ing styles, and sensory preferences, and are taught spe-
cific strategies designed to facilitate communication and
language. Parent training is carried out in both small
group workshops and individual sessions with coaching
and feedback by a speech-language pathologist who has
received specialized training.
Communicating Partners (CP) (MacDonald, 2004) is
a parent and professional education program guided by
the belief that parents are in the best position to ensure
that their children reach their potential in social commu-
nication skills. Previously known as the “ECO” ecologi-
cal program (MacDonald & Carroll, 1992), the current
version of the approach provides explicit guides for both
parents and professionals working with children who are
delayed in their communication skills, including children
with ASD. The focus of the program is to enable children
41
to become social in the context of their family members
who serve as daily life partners. The key goal of the pro-
gram is to help parents and professionals develop socially
effective relationships with the child who might other-
wise become isolated from society. The philosophy of the
approach is to support each child’s current strengths to
build enduring social relationships, primarily in the con-
text of the home.
The Developmental Individual Difference Relationship-
based Model™ (DIR) (Greenspan & Wieder, 1997a) rests
on a comprehensive intervention program with the goal
of strengthening individual developmental domains such
as engagement, symbolic play, language, and motor
planning. DIR, which is often referred to as Floortime (a
specific strategy within the broader model), is an inter-
disciplinary approach for working with children with de-
velopmental challenges. Although not specifically a lan-
guage intervention program, the DIR approach speaks to
the kinds of capacities that are integrally tied to the de-
velopment of language. A goal of the program is to help
children build core functional developmental capacities,
which serve as the foundations for relating, thinking, and
communicating. The functional developmental capaci-
ties include the ability for shared attention, engagement,
reciprocal emotional interactions, and the creative and
logical use of ideas. At the higher levels of development,
the DIR model addresses the kind of symbolic thinking
that leads to more complex levels of language such as
cause and effect, problem solving, inference, and critical
thinking. The comprehensive intervention focuses on
interdisciplinary developmental domains, the child’s in-
dividual profile of processing abilities, and relationship-
based work. As with the other programs mentioned
above, parent involvement throughout the intervention is
required.
In summary, MTW (Sussman, 1999), CP (MacDon-
ald, 2004), and DIR (Greenspan & Weider, 1997a) are in-
terventions developed for young children with ASD
which emphasize engagement and effort, the two compo-
nents of the Intentionality Model (Bloom & Tinker,
2001). Each program underscores the importance of the
child’s connectedness to his primary caregivers who are
encouraged to play critical roles in their child’s develop-
ment and addresses the individual differences which im-
pact on the child’s effort in learning to talk.
Similarities among the Programs
We begin the review of the three programs by ad-
dressing the shared core components which tie them
to one another and to a distinct perspective on serving
42 SUSAN LONGTIN AND SIMA GERBER
young children with developmental challenges. These
components include the theoretical paradigms from
which they have been generated, the child’s developmen-
tal profile, and the family-centered commitment which is
consistent with current thinking about best practices. Fol-
lowing this, the differences among the programs are de-
lineated, including how the clinicians are taught to work
with parents, how the parents are taught to work with
their children, and the specific goals and strategies used
in each of the interventions. The review of the similarities
and differences between and among the programs sets the
stage for the kinds of competencies needed by profes-
sionals who are eager to embrace this approach and are
interested in preparing themselves to do so.
Theoretical Paradigms. MTW. Unlike its predeces-
sor, It Takes Two to Talk (Manolson, 1992; Pepper &
Weitzman, 2004), the MTW program, while clearly
developmental, blends aspects of both behavioral and nat-
uralistic child-centered models, taking an eclectic middle
ground approach (Sussman, 2002) described as contem-
porary behavioral (Prizant & Wetherby, 1998). The break-
down of activities into structured small steps is consistent
with a behavioral approach, whereas the provision of op-
portunities to use language for spontaneous, functional
communication is consistent with social pragmatic mod-
els. MTW is theoretically based on social interactionism
(Bohannon & Bonvillian, 1997) emphasizing the child’s
learning in the social context of everyday, naturalistic in-
teractions in the home. A central tenet of this framework
is the facilitative effect of the responsiveness of the par-
ent on the development of the child’s social communica-
tion (Girolametto, Sussman, & Weitzman, 2007).
CP. This program “reflects values and perspectives
from several fields including child development, dis-
abilities, education, and behavior change” (MacDonald,
2004, p. 60). Like MTW ™, CP is a developmental ap-
proach which shares some contemporary behavioral the-
oretical foundations. For example, MacDonald (2004)
draws on the notion of identifying pivotal response be-
haviors (Koegel, Koegel, & McNerney, 2001) as im-
portant intervention targets because they impact on the
development of several other behaviors. Motivation, a
pivotal behavior, (Koegel et al., 2001) is relevant to the
CP model because it is necessary for spontaneous com-
munication. MacDonald (2004) notes the tendency of
children with ASD to exhibit “learned helplessness”
(Seligman, 1990) allowing their caregivers to communi-
cate for them. He emphasizes that children’s motivation
to interact with others improves when they are encour-
aged to express their own interests and intents. Four ad-
ditional pivotal response behaviors, self-regulation, initi-
ation, empathy, and social interaction (Koegel et al.,
2001), have been identified as playing essential roles in
the development of social communication.
Developmental principles are key in all aspects of the
CP approach, which emphasizes reciprocal responsive re-
lationships between the child and members of his family.
Engagement between children and their life partners is at
the heart of the program. Social relationships are seen as
crucial not only to the development of communication,
but also to the development of other domains such as
cognition, a position consistent with prominent psychol-
ogists, including Bruner (1977) and Vygotsky (1978),
whose work has influenced the program.
DIR. Although not specific to language and commu-
nication, the DIR model is consistent with the programs
described above. In this approach, six functional emo-
tional developmental levels serve as the foundation of the
assessment and intervention. These levels represent how
children integrate their capacities (motor, cognitive, lan-
guage, spatial, sensory) to achieve emotionally meaning-
ful interactions and to develop higher levels of thinking.
Thus, similar to MTW and CP, stages of typical develop-
ment are used as the theoretical-clinical paradigm from
which children with challenges are understood. In DIR,
these stages address different domains including emo-
tional development, symbolic development, sensory pro-
cessing and regulation, as well as language. The science
of early development, which supports the parent-child re-
lationship as the context for learning in the young child,
is realized in the intervention program by emphasizing
the coaching of parents as the clinician’s major role. This
perspective is common to the three programs discussed
here and is distinct from interventions where the therapist
works with the child with the parent on the sidelines.
As can be seen, MTW (Sussman, 1999), CP (Mac-
Donald, 2004), and DIR (Greenspan & Weider, 1997a)
address aspects of engagement and effort, the two com-
ponents of the Intentionality Model (Bloom & Tinker,
2001). Like the Intentionality Model, the three programs
recognize the importance of developmental sequences
such as engagement before communication and commu-
nication before language, the transactional relationship
between partners in a dyadic interaction, and the impor-
tance of responsivity of the partners in order to foster af-
fective interactions. Further, like the Intentionality Model
(Bloom & Tinker, 2001), the programs acknowledge the
role of the child as an active participant in the language
learning process, the limitations of the child’s resources,
and the effort or work needed to learn language, espe-
cially when learning capacities are compromised.
The Child’s Developmental Profile. MTW, CP, and
DIR have been designed to support the development of
children with disorders of communicating and relating, in
 Contemporary Perspectives on Facilitating Language Acquisition for Children on the Autistic Spectrum
particular children on the autistic spectrum. Despite the
fact that this diagnosis represents a heterogeneous group
of children, challenges in social interaction, communi-
cation, and range of interests are typical (American Psy-
chiatric Association, Diagnostic and Statistical Manual
of Mental Disorders, 2000, text revision).
In reference to challenges in social interaction and
communication, or engagement, children with ASD may
be placed on a continuum ranging from those children
who are preintentional and nonverbal to those who are in-
tentional and verbal. Children who are preintentional do
not communicate with others. The child might whine or
fuss, causing a reaction from a listener, but she has not
produced those signals for purposeful communication. In
contrast, the child who is intentional but nonverbal, may
also fuss or whine, or use other nonverbal forms of com-
munication such as eye gaze and gesture, in order to
achieve a result (e.g., mother’s attention). Children who
are both intentional and verbal communicate through
words, word combinations, and/or well-developed syn-
tactic utterances, but may have difficulties in the prag-
matic aspects of language use.
Notably, while each program addresses different do-
mains relative to stages of development, all three ap-
proaches describe children using developmental anchors.
MTW identifies four stages of development in social
communication and language: 1) the own agenda stage,
2) the requester stage, 3) the early communicator stage,
and 4) the partner stage (Sussman, 1999). These reflect a
child’s ability to engage with others, the forms and func-
tions used to communicate, and the child’s level of lan-
guage comprehension. For example, children who are at
the own agenda stage interact briefly, but do not yet com-
municate intentionally or understand words. In contrast,
children at the partner stage interact for longer periods,
communicate intentionally for a variety of purposes
using gestures, words and sentences, and understand
many different words.
Like MTW, the CP stages of development focus on
social interaction and communication. The stages of CP,
1) interaction, 2) nonverbal communication, 3) social
language, 4) conversation, and 5) civil behavior, repre-
sent a continuum from earliest engagement to later com-
plex conversations (MacDonald, 2004). Children at the
interaction stage join the activities of others engaging in
reciprocal turn-taking such as rolling a ball back and
forth. Children at the stage of nonverbal communication
interact for social reasons other than to satisfy their
needs. For example, the child might point to an object to
capture the parent’s attention, whereas at the earlier stage
of interaction, the child might point only to satisfy a need
such as obtaining a toy out of reach on a shelf.
43
In the DIR approach, the stages represent six levels
of functional emotional development: 1) shared attention
and regulation, 2) engagement and relating, 3) two-way
purposeful emotional interactions, 4) shared social prob-
lem solving, 5) creating symbols and ideas, and 6) build-
ing logical bridges between ideas: logical thinking. Al-
though these six levels are not specific to language and
communication, they are integrated with the interper-
sonal and symbolic domains of language at every stage.
More recently (ICDL-DMIC, 2005), corresponding de-
velopmental levels of speech, language and communi-
cation have been generated within the DIR paradigm
and include 1) self-regulation and interest in the world,
2) forming relationships and affective vocal synchrony,
3) intentional two-way communication, 4) first words,
5) word combinations and, 6) early discourse.
In terms of effort, young children are limited in the
cognitive processes and resources they bring to the task
of acquiring language (Bloom & Tinker, 2001). Learning
to communicate and use language becomes even more of
an effort for children with ASD who may have limitations
in cognitive processing and challenges in sensory pro-
cessing and self-regulation. The three programs empha-
size the importance of characterizing children in terms of
their individual differences in reactions to the sensations
of movement, touch, sight, sound, and smell. Some chil-
dren are oversensitive, or hyperreactive, to certain sensa-
tions and consequently try to avoid them, whereas others
are undersensitive, or hyporeactive, and seek out certain
sensory stimuli. For example, a child who is hypersensi-
tive to movement might be afraid of escalators. Another
child who is hyposensitive to movement might enjoy
jumping on the bed. These individual differences are im-
portant in helping parents understand their children’s
atypical behavior beyond language and can be used to
create contexts which may compensate for the child’s
regulatory needs. For example, parents can turn their
children’s love of motion into an interactive chasing
game in which parent and child take turns playfully pur-
suing one other.
Role of the Family. The three programs share the
view that parents are the primary agents of engagement
and learning. All recognize that as partners in their child’s
first relationship (Stern, 1977), parents are the most emo-
tionally invested agents of their child’s development as a
social-communicative person. Not only are parents seen
as the best facilitators of development, but they are also
recognized as the ones who can offer the intensity of
intervention recommended by the National Research
Council (2001). As such, parents are seen as indispens-
able to their children’s progress in learning to interact
and communicate. All three programs seek to empower
44 SUSAN LONGTIN AND SIMA GERBER
parents to become their child’s primary language and so-
cial-emotional facilitator through natural interactions that
take place during everyday events such as meal time,
bath time, or looking at books. The role of the clinician is
seen as providing a collaborative, respectful partnership
with the parents who clearly know their child best.
In terms of similarities, MTW, CP, and DIR are de-
velopmental parent-based, family-centered interventions
whose goal is to facilitate social communication and lan-
guage in children with ASD. The programs place parents
center-stage, recognizing them as the primary agents of
change in their child’s development as we saw in Sce-
nario Two at the beginning of the article.
A final similarity across the programs is that the
child’s particular profile of sensory processing and regu-
lation is considered key to determining the contexts of
learning. We suggest that the threads of engagement and
effort (Bloom & Tinker, 2000) are interwoven in the three
aspects of the programs discussed thus far.
Differences across the Programs
Having discussed the common theoretical bases of the
three programs, the characteristics of the children they
were designed to help, and the significant role of the fam-
ily in each of them, we now address the differences
among the interventions. Reviewing these differences al-
lows us to consider additional program components,
which are translated into interdisciplinary competencies
for graduate or continuing education at the end of the ar-
ticle. These include: 1) how the clinician learns to teach
the parents, 2) how the parents learn to teach their child,
3) the goals the parents facilitate, and 4) the strategies the
parents learn.
How the Clinician Learns
The three programs represent a continuum for teach-
ing clinicians how to engage parents in the intervention
process, from the more explicit to the more experiential.
On the more explicit side, in MTW, speech-language
pathologists are taught how to provide parents with the
information and support needed to facilitate their child’s
social-communication by participating in a variety of
learning experiences including demonstration, discus-
sion, and role-play. Clinicians are encouraged to teach
parents to make changes in their language interactions by
remembering helpful phrases. For example, “go slow and
show” and “say less and stress” facilitate parents’ ability
to increase the salience of their speech, reduce the com-
plexity of their language, and emphasize key words.
In contrast to MTW, the CP training is available not
only to speech-language pathologists but to other profes-
sionals such as psychologists. Training of the profes-
sional occurs through large group seminars, review of
videotapes of parent-child interactions, which demon-
strate the five stages and the five strategies of the pro-
gram (MacDonald, 1992; MacDonald & Wilkening,
1993), and a manual-based curriculum (MacDonald &
Mitchell, 2002). Specific strategies, which can be used by
the clinician to coach parents, are suggested. For exam-
ple, parents are taught to increase certain behaviors, such
as “waiting silently with expectation” and decrease other
behaviors, such as “dominating turns” to promote recip-
rocal turn taking.
On the more experiential end, the DIR training em-
braces clinicians who are from many fields such as
speech-language pathology, psychology, social work, oc-
cupational therapy, education, and pediatric medicine.
The learning process involves periodically presenting
one’s work with children and parents to an interdiscipli-
nary group of peers and engaging in ongoing supervision
with a DIR certified mentor. A primary competency in the
training is for clinicians to demonstrate how they have
coached parents to interact with their children, a skill
learned through didactic training and review of their
work with the mentor. Although not a prescribed pro-
gram, the supervisory process would be considered the
most effective avenue for teaching clinicians to help par-
ents facilitate their child’s development. Clinicians are
also supervised regarding mental health issues that im-
pact on the parent-child relationship and are encouraged
to engage in reflective practice.
How the Parents Learn
MTW. Each MTW program begins with a group ori-
entation meeting for each family that has enrolled. The
intervention consists of a combination of group-training
sessions and individual home visits for videotaping,
coaching, and feedback. A unique aspect of all Hanen
programs is that parents are taught through principles of
adult learning, which include providing opportunities
within the group sessions for parents to practice what has
been presented (McCarthy, 1987). For example, to teach
parents about a particular strategy such as “follow your
child’s lead,” parents might be presented with segments
of the teaching videotape that demonstrate other parents
applying that strategy with their children, followed by a
discussion of how they could practice the strategy at
home with their own child.
CP. In CP, parent training occurs through three phases:
education, professional training, and home practice. In the
 Contemporary Perspectives on Facilitating Language Acquisition for Children on the Autistic Spectrum
education phase, parents are introduced to developmental
information on how children communicate at different
stages. The clinician helps the parents identify their child’s
stage of development, how to facilitate the child’s develop-
ment at different stages, and how to move the child across
stages, for example, from nonverbal communication to
social language. In the professional training phase, a clini-
cian demonstrates the program strategies such as “bal-
ance,” “match,” and “respond,” and then coaches the par-
ent to become the child’s communicating partner. During
the home practice phase, parents apply the strategies dur-
ing daily routines and are encouraged to maintain a written
diary of concerns and progress. Although designed for
families for home use, the program can be adapted for clin-
ical and educational settings.
DIR. In the DIR model, the parents are asked to play
with their child while the therapist provides coaching on
the use of DIR principles. For example, parents are en-
couraged to promote “circles of communication” which
are continuous back-and-forth exchanges between the
child and the parent. The therapist helps the parent to
identify the child’s functional emotional level and to
work towards strengthening and expanding the child’s
capacities. The clinician reflects with the parent, address-
ing her questions and concerns relative to the roadblocks
to achieving interactive flow and higher symbolic capac-
ity. The clinician also guides the parent’s understanding
of the child’s sensory and regulatory challenges and mod-
els how the parent might work around and with them. For
example, the parent might be instructed to bounce their
child seated on a large therapy ball in order to increase af-
fective interactions and vocalizations.
Goals Parents Facilitate
In each of the programs, goals are determined based
on paradigms of language acquisition and/or social-
emotional and symbolic development. Differences can be
seen in the specific parameters addressed.
MTW. In MTW, parents complete a form/function
checklist at the outset of the program. This form is used
to identify why their child communicates, for example, to
request a desired object, and how the child communi-
cates, for example, through gestures, vocalizations, or
words. From this, the child’s specific form/function goals
are generated, such as using pointing to indicate. A sec-
ond area for goal setting is expressing communicative
functions through more sophisticated forms, such as the
child’s use of words rather than sounds to comment. A
third area for goal-setting is turn taking, for example, the
child’s engagement in a reciprocal game of blowing and
popping bubbles with the parent.
45
CP. The CP program uses the Adult-Child Relation-
ship Map (ARM) for assessment and for determining
goals. The child’s stage of communication, that is, inter-
action, nonverbal communication, social language, con-
versation, or civil behavior is determined. Parents focus
on moving the child through these stages to promote
more sophisticated levels of social communication. The
most effective goals derive from the child’s current
strengths rather than norms of typical development based
on chronological age. A goal at the stage of interaction
might be for the child to play reciprocally in a give-and-
take manner, for example, rolling a ball back and forth
several times. Goals at the level of nonverbal communi-
cation include helping the child to express intentions
such as getting attention or protesting through facial ex-
pressions, gestures, or vocalizations. A goal at the con-
versational stage might be for the verbal child to take re-
ciprocal back-and-forth turns with her parent while
looking at pictures in a book together.
DIR. In DIR, parents and therapists collaboratively
focus on moving the child up the Functional Emotional
Developmental Levels (Greenspan & Wieder, 1997a),
eventually helping the child mobilize all six levels in
each interaction. Since the program is interdisciplinary,
goals are established in several developmental domains
such as symbolic play, language and communication,
sensory integration, and regulation. Eventually, parents
are asked to provide the child with three types of activi-
ties: 1) spontaneous, floor-time sessions throughout the
day, 2) semi-structured, problem-solving interactions to
learn new skills, concepts and academics, and 3) motor,
sensory, and spatial play to strengthen processing. Par-
ents are instructed that the floor-time sessions are the
core of the DIR approach and that this kind of sponta-
neous, emotional, symbolic, creative interaction is criti-
cal to the child’s progress.
The Strategies Parents Learn
While all of the strategies that parents are taught re-
flect attention to the notion of effort (Bloom & Tinker,
2001), each program offers some interesting alternatives.
MTW. Parents participating in MTW instruction
learn three groups of strategies: 1) child-oriented strate-
gies such as being face to face at the child’s physical
level, 2) interaction-promoting strategies such as cueing,
then waiting for the child to take a turn, and 3) language-
modeling strategies such as labeling objects the child is
attending to and expanding the verbal child’s utterances.
In addition, parents are taught strategies to improve the
child’s interactions and communication such as intrud-
ing on the child’s unengaged, repetitive behavior. For
46 SUSAN LONGTIN AND SIMA GERBER
example, if a child is repetitively turning a Ferris wheel
in an unengaged manner, the parent can playfully stop the
Ferris wheel, saying “stop!” at the same time joining in
and expanding the child’s play by placing a small figure
on the Ferris wheel for a ride. Parents’ engagement of
their children in interaction, reciprocity, play, and the fa-
cilitation of communication and language is at the heart
of these MTW strategies.
CP. In the CP program (MacDonald, 2004), social in-
teraction is fostered through the adult’s use of five key
strategies: 1) balance, 2) match, 3) respond, 4) share con-
trol, and 5) be emotionally playful. Balance assures that
neither child nor parent dominates the interaction. In this
way, the interaction has the frequent give and take typical
of conversation. To match, the partner acts and commu-
nicates in ways that are appropriate to the child’s level.
For example, if the child is pushing a car, the parent can
join in the play and push the car too, engaging in a back-
and-forth game rather than directing the child to push the
car to a specific destination. The third strategy requires
the caregivers to respond without judgment or correction
and to ignore disruptive behavior. When sharing control,
the partner and child both contribute to the activity
equally. This is achieved when parents limit questions,
directions, and commands while increasing their com-
ments on their child’s behavior. The fifth strategy of
being emotionally playful refers to the partner’s accept-
ance of what the child is doing, finding ways to enjoy the
child, and interacting flexibly with animation, affection,
and emotion to keep the child engaged and interactive.
For example, if the child enjoys being tickled, the parent
can engage the child in a spirited tickling game where
rules of back-and-forth interactions can be learned.
DIR. DIR strategies include using high affect and
playful obstruction, obligating responsiveness, opening
and closing circles of communication, and using one’s self
as the “first toy.” Parents are steered away from more
structured adult-led interactions and are encouraged to use
whatever the child is doing to promote thinking. The idea
that the child creates the context of play by his actions and
interests is a basic tenet of this approach. Even the objects
of the child’s preoccupations can be hidden and searched
for in a playful interchange. At more sophisticated levels,
the parent is taught how to keep the circles going by up-
ping the ante in the play (e.g., giving the child a pretend
horn when he asks for a real one), asking questions (e.g.,
“why do you want to go to the park?”), exaggerating af-
fect, or doing something unexpected, which leads to a
problem that requires a solution (e.g., “uh oh, the door is
locked” when the child is trying to go outside).
In summary, MTW, CP, and DIR differ along several
dimensions including the ways clinicians learn to work
with parents, how parents learn to engage their child, how
the goals for social-communication and language are de-
rived, and the strategies parents learn to use with their
child. Despite the differences among the three programs,
the two components of the Intentionality Model (Bloom
& Tinker, 2001), social-emotional engagement and cog-
nitive effort, are apparent in the goals and strategies typ-
ical of these programs.
What the Evidence Indicates
In this section, evidence-based practice, a topic of
increasing interest in clinical decision-making in speech-
language pathology and related fields, is addressed to
gauge the effectiveness of the programs described.
Evidence-based clinical practice shifts the basis of clini-
cal decision making from protocols centered solely on
expert opinion to the integration of best current research
evidence, clinical expertise, and individual client values
(ASHA, 2004).
The levels or strength of evidence refers to the scien-
tific rigor and quality of research (Robey, 2004). While
the gold standard in intervention research is the random-
ized controlled clinical trial, Johnston (2006) points out
that this level of evidence does not exist in parent educa-
tion program research. This rigorous research design
poses ethical and logistical problems, including the pos-
sibly of assignment to a no treatment group (Mahoney
et al., 1999; Woodyatt, 2005). An additional challenge to
conducting research in this area is that parents often en-
roll their child with ASD in multiple treatments with var-
ious and sometimes conflicting theoretical orientations
(Prizant & Rubin, 1999), which would confound the de-
pendent variables or outcomes of the research. Finally,
the limited evidence for approaches which prioritize en-
gagement is a result of the dominance of the behavioral
paradigm for clinical interventions for children with ASD
over the past fifty years. (National Research Council,
2001). Despite these challenges, some attempts have
been made to gather evidence regarding the value of the
three programs.
MTW. The evidence base for the MTW program fol-
lows a tradition of empirical validation characteristic of
all Hanen programs such as It Takes Two to Talk (Giro-
lametto, 1988; Tannock, Girolametto, & Siegel, 1992;
Girolametto, Weitzman, & Clements-Baartman, 1998;
see McCauley & Fey, 2006 for a review) and Learning
Language and Loving It (Girolametto & Weitzman, 2002;
Girolametto, Weitzman, & Greenberg, 2003; 2004). Mc-
Conachie, Randle, Hammal, & LeConteur’s (2005) study
of MTW is a controlled trial of 51 participating families
 Contemporary Perspectives on Facilitating Language Acquisition for Children on the Autistic Spectrum
who were assigned to an immediate intervention group or
a delayed intervention control group, which consisted of
those on a waiting list for the program. The results indi-
cated that the parents who enrolled in the program im-
proved in their use of facilitative strategies based on rat-
ings of videotaped observations. The children who
participated improved in their vocabularies, but not in so-
cial communication. This study provided preliminary ev-
idence that participating in MTW positively impacted
parent-child interactions and an aspect of children’s early
language.
Girolametto, Sussman, and Weitzman (2007) con-
ducted detailed case studies of three children whose fam-
ilies were enrolled in an MTW program. These investiga-
tors, like McConachie and others. (2005), reported
positive outcomes for both the participating mothers and
their children. The three mothers increased their respon-
sive comments during play interactions and were rated as
more responsive on a rating scale. The three children
demonstrated positive outcomes in vocabulary, frequency
of engagements in social interaction, and social initiation
skills. This study provides preliminary support that the
MTW program positively impacts children’s social com-
munication skills.
CP. MacDonald’s (2004) research support for the CP
program consists of a series of pre- and post-treatment
designs without controls. For example, in a one-year
study conducted at Ohio State University, 80% of 25 pre-
school children with ASD showed significant improve-
ment in their social interactions with their parents. Unfor-
tunately, the particular aspects of social interaction that
improved were not specified. Parents were more ani-
mated, playful, and responsive with their children follow-
ing participation in the program as measured by evalua-
tor judgments of videotaped samples.
In another study, 50 families including 20 with chil-
dren with ASD participated in training on the CP strategies
during hourly training sessions conducted over a year. Re-
sults indicated that the parents became more responsive,
matched, playful and balanced with their children and that
the children demonstrated gains in social communication
skills and language, although specific areas were not de-
lineated. Results for the children with ASD were grouped
with the data for the children with other developmental de-
lays, making it difficult to determine the impact of the pro-
gram on this specific population. In addition, since a con-
trol group was not employed, the effects of maturation
cannot be discriminated from the treatment effects, a lim-
itation of all studies without controls.
DIR. Greenspan & Weider (1997b) conducted a chart
review of 200 children with ASD who received the DIR
model of intervention for at least two years. The children
47
were diagnosed between 22 months and 4 years. Out-
comes for the children were reported as percent of cases
that realized three levels of response to the DIR treat-
ment: 58% of the children achieved “good to outstand-
ing” outcomes, 25% attained “medium” outcomes, and
17% demonstrated “continued difficulties.” In terms of
engagement, 95% of the children demonstrated recipro-
cal gestures and imitation to fulfill needs. A limitation of
the study was that the outcomes were based on the obser-
vations of one experienced clinician so the reliability of
the data could not be determined. Further, outcomes for
the parents were not provided and the outcome measures
for the children lacked specificity. Nonetheless,
Greenspan & Weider’s (1997b) chart review of a large
number of cases elucidated clinical patterns among this
group of children and generated hypotheses for future
research.
In summary, the evidence base for the three programs
is limited. Of the three interventions, MTW has the high-
est level of evidence with one controlled trial involving
relatively large groups of children (McConachie et al.,
2005) and a series of case studies, which reported de-
tailed positive outcome measures for both parents and
children (Girolametto, et al. 2007). The research base for
CP involves large groups of children but lacks rigorous
controls, and it groups children with ASD with those with
other developmental delays, making it difficult to draw
conclusions regarding the impact of the treatment on the
target population. The one study of the DIR approach in-
volved a large number of subjects, but it did not include
detailed outcome measures. Indeed, the need for rigorous
research on all the programs is apparent and may be due,
in part, to the challenges of conducting developmental in-
tervention studies. Until further investigations are re-
ported, speech-language pathologists can rely on the ex-
isting research as well as the two other parameters of
evidence-based practice suggested by ASHA (2004),
namely, practitioner expertise and family preferences
when making clinical intervention decisions.
A Paradigm Shift for
Contemporary Clinical Training
Currently, students in speech-language pathology re-
ceive minimal training in relationship-based work with
parents. Graduate students and practicing clinicians alike
acknowledge the importance of this area for personnel
preparation programs (Justice & Ezell, 2001; Bernstein,
2005). In terms of coursework, students are generally ex-
posed to views about the impact of disability on the fam-
ily and the value of supporting parents in their efforts to
48 SUSAN LONGTIN AND SIMA GERBER
facilitate language, but are rarely taught the specifics of
how to address these feelings or how to orchestrate the
support. Further, in the area of clinical practice, students
typically do not learn how to collaborate with parents or
how to coach them to interact with their child. In training
programs, students’ interactions with parents are often fo-
cused on reporting how their child’s therapy is progress-
ing or providing follow-up home practice assignments or
suggestions at the end of a session.
In addition to limited coursework and clinical experi-
ence with family issues and coaching, graduate speech-
language pathology students typically receive minimal
training in ASD. In most graduate programs, this com-
plex area is addressed in courses which cover several
groups of language-impaired children including the hear-
ing impaired, mentally retarded, and learning disabled
in addition to children with ASD. Due to the breadth of
the other topics to be covered, the discussion of ASD is
generally limited to one or two class sessions. This is in-
adequate given the depth of the knowledge required to
understand this complex, developmental disability.
Presently, professionals across clinical and educational
fields who wish to obtain the type of training recom-
mended here must expand their knowledge and skills
after graduate school by engaging in continuing profes-
sional education.
The review of MTW, CP, and DIR suggests basic inter-
disciplinary competencies which reflect contemporary
thinking from the science of child development (e.g., Na-
tional Scientific Council on the Developing Child, 2004;
National Research Council & Institute of Medicine, 2000)
and more specifically, the science of language acquisition
(Bates, 1976; Bloom, 1970; Bloom & Lahey, 1978; Bloom
& Tinker, 2001; Brown, 1973; Bruner, 1977). A list of In-
terdisciplinary Clinical Competencies is offered as a start-
ing point for the development of training modules for grad-
uate programs and continuing education seminars. The
competencies, which are neither hierarchical nor sequen-
tial, are presented in Table 1 under the organizational head-
ings, which framed this review and are referred to as Cur-
riculum Content Areas.
Summary and Conclusions
In summary, MTW, CP, and DIR are parent-based,
family-centered programs which address the develop-
ment of social-communication and language in children
with ASD. The Bloom and Tinker (2001) Intentionality
Model of typical language acquisition captures two im-
portant features common to the programs, social-
emotional engagement and cognitive effort. While differ-
ences among the programs have been discussed, the in-
dispensable role of parents in facilitating their child’s de-
velopment, the assessment of individual differences in
sensory capacities and learning styles, the generation of
goals that are grounded in developmental sequences, and
the use of strategies to facilitate the child’s engagement
and communication in everyday routines and play are
common ground. Professional preparation and continu-
ing education programs can provide better training to
graduate students and practicing clinicians working with
children with ASD by embracing a shift to greater inte-
gration of contemporary models of child development
and language acquisition.
Perhaps the clinician involved with children on the
autistic spectrum can use the notions of engagement and
effort as central organizing principles for her own process
of learning and evolving. For both the child and the fam-
ily, engagement with the therapist must be the first goal
of any therapeutic process that hopes to enhance the
learning of language and the pleasures of communication
for the child and his caregivers. Although somewhat
overlapping, engaging with children and their parents
goes beyond the notion of teaching them. It is this en-
gaged quality and therapeutic talent that we must expect
from those who support a child’s development and a par-
ent’s potential to enhance this development. The chal-
lenges to the child, the parent, and the clinician are im-
posing and require a great deal of knowledge and a broad
range of skills including sensitivity to the dynamics of
human interactions.
As the clinician recognizes the enormous effort that it
takes the child to regulate, engage, and learn as well as
the constant effort that is demanded of the parent in the
process of nurturing the child, so too, the clinician must
understand and reflect on the effort that is required of her
in the moments of struggle that are a natural part of the
process. As the parent supports the child and the clinician
supports them both, so too, the clinician’s efforts can best
be enhanced by finding a safe haven in a mentor or super-
visor. Within this relationship, the clinician has the in-
valuable opportunity to learn and grow, and with this,
move closer to providing the most informed intervention
program for the child and his family.
Acknowledgment
Susan Longtin received support for this article from
the Faculty Fellowship Publication Program (FFPP) of
the City University of New York. She thanks the mem-
bers of her group for their insightful comments and help-
ful feedback on earlier drafts of this article.
 Contemporary Perspectives on Facilitating Language Acquisition for Children on the Autistic Spectrum 49

Table 1.
Interdisciplinary Clinical Competencies for Professionals Working with Children with ASD and their Families
Curriculum Content Areas Interdisciplinary Clinical Competencies

Theoretical Paradigms • Be well versed in the trajectory of early development in social-emotional, affective, cognitive,
language, and regulatory domains.
• Be well versed in the integration of developmental domains and the potential derailment of all
domains when one or more is challenged.

Child’s Developmental Profile • Be well versed in clinically relevant developmental assessment paradigms.
• Be well versed in the individual sensory and regulatory challenges that can disrupt the development
of communication and language.

Role of the Family
• Recognize and address the need to prioritize, observe, and analyze parent-child interaction as the
anchor of the intervention program.
• Recognize and address the parental issues, which emerge when raising a child whose language and
communication is severely compromised.
• Recognize and address the impact and the complexity of relationship-based work with families.

How the Clinician Learns • Recognize and address mental health constructs, which embrace the nature of the child’s issues as
well as the family’s.
• Recognize and address the notion of reflective practice as an invaluable part of one’s learning.
• Recognize and address the need to identify master clinicians to serve as mentors.

How the Parents Learn • Appreciate the ongoing process of parent learning and embrace individual variation in styles and
rates.
• Appreciate and embrace the need for frequent therapeutic contact between the parent and clinician.

The Goals Parents Facilitate • Recognize and address the importance of relationship-based intervention.
• Recognize and address the importance of children’s expression of intentionality before language.
• Recognize and address the importance of affective engagement, symbolic thinking, and individual
differences across developmental stages.

The Strategies Parents Learn
• Appreciate and facilitate the parents’ role in incorporating their child’s goals throughout the
contexts of daily life to insure that the therapeutic process extends beyond the therapy room.
• Appreciate and facilitate the parents’ understanding of effort and resources as they balance their
child’s learning opportunities.
• Appreciate and facilitate the parent’s individual strengths in using specific strategies to enhance
development.

What the Evidence Indicates • Be well versed in the need for evidence-based clinical decision-making.
• Be well versed in the use of single subject designs to collect and evaluate the effectiveness of one’s
work with individual children.

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Differential Treatment of Toddlers with Sensory Processing Disorders
in Relation to Their Temperament and Sensory Profile
Pnina S. Klein
School of Education
Bar-Ilan University
Ramat-Gan, Israel
pninak@mail.biu.ac.il
Renat Laish-Mishali
Bar-Ilan University
Nurit Jaegermann
Bar-Ilan University
Abstract: The major question posed in the current study
was how temperament and sensory processing variables
predict maternal behavior in interactions with toddlers
identified as having sensory processing disorders. Partici-
pants were 49 mothers and infants with sensory processing
disorders. They were videotaped in a free-play interaction.
Observations were coded using general interaction criteria
and criteria of teaching behavior (mediation). A clear dis-
tinction was found between temperament characteristics of
children whose sensory processing was identified as sensory
seeking or sensory avoiding. The main difference between
them was their emotional behavior. High levels of sensory
seeking were related to a high activity level and positive af-
fect, whereas high levels of sensory avoiding were related to
low levels of positive affect and high levels of anger. It was
found that children’s temperament and sensory profiles were
related to the profile of their mother’s mediation.
One of the major findings of this study was that chil-
dren’s level of activity may not be related to maternal behav-
ior. This trait is represented in two distinguishable groups of
children for whom high activity levels are related to differ-
ent neuro-physiological causes—a group of children whose
high level of activity is caused by sensory avoidance and an-
other group whose high activity level is related to sensory
seeking.
Introduction
There is no question today that both child and parent
variables play a significant role in weaving the complex
pattern of child development. The question in recent stud-
52
ies is no longer which of these two sets of variables has
more of an effect than the other, but rather which specific
child variables relate to which specific parent variables,
thus affecting the interactions or transactions between
them and consequently shaping child development. There
is a considerable amount of research on children’s tem-
perament. In fact, it is one of the most researched child
variables, following age and gender. Temperament repre-
sents typical characteristics of children’s behavior across
different contexts and is, at least partially, genetically de-
termined. In view of the growing awareness that the qual-
ity of adult-child interactions affects social-emotional and
cognitive development, the effect of temperament on par-
ent-child interactions has been studied extensively (Bar-
ton & Robins, 2000; Kochanska, Aksan, & Joy, 2007;
Rothbart & Bates, 2006).
Following the classical longitudinal studies on tem-
perament by Thomas, Chess and Birch (1968), tempera-
ment has been assessed and studied in a variety of ways.
The basic assumption underlining all of them is that tem-
peramental traits, which are genetically based, determine
the characteristic patterns of responding to environmen-
tal experiences as well as regulating inner sensations and
creating patterns of interpersonal relations. Temperament
has been defined as an expression of biologically based
individual differences in the basic functioning of the cen-
tral nervous system, particularly in relation to the individ-
ual’s ability for self-regulation (Rothbart, 1981). In line
with this definition, temperament variables may be at
least partially expressed in terms of sensory processing
variables (Barton & Robins, 2000).
 Toddlers Temperament and Sensory Profile
Sensory processing refers to the brain’s ability to re-
ceive sensory information from the environment, com-
bine it with internal sensory information from the body
(e.g., movement, balance and touch), and process it into
a coherent understanding of what is going on in a given
situation and what is the appropriate response (Ayres,
1979; Bundy & Murray, 2002; Kandel, Schwartz, & Jes-
sell, 2000). Self-regulation is a complex ability develop-
ing rapidly in the first two years of life when infants are
faced with the need to process sensory information, reg-
ulate their emotions and behavior via this incoming sen-
sory information, and respond appropriately (Ayres,
1979; DeGangi, 2000; Dunn, 1997; Miller & Lane, 2000;
Miller, Reisman, McIntosh, & Simon, 2001; Miller &
Summers, 2001). Self-regulation is related to physiologi-
cal factors including arousal, attention, affect, and action
(Dunn, 1997; Williamson & Anzalone, 2000), as well as
to environmental variables, particularly those related to
caregivers’ sensitivity and responsivity to the child (De-
Gangi, 2000; Zero to Three, 2005). There is growing ev-
idence that interpersonal relations, particularly mother-
child early relations, may have a marked effect on
children’s ability to process sensory information, to
maintain a well regulated, positive emotional state, and to
develop the ability for future regulation of emotion and
behavior (Dunn, 2002; Greenspan & Wieder, 1998; Zero
to Three, 2005).
Regulation of behavior has been identified as one of
the best predictors of children’s cognitive and social-
emotional learning (Blair, 2002). Difficulties in sensory
processing and self-regulation are related to a wide range
of behavior disorders including attention deficits, temper
tantrums, and social isolation (Barton & Robins, 2000).
Young children with sensory-processing and self-regula-
tion disorders have been found to have difficulties in so-
cial, emotional, cognitive and sensory-motor develop-
ment (Case-Smith, Butcher, & Reed, 1998; DeGangi,
2000; Dunn, 1997; Greenspan & Wieder, 1998) and are at
risk for non-optimal development (DeGangi, Breinbauer,
Doussard-Roosevelt, Porges, & Greenspan, 2000; De-
Santis, Coster, Bigsby, & Lester, 2004) There is an urgent
need for early interventions that target these toddlers’
mal-adaptive behavior and enhance their developmental
outcome. Identifying parental behavior that meets the
toddlers’ special sensory and regulatory needs should be
a focus for such intervention.
Most educators and other professionals working with
young children commonly use temperament variables to
describe individual differences between children. Tem-
perament variables describe patterns of behavior, but
hardly suggest information about what may cause those
patterns of behavior. Thus, temperament variables may
53
not provide information that would be sufficient for con-
structing intervention programs that may enhance inter-
action with children, particularly those with sensory pro-
cessing disorders. Better understanding of the interplay
between temperament and sensory processing to patterns
of mother-child relationships is needed.
The general objective of the current study was to ex-
amine the relations between infants’ sensory processing
variables and their temperament variables in relation to
their mothers’ interaction with them. The specific objec-
tive of the study was to examine possibilities of differen-
tial treatment of children with various sensory-processing
disorders, as reflected in their mothers’ play with them.
Most studies of mother-child interactions focus on
general factors such as sensitivity and responsivity, syn-
chrony, or mutual organization, intrusiveness etc. The
current study incorporates a double focus both on the
general interaction variables and on the maternal pattern
of teaching behavior (Klein, Wieder, Greenspan, & 1987;
Klein, 1996; Klein, 2006).
Method
Participants
The participants were 49 infants and toddlers with
sensory processing disorders. They were healthy, full-
term infants with no medical problems or developmen-
tally clear and defined problems (i.e., cerebral palsy,
metabolic problems, or genetic syndromes such as
Down’s syndrome, etc.).
The infants and toddlers ranged in age between 13–19
months and 53% of them were boys. Most of the partici-
pants were first born (57%) and were only children
(55%). The mothers’ age ranged between 21–40 years
and their education was mostly above high school; 51%
were university graduates, 14% had some college educa-
tion, and 35% were high school graduates.
The diagnosis of sensory processing disorders was
based on the following three measures: Infant/Toddler
Symptom Checklist (DeGangi, Poisson, Sickel, &
Wiener, 1995); Sensory Profile (Dunn, 2002) and the Test
of Sensory Function in Infants (TSFI), (DeGangi &
Greenspan, 1989).
In the current study, children were identified as hav-
ing sensory processing disorders when they were identi-
fied as “at risk” on at least two of these three measures.
The following are definitions of criteria for children’s
sensory processing (Dunn, 2002).
Sensory seeking refers to the child’s behavior that rep-
resents his attempts to compensate for high neurological
54 PNINA S. KLEIN, RENAT LAISH-MISHALI AND NURIT JAEGERMANN
thresholds (under-sensitivity). It is expressed in active
behavior in order to get intensive sensory input that the
child misses due to his high thresholds.
Sensory avoiding refers to the child’s behavior that
represents her attempts to compensate for her low neuro-
logical thresholds (over-sensitivity) by acting in a non-
adaptive manner in order to avoid threatening situations.
Sensitivity to stimuli refers to the child’s behavior that
is caused by low neurological thresholds (over-sensitivity).
Children who have sensory sensitivity tend to be distracted
easily and may display hyperactivity.
Poor registration refers to high neurological thresh-
olds (under-sensitivity). In this case, the child is missing
basic sensory input that he needs in order to engage him-
self in an adaptive response. These children tend to ap-
pear uninterested, overly tired, self-absorbed and can
have flat or dull affect.
Measures
In addition to the three measures of sensory process-
ing used in the process of selecting the participants in this
study, the children’s temperament was assessed using the
Toddler Behavior Assessment Questionnaire (TBAQ)
(Goldsmith, 1994), yielding measures of activity level,
joy, social anxiety, anger, and interest.
Mother-child interactions were assessed based on the
analysis of videotaped interactions during free play.
Mothers were instructed to play with their children as
they normally do at home. The interactions were ana-
lyzed using two measures:
• The CIB—Coding of Interactive Behavior (Keren,
Feldman, & Tyano, 2001), focusing on maternal
sensitivity and responsivity, intrusiveness, mutual
organization, and the child’s positive involvement.
Due to the low level of consistency, the factor of
child’s positive involvement was eliminated from
the analysis.
• The OMI—Observing Mediational Interactions, fo-
cusing on maternal teaching behavior (Klein, 1996;
Klein & Alony, 1993; Klein, Wieder & Greenspan,
1987). The OMI yielded measures of five major
variables: Focusing, Affecting, Expanding, Encour-
aging, and Regulation of Behavior. For an overview
of the developmental mediation approach, includ-
ing the variables of teaching behavior (mediation)
in adult-child interaction see Klein’s article on the
literacy of interaction (2006). Although well known
in educational research, these criteria have not been
previously used in research within this context.
Thus, the basic criteria of mediation behavior are
presented as follows.
Focusing. Any act or a sequence of acts that appears
to be directed toward affecting a child’s perception or be-
havior. Examples include bringing objects closer to the
child; exaggerating or accentuating sights, sounds, or fra-
grances; moving objects; and covering up distracting
stimuli to assure that the child focuses on others. These
behaviors are considered as focusing only when they are
reciprocal, i.e., when the child responds, vocally, ver-
bally, or nonverbally.
Affecting (Exciting). This is behavior that expresses
verbal or nonverbal meaning and significance, excitement,
appreciation, or affect in relation to people, animals, ob-
jects, actions, or any form of cultural content. For example,
the mother might say, “Wow, what a beautiful bird,” “This
is an interesting story about a little girl,” or “This pen is
very special. It belonged to your grandfather.”
Expanding. This is behavior directed toward the ex-
pansion of a child’s cognitive awareness, beyond what is
necessary to satisfy the immediate need that triggered the
interaction. For example, the caregiver might talk to the
child about the origin of different types of food while
feeding, or relating to the temperature of the water or to
the specific fragrance of the soap while bathing the child.
Encouraging. This is verbal or nonverbal behavior
that expresses satisfaction with a child’s behavior and
that identifies a specific component or components of the
child’s behavior which contribute to the experience of
success. For example, the mother might say, “Very good,
Dan, you have used all these colors,” or “Good boy, you
have packed every toy back into its box.”
Regulation of Behavior. These are behaviors that
model, demonstrate, and/or verbally suggest to the child
regulation of behavior in relation to the specific require-
ments of a task, or to any other cognitive process required
prior to overt action. The caregiver suggests the need to
think or plan before doing, for example, “Be careful now,
slowly, gently” or “Let’s see, what do we put on first, the
boots or the pants?” or “First, we look for all the pieces
that have the picture of a dog and then we are going to see
if they fit in here.”
Two graduate students were trained over a period of
three months until reliability of over .85 was reached.
Inter-rater reliability for both measures ranged between
.85 and .92 for all the categories observed.
Procedure
Mothers of all participants were approached by the
medical staff of public infant health centers in the munic-
 Toddlers Temperament and Sensory Profile 55

Table 1.
Pearson correlations between temperament variables and sensory processing variables
Sensory Processing

Poor Sensory Sensitivity to Sensory

Temperament Registration Seeking Stimuli Avoiding

Activity level .25 .37** –.09 –.02

Anger (negative affect) .18 .19 .07 .27**
Joy (positive affect) –.07 .50*** –.08 –.36*
Social Anxiety –.16 –.19 .10 .19
*p<.05, **p<.01, ***p<.001

ipality of the city of Tel-Aviv, located in the urban central
region of Israel. The public health nurses handed out
questionnaires describing infants’ behavior in relation to
sensory processing in everyday interactions involved in
caregiving and play. This questionnaire served as an ini-
tial screening tool for the identification of children with
sensory processing disorders. Mothers of all children
with a score of 6 or higher on this questionnaire (namely,
children with significantly more than average problems
involving sensory regulation) were invited for a follow-
up and further evaluation. Mothers who agreed to partic-
ipate (85% of the mothers) were invited to come with
their children for the two additional assessments of sen-
sory processing.
Infants and toddlers whose difficulties regulating be-
havior were identified as related to sensory processing
disorders were chosen as potential participants in the
study. Most (92%) of the mothers of these children
agreed to participate in the study.
Children identified on the two measures as having
sensory processing disorders were videotaped interacting
with their mothers in a 10-minute free-play situation. The
observation was carried out in the child health center. A
10-minute time unit was found to represent the major
characteristics of the interaction as efficiently as much
longer observation periods of two hours or more (Klein,
1988; Klein & Alony, 1993).
The observation room was carpeted. A box of toys
was placed in the center of the room. The box contained
a doll, small plastic feeding utensils, a ring tower, a small
picture book, a toy telephone on wheels, and a simple
wooden puzzle of basic geometric forms. Mothers were
given the following instructions: “play with your child as
you normally play with him/her at home.”
Results
In Table 1, we see several statistically significant re-
lations between temperament and sensory processing
variables. Children rated high on sensory seeking were
found to rate high on activity level as well as on positive
affect; whereas sensory-avoiding children were charac-
terized by low frequencies of positive affect and much
negative affect. The mothers’ general behavior in interac-
tions with their toddlers did not seem to be related to their
ratings of their infants’ temperament (see Table 2); how-
ever, their teaching behavior did relate significantly to
their ratings of their children’s affect (see Table 3).
In Table 3, the toddlers’ high level of negative affect
(anger) was found to coincide with high levels of focus-
ing (directing the child’s attention), and low levels of af-
fecting (expressing meaning and significance of things).
A high level of positive affect was related to high levels

Table 2.
Correlations between sensory processing variables and general criteria of mother-
child interaction (CIB).
Sensitivity/ Mutual Positive
Sensory Processing Responsivity Organization Involvement

Poor Registration –.13 –.21 –.04

Sensory Seeking –.01 .09 –.11
Sensitivity to Stimuli .00 .05 –.02
Sensory Avoiding –.04 –.08 –.11
56 PNINA S. KLEIN, RENAT LAISH-MISHALI AND NURIT JAEGERMANN

Table 3.
Correlations between temperament variables and maternal mediation variables.
Maternal Teaching Behavior

Temperament Focusing Affecting Encouraging Expanding Regulating

Activity level .28 –.13 –.05 –.06 .11

Anger (negative affect) .38** –.33 –.21 .00 –.16
Joy (positive affect) .09 –.09 .03 .33* –.06
Social Anxiety .02 –.13 –.18 –.14 –.08
*<.05, **p<.01

Table 4.
Correlations between sensory processing variables and maternal teaching (mediation) behavior.
Maternal Teaching Behavior

Sensory Processing Focusing Affecting Encouraging Expanding Regulating

Poor Registration .16 -.14 -.18 .06 -.19

Sensory Seeking .15 -.08 .13 -.41** .19
Sensitivity to Stimuli -.16 -.12 .01 .23* -.12
Sensory Avoiding .23* -.10 -.24* .22 -.17
*p<.05, **p<.01

of expanding (providing information and creating associ-
ations that go beyond the immediate experience).
Clear specific relations were found between sensory-
processing variables and maternal teaching behavior
(see Table 4). Children rated high on sensory seeking re-
ceived low rates of expanding, whereas those who rated
as highly sensitive to stimuli received high rates of ex-
panding. Children who were sensory avoiding received
more focusing and less encouraging mediation. Based on
the videotaped observations and on qualitative analysis
of recorded informal open conversations with the moth-
ers prior to or following the videotaped observations, the
following information and behavior patterns emerged.
Children who scored high on sensory seeking were
expressing their hunger for visual, auditory, tactual, or
vestibular stimulation, by actively moving from one thing
to another. They did not create optimal situations for the
maternal teaching behavior of expanding, i.e., behaviors
involving creation of associations between objects,
events or experiences in the immediate present and other
experiences, relating to similarities, differences, cause
and effect relations, and other cognitive functions involv-
ing the use of higher levels of reasoning. Mothers seemed
to be repeatedly trying to ensure that their child will sit
down and look at them quietly as they try to tell or teach
him something. Since this was difficult for the child, few
instances of expanding occurred in mothers’ interactions
with these children. Children who were highly sensitive
to stimuli, i.e., children who easily noticed even the
slightest sensory input or variations between stimuli,
seemed to “invite” maternal expanding, for example,
through their immediate differential responses to varia-
tions in sound, taste, or feel of things. They were captive
audiences for maternal mediation, which served at times
as a way of reducing anxiety by persuading them that the
stimuli they were experiencing at the moment as different
was in fact similar to one they had experienced before.
Mothers of children who were sensory avoiding
tended to use more focusing behavior in order to ensure
that their children were focusing on what they considered
important at the moment. However, focusing most fre-
quently did not suffice to lead the child to be active and
consequently did not invite the mothers to give encour-
agement. It should be noted that no statistically signifi-
cant gender differences or age differences were found in
this study.
In summary, in terms of teaching behavior, children
who were identified as most at risk for receiving poor
mediation were those rated as high on negative affect (the
angry children), the sensory-avoiding children, and those
who were sensory seeking. A summary of the findings re-
lating temperament, sensory processing variables, and
maternal teaching behavior variables is presented in
Table 5.
 Toddlers Temperament and Sensory Profile 57

Table 5.
Summary of Findings: Relations between Temperament, Sensory Processing, and Maternal Teaching Behavior
Maternal Teaching Behavior

Child Variables Focusing Affecting Expanding Encouraging Regulating

Negative Affect + –
Positive Affect +
Sensory Seeking –
Sensitivity to Stimuli +
Sensory Avoiding + –
Note: Statistically significant positive and negative relations between variables are represented by + and – signs.

Discussion causing fragmented unrelated experiences (Klein, 1996;

There are many studies in the literature concerning the
relations between children’s characteristics and maternal
behavior. Some studies suggest that mothers are less sen-
sitive and responsive to infants with sensory processing
disorders or to fussy infants. (Calkins, Hugerford, & Ded-
mon, 2004; DeGangi et al., 1997; Feldman, Greenbaum,
Mayes, & Erlich, 1997; Van den Boom & Hoeksma,
1994). In previous studies, maternal sensitivity, responsiv-
ity, and mutual organization were found to be related to
their children’s temperament (Feldman et al., 1997; Klein,
1988). In the current study, maternal sensitivity and re-
sponsivity, mutual organization, and intrusiveness were
not found to be related to maternal perception of their
children’s temperament. However, maternal teaching be-
havior was found to be related to some of the tempera-
ment variables; mothers who rated their children as show-
ing more positive affect provided more experiences of
expanding. Children rated high on negative affect (anger)
were given more mediation of focusing. There were fewer
statements such as “This is a big, hairy dog,” “Listen to
the bird singing,” or “The rose smells good.” Although not
a statistically significant finding, angry children appeared
to have higher levels of activity. It is possible that in an at-
tempt to assure that the children benefited from various
experiences, their mothers tried to focus their attention
again and again on different things in the environment.
The latter might have resulted in high frequencies of fo-
cusing but low frequencies of affecting, (i.e., endowing
things with meaning), rarely engaging in more complex,
higher levels of mediation such as expanding the experi-
ence of “here and now” to developmentally appropriate,
more abstract thinking processes.
High frequencies of focusing unaccompanied by suf-
ficient mediation of affecting, expanding, regulation of
behavior and encouraging, were found to be ineffective
in promoting cognitive development, or even harmful,
Klein, 2006). Angry children were less interactive and
expressed less positive affect in interactions with their
parents. Consequently, their parents might have had
fewer chances to learn what makes their children happy
and had less experience in which they themselves were
successful in eliciting positive responses in interaction
with them.
The current findings suggest that mothers were able
to regulate their general interaction behavior as measured
by the CIB factors. They were sensitive and responsive to
their children, regardless of their perceived temperament.
However, they were probably not aware of their teaching
behavior and their children’s “mental diet” in relation to
their own teaching behavior. As stated earlier, a “diet” of
high frequencies of focusing and low affecting and ex-
panding may be problematic to future development
(Feuerstein, 1980; Klein, 1996; Klein & Alony, 1993).
It was hypothesized that infants characterized by high
sensory seeking or sensitivity to stimuli (both associated
with high activity levels), invite higher rates of intrusive
behavior associated with more focusing designed to keep
the children attentive. Alternatively, infants with a sen-
sory profile characterized by high rates of sensory avoid-
ing or poor registration (both associated with low activity
levels), are involved in interactions with more mediation
of expanding and meaning.
It was found that children characterized as sensory
seeking seemed to receive different types of mediation as
compared to children characterized as sensitive to stim-
uli. Although both of these groups typically have high
levels of activity, the sensory-seeking children received
significantly lower rates of expanding behavior as com-
pared to children with high rates of sensitivity to stimuli.
Mothers of the sensory-seeking children, seemed to give
up on telling their children things beyond the here and
now, possibly because these children seem to crave sen-
sory motor experiences that are gained by moving around
58 PNINA S. KLEIN, RENAT LAISH-MISHALI AND NURIT JAEGERMANN
from one motor experience to another, touching, jump-
ing, pushing, opening, etc. Children who were highly
sensitive to stimuli seemed uneasy with their experiences
and parents were called upon to help their children adjust
to situations by explaining, associating, comparing, con-
trasting, etc. All of these experiences actually represent
expanding.
Contrary to the mediation provided to children who
were highly sensitive to stimuli, maternal interactions
with children who were sensory avoiding (characterized
by low levels of activity, retreating from uneasy sensory
experiences) included high frequencies of focusing or
attempts to direct their children’s attention, to “wake
them up” to experience the world around them. These in-
teractions were also characterized by low levels of en-
couragement. The latter may be understood in light of the
relatively low activity levels of these children, which re-
duced their chances to experience success.
Children who are sensory seeking may be jeopardized
by an educational environment that attempts to block
their movement—the fulfillment of their need for sensory
stimulation. This study calls for rethinking the need to
stop motor activity in order to force children to learn.
Based on this finding, possible strategies may involve the
need to include creative means of mediation that may en-
able these children to benefit from experiences of ex-
panding while the child is moving around. For example,
we can introduce situations in which variability in the
sensory-motor experience is associated with meaning and
cognitive challenges. For example, solving meaningful
motor challenges, jumping on different surfaces, bounc-
ing balls of varying materials, the need to recall and re-
construct experiences in a meaningful social context, are
possible options.
One of the interesting findings of this study was that
children’s level of activity is differentially related to their
mother’s teaching behavior, depending on the etiology of
their activity level. High levels of activity are represented
in two distinguishable groups of children for whom high
activity levels are related to different neuro-physiological
ethiologies: A group of children whose high level of ac-
tivity is probably caused by sensory avoidance and an-
other group whose high activity level is related to sensory
seeking. Each of these groups may have different educa-
tional needs that are not met by the use of a “one size fits
all” approach, i.e., reducing children’s level of activity to
achieve learning.
There is a general consensus regarding the basic edu-
cational approach to children who are characterized by
high activity levels. There is also a general assumption
among educators that children’s attention span or ability
to concentrate could be enhanced by causing them to re-
main inactive for the period in which learning is assumed
to occur. Following this assumption, any attempt to teach
children who are highly active has to be preceded by at-
tempts to stop their motor movement. The current find-
ings suggest the need to reexamine this generalized as-
sumption. Behavior patterns of children labeled as having
high activity levels may be related to two different sen-
sory processing patterns and may consequently invite dif-
ferent teaching behaviors in interaction with their moth-
ers. For the infant or toddler who is highly sensitive to
sensory sensation, every minor variation in sensory input
attracts attention and is followed by movement, so less
movement and a quiet environment may be needed for
concentration and learning. Some infants who have high
sensory thresholds, however, may move around craving
sensory input, so that slowing them down may actually
prevent them from concentrating on anything. It is almost
like a hungry child who finds it difficult to concentrate
when she needs to eat.
Raising the awareness of parents and teachers or care-
givers about the mediation they provide for very young
children may be the first important step toward improv-
ing the children’s future development.
Note: This study was partially supported by the Baker
Center and the Machado Chair for research on cognitive
modifiability and the development of intelligence, Bar-
Ilan University.
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Book Essay
Ira Glovinsky
The Interdisciplinary Center for the Family
West Bloomfield, Michigan
ira1834@sbcglobal.net
Bipolar Children: Cutting-Edge Controversy, Insights, and Research
Edited by Sharna Olfman, Praeger Publishers 2007
This book presents a very controversial picture of pedi-
atric bipolar disorder. Its editor, Sharna Olfman, Profes-
sor of Clinical Psychology at Point Park University, and
the Founding Director of the Childhood and Society
Symposium, has assembled a group of professionals who
question the validity of “pediatric bipolar disorder” as a
diagnosis, and describe the abuses of misdiagnosis and
medication giving.
Pediatric bipolar disorder is a very complex illness
and very difficult to diagnose. Bowring and Kovacs
(1992) discussed reasons for the difficulty in diagnosing
the disorder. They focused on the base rate problem: the
fact that the typical clinician would tend to have a very
low rate of exposure to youths with the disorder. Because
of the rarity of the disorder and the heterogeneity of the
symptoms, there is no template to which a clinician can
refer.
Second, there is a wide range of characterizations of
childhood mania. The symptoms of mania in the pediatric
population are intrinsically labile, and there are gradients
of severity within an episode or across episodes. The la-
bility of emotions, instability, and fluctuation in moods is
particularly evident in the pediatric population.
Third, the symptoms of pediatric bipolar disorder
overlap with those of other issues, including ADHD, Op-
positional Defiant Disorder, Post-traumatic Stress Disor-
der, sexual abuse, and other causes. What we are learning
about this illness is that it is extremely complex and co-
morbidity, i.e., other illnesses co-occurring, is extremely
high.
Finally, Bowring and Kovacs noted that the age of
the child influences the symptom expression. For exam-
ple, some of the classic symptoms of mania are not yet a
part of the behavioral repertoire of very young children.
60
It is also difficult to draw the boundary between the
extremes of developmentally appropriate behavior and
psychopathology.
The arguments of the contributors to this book are
reminiscent of earlier attempts to eliminate pediatric af-
fective disorders. For example, in 1945, Charles Bradley,
then an eminent child psychiatrist, wrote that the diagno-
sis of pediatric manic-depression should not be given to
children. This appeared to have done away with the disor-
der until John Campbell published case studies of children
and adolescents who presented with manic-depressive ill-
nesses. In 1960, E. J. Anthony and P. Scott wrote their
own criteria for the disorder, developing criteria that made
it almost impossible for a child to be diagnosed with
manic-depression, as it was called at that time. Up until
the early 1970s, it was also felt that children could not be
depressed because they did not have the ego structures
necessary for developing depression. Thus, in every case,
while parents were struggling with severe affective distur-
bances in their children that were catastrophic to family
relationships and school performance, the professionals
were saying that these disorders could not exist.
Parents of children with severe affective disorders
will disagree with the most eminent mental health profes-
sionals who posit the non-existence of these disorders.
The words in articles and in texts cannot come close to
describing the devastation that is experienced by parents
on a daily basis. Their children are not merely spoiled
brats, as alluded to by Elizabeth Roberts (Chapter 5).
Words like “tantrums,” “rages,” or “explosions” cannot
describe the intensity of symptoms with which parents of
these children are confronted every day. If parents are
able to sleep for a night, they can be sure that the next
day, at some point, they will be faced with a volcano. The
 Bipolar Children: Cutting-Edge Controversy, Insights, and Research
terror that is associated with these unpredictable cata-
strophic events—coupled with the chronic grief that the
parent experiences daily—is something with which pro-
fessionals cannot possibly identify unless they have had
personal experiences living with the disorder. This illness
can be lethal. In my clinical practice parents have re-
ported behaviors such as a four-year-old child climbing
out of a window in the middle of the night; a five-year-
old boy wearing a Superman costume starting to climb
out of his bedroom window because he thought he could
fly; or a six-year-old boy who was sure that he could stop
a truck coming down the street in his neighborhood.
Luckily the driver saw the child and was able to stop in
time.
Although many of the contributors to this book dis-
cuss the catastrophic effects of misdiagnosis and mis-
medication, none provide sound interventions that would
help a parent get through a typical day with such a child.
As the parent of a daughter with pediatric bipolar disor-
der as well as a clinician whose career evolved from this
experience, I know firsthand that the generalizations
about misdiagnosis and mis-medication interfere with
children getting the treatment that they need. The contrib-
utors to Olfman’s book do not speak to the enormous
number of children whose lives are saved by ethical treat-
ments that include psychopharmacology. With this illness
untreated, danger and catastrophe are ever present. The
work with these truly bipolar children must be aggressive
and immediate. The contributors to this book do not
speak to this issue.
Two main issues are highlighted in the chapters of
Olfman’s book. The first is misdiagnosis and the second
is the inappropriate use of medication. Because of the
complexity of this illness, training professionals to iden-
tify the disorder is critical. In a number of chapters in the
book, some of the pioneering professionals in pediatric
mental health are inappropriately taken to task. Barbara
Geller, Joseph Biederman, and Robert Post, among oth-
ers are blamed for the epidemic of pediatric bipolar
disorder. The careful, methodical approaches that these
latter clinicians use in diagnosing the disorder are juxta-
posed to case material presented in this book that sug-
gests inadequate training in diagnoses.
Two years ago, I had the opportunity to obtain train-
ing from Geller’s group at Washington University Med-
ical School in St. Louis. The tool that was used in
making the diagnosis was the WASH-U-K-SADS, a
structured diagnostic instrument that is administered to
both the child and to the parent. The interview is ex-
tremely rigorous and can take up to four or more hours to
complete. For each question, the frequency, duration, and
intensity of a symptom is discussed with fine-tuned ques-
61
tioning until the interviewer is absolutely sure that the re-
sponse either does or does not meet the criteria of a
symptom for mania or depression. Videotapes are closely
reviewed, insuring that the professionals are thorough in
their conclusions. When there are differences in opinion,
the team discusses them comprehensively until there is
agreement.
The work done by Biederman’s team is similarly rig-
orous rather than superficial, as is intimated by the con-
tributors of this book. Because of the dangers of this dis-
order, I have had the opportunity to refer a small number
of families (N=5) to Massachusetts General Hospital for
psychopharmacological treatment by Biederman’s group.
Thus far, all of the parents I have referred have reported
satisfaction, no catastrophic medication events, and con-
sistent improvement made by children suffering from this
disease.
In the chapter “Bipolar Syndrome by Proxy?: The
Case of Pediatric Bipolar Disorder,” David Healy and
Joanna Le Noury criticize Robert Post, who has pub-
lished a large number of articles and chapters of books on
bipolar disorder, for favoring efforts at early recognition
of bipolar disorder. The authors write:
Take for example, the case of the academic Robert
Post, who was among the first to propose that
anticonvulsants might be useful for manic-
depressive disease in adults. When the frequency
of the disorder began to increase rather than to de-
crease, Post began to promote the idea that the
reason for this failure was that the affected indi-
viduals had not been caught early enough—and
no age seemed too young. (p. 26)
Post had written (2002):
One would encourage major efforts at earlier
recognition and treatment of this potentially inca-
pacitating and lethal recurrent central nervous sys-
tem disorder. It would be hoped that instituting
such early, effective and sustained prophylactic
intervention would not only lessen illness-related
morbidity over this interval, but [would] also
change the course of this illness toward a better
trajectory and more favorable prognosis. (p. 26)
It is not clear to me why anyone would criticize such
a goal. What we are learning about pediatric disorders is
that early identification and intervention result in a better
prognosis. We are seeing this in the most extreme and
complex childhood disorders, including Autism Spec-
trum Disorder. From early studies on brain plasticity in
rodents (Greenough & Black, 1992; Black & Greenough,
1998) and emerging work on early biological insults and
62 IRA GLOVINSKY
the developing human brain (Shonkoff & Phillips, 2002;
Huttenlocher, 2002), we are beginning to see that path-
ways can be built that enable young children to develop
capacities that heretofore were thought to be out of reach.
It is true that meaningful diagnosis can only come
from thorough evaluations. For example, in our multi-
disciplinary practice in the Mood Disorder Program at The
Interdisciplinary Center for the Family in West Bloomfield,
Michigan, we have developed an evaluation paradigm that
has increased the probability of correct diagnoses of mood
disorders. The parents are first seen by a clinical social
worker for a complete family and developmental history.
The child is interviewed using the Children’s Interview of
Psychiatric Symptoms (ChIPS) (Weller, Weller, Teare, &
Fristad, 1999). For children below the age of six we video-
tape father and child, mother and child, father, mother and
child for 15-minute unstructured play sessions and use the
Greenspan Functional Emotional Assessment Scale
(FEAS) (2001) to evaluate the interactions. We also invite
parents to bring us home videos. The child’s mother then
participates in an intensive interview similar to the WASH-
U-K-SADS, the Psychiatric Assessment for Preschool-
Aged Children (PAPA) (Egger, Ascher, & Angold, 1999),
or the Childhood Age Psychiatric Assessment (CAPA). The
parents are given a number of questionnaires, including a
Sensory Profile (Dunn, 1999); Behavior Rating Inventory
of Executive Functions (Giola, Isquith, Guy, & Kenworthy,
2000); a Symptom Checklist, Childhood Behavior Check-
list (Achenbach, 1991); and a Life Events Scale. The child
is then administered a series of psychological tests to eval-
uate intellectual and cognitive capacities in order to make
appropriate recommendations for educational program-
ming. After the material is discussed in a case conference,
collaborative feedback is given to the parents. A psychiatric
consultation is then set up and the parents are taught to
chart the child’s mood for a period of one month. We feel
that this longitudinal evaluation is comprehensive and pro-
vides the parents with necessary information that guides
the treatment plan. We are now beginning to explore differ-
ent outcome measures and can begin the treatment plan.
In truth, we recognize that the majority of practition-
ers do not use as comprehensive an evaluation, but this
reflects the models that they have had in their training ex-
periences as well as the use of shortcuts. We have had nu-
merous complex cases in our interdisciplinary practice
and have run into many roadblocks. However, our solu-
tion to this problem has been to arrange consultations
with the group at Massachusetts General Hospital, with
the Pediatric Neurology Department at Duke University,
and with the Department of Child Psychiatry at The Uni-
versity of Illinois-Chicago. The families of such complex
children need to be seen by the most highly trained clini-
cians and researchers in the field. The contributors to this
volume criticize those who do the most rigorous work.
We need to take a closer look at our training of profes-
sionals in all mental health disciplines.
This leads to the second issue on which this volume
focuses: the misuse of medication. In their chapter, Healy
and Le Noury state that:
All studies of life expectancy of patients taking
antipsychotics show a doubling of mortality rates
compared to control groups, and this doubling in-
creases again for every added antipsychotic drug
the patient takes. Patients on antipsychotics also
have a reduced life expectancy. In addition, all
studies to date on the treatment of bipolar disorder
with mood stabilizers such as Depakote, Zyprexa,
and Risperdal show that suicide risk doubles,
compared to treatment with placebo. (p. 14)
The authors cite a single study relating to schizophre-
nia, neuroleptic medication, and mortality (Joukamaa et
al., 2006). It is not surprising that a severely disturbed
population would have higher mortality rates or higher
suicide rates, as these individuals suffer from extreme
psychopathology, but perhaps the rates would be higher
and mortality earlier without treatment. Similarly, as in
all studies, the sample studied may not be representative
of all people suffering from a particular disorder.
Two particularly disturbing chapters are “But Don’t
Call It Science,” by Lawrence Diller and “Creating the
Bipolar Child: How Our Drug-Based Paradigm of Care Is
Fueling an Epidemic of Disabling Mental Illness in Chil-
dren.” by Robert Whitaker. Diller writes, “Children break
down every day in my office but no more than a dozen or
so of the 2,500 I’ve seen have met my [italics added] cri-
teria for a major mental disorder (p. 38). In this state-
ment, the author may be challenging an entire psychiatric
establishment that has developed diagnostic criteria such
as those found in the Diagnostic and Statistical Manual
of Mental Disorders IV-TR.
Whitaker’s chapter is equally disturbing. He focused
on and criticized single variable theories of affective dis-
orders and in his conclusion, he did the same thing as
those whom he criticizes. Whitaker begins by critiquing
the earliest psychiatric studies on the chemical imbalance
hypothesis of schizophrenia and depression as being
overly simplistic and makes it sound like we are still at
that point in terms of our research. The recent publication
of Jamison and Goodwin’s volume Manic-Depressive Ill-
ness clearly shows have far we have come in our research
on bipolar disorder, with numerous theories being ex-
plored. Then the author makes a case for the cause of
bipolar being the use of stimulants and anti-depressants,
 Bipolar Children: Cutting-Edge Controversy, Insights, and Research
i.e., for a one-dimensional theory. The work of
Schloesser, Huang, and Manji (2008) demonstrates how
far neuroscience has come in understanding the under-
pinnings of bipolar disorder.
Similarly, in a beautifully written book called Un-
strange Minds, Roy Grinker (2007) shows how numbers
can be deceiving and how the extraordinary increase in
the number of cases of autism, the “autism epidemic” is
not in fact an epidemic, but more likely a failure to con-
sider what the numbers mean and how these numeric
findings came about. The numbers may mean a number
of things including earlier diagnosis of the disorder, a
broader definition of the disorder, or changes in epidemi-
ological methods, among other reasons. In all likelihood,
the numbers reported by Whitaker provides were a result
of similar complex factors.
Studies reveal that bipolar disorder has a strong genetic
basis (Jamison & Goodwin, 2007). Recent research in the
area of the “narrow phenotype” subtype of pediatric bipo-
lar disorder (Leibenluft, 2003) indicates that in the family
history of children with bipolar disorder there is a high ge-
netic loading for mood disorders including bipolar disor-
der, as compared to the family background of children who
are misdiagnosed with bipolar disorder and in fact suffer
from a comorbid pattern of ADHD and oppositional defi-
ant behavior. In the latter group there is significantly less
psychopathology in the family and family history. Thus, if
clinicians do a thorough history of the family there are red
flags that are useful in considering different diagnoses. We
try to go back three generations and if there is a family his-
tory of mood disorder, alcoholism, or substance abuse we
are very careful in making recommendations. Before
doing so, we also obtain information from informants be-
sides the parents, including the child’s teacher.
Whitaker cites a study on “treatment emergent
mania” without citing the source. In a study in which I
was involved (Faedda, Baldessarini, Glovinsky, &
Austin, 2004), we found that a significant number of chil-
dren who were prescribed anti-depressants and stimu-
lants suffered adverse effects within three weeks of being
prescribed the medication. In that sample, which was
comprised of 82 children from New York and Michigan,
the children evidenced severe pathology before they had
been placed on medication. The solution was not to stop
medication. Our solution was to recommend that the chil-
dren be taken off their present medication and then to rec-
ommend that the children be put on mood stabilizing
medication. We found improvements in all of the chil-
dren. These children are being followed longitudinally to
determine if they remain stable.
Greenspan and Glovinsky (2002, 2007) have looked
at the developmental pathways of bipolar patterns rather
63
than looking solely at symptoms. Looking at bipolar pat-
terns developmentally, we find that the disorder is ex-
tremely complex and involves biological factors, external
factors, as well as an understanding of the level at which
the child is functioning developmentally. Many systems
are involved in the disorder, including biochemical sys-
tems, sensory systems, emotional dynamics, thinking pat-
terns, and parent-child interactions. In all likelihood, we
will find that intervention should be multi-disciplinary in
nature and that medication will help these children to be
emotionally available to these interventions. Unless
adults can help a child to become available to interven-
tion, change does not take place. The contributors to this
book seem to be stating what the best practitioners al-
ready know—one needs to be careful in making a diag-
nosis and in prescribing treatments.
This book points out how controversial pediatric
bipolar disorder still is. Pharmacotherapy in particular
gets the blood boiling in many people who consider
themselves child advocates. It is ironic and unfortunate
that in their attempts to help children and their families,
the practitioners may inhibit both from getting the help
that they need.
In defining bipolar disorder, the contributors to this
book primarily focus on children’s behavior patterns.
They describe children who display rage behaviors. How-
ever, we know that rages are a non-specific behavior and
are found in many disorders. Even typical children have
rages, but rage is not the same thing as bipolar disorder.
The most recent research on pediatric bipolar disorder in-
dicates its complexity. For example, Luby and Belden
(2006) distinguish normative elevated self-concept that is
grounded in concrete and observable variables such as ap-
pearance, possessions, and preferences from pathological
overly positive and elevated self-concept beliefs that are
fixed, not reality based, and are indicative of more serious
grandiosity. In a recent study comparing children with
manic symptoms with healthy controls, with disruptive
children, and with children with major depressive disor-
ders, they found that the children evidencing manic-like
symptoms could be differentiated from health controls by
symptoms of grandiosity, hypersexuality, uninhibited gre-
gariousness, greater talkativeness, elation, flights of ideas,
irritability, racing thoughts, increase in motor activity,
greater activity level than usual, decreased need for sleep,
and unusually high energy levels. These differences were
significant at the .001 level. These children also differed
from children exhibiting major depression in the same
symptoms stated above, with the exception of irritability,
which was non-significant, and racing thoughts, which
was significant at the .01 level. Finally, children with
manic symptoms differed from the DSM-IV disruptive
64 IRA GLOVINSKY
disordered children in all symptoms with “more active
than usual” and “unusually energetic” being significant at
the .01 level. The researchers conclude:
The data presented provided empirical evidence
that children as young as 3 years of age manifest
manic symptoms, and can meet DSM-IV symptom
criteria for BP…. Notably, preschool children
who met criteria for BP emerged as a highly dis-
tinct (italics added) and severely impaired group
(p. 984).
Brotman, Schmajuk, Rich, and Dickstein (2006) and
Carlson (2007) distinguish a group of children who have
a co-morbid pattern of ADHD and Oppositional Defiant
Disorder from those with “narrow phenotype” bipolar
disorder that is defined by the cardinal symptoms of bipo-
lar disorder as delineated in the DSM-IV-TR. While these
groups are phenotypically similar in behavior, we are
now beginning to see differences in brain functioning
through imaging studies.
In a recent issue of The Journal of Child and Adoles-
cent Psychiatry (2007), Gleason et al. (2007) [the
Preschool Working Group] present guidelines addressing
preschool psychopharmacological treatment in very
young children:
A child with moderate to severe symptoms and
functional impairment that persists despite appro-
priate psychotherapeutic interventions may be bet-
ter served by a carefully monitored medication trial
than by continuing other ineffective treatments. For
some children, the safety concerns and develop-
mental risks related to the psychiatric disorder may
outweigh safety concerns related to planful psy-
chopharmacological treatments. Our group recom-
mends that trial of evidence-supported psycho-
social treatments precede psychopharmacological
treatments. In the authors’ view, psychopharmaco-
logical treatment is not indicated for preschoolers
with only mild or single-context symptomatology
and impairment [italics added]. (p. 1536)
The children about whom this book is written have
behavior patterns that go far beyond the mild or single-
context symptomatology and impairment that may typi-
cally be seen in a pediatric or psychiatric practice. Their
families have seen numerous practitioners, and the chil-
dren continue to evidence catastrophic symptoms. Luby
and Belden (2006) have published a controlled ex-
ploratory investigation of children with age-adjusted
manic symptoms and demonstrated that a manic-like pat-
tern of symptoms could be identified in preschoolers
when the age-adjusted mania manifestations were ad-
dressed (Gleason et al., 2007, p. 1549). The key symp-
toms that distinguished this group from normative devel-
opmental extremes were (1) elation, (2) grandiosity, and
(3) hypersexuality. This cluster of symptoms distin-
guished these children from other diagnostic disorders,
including disruptive behavior disorders. The impairment
in these children was significantly greater than the im-
pairment of children with other psychiatric disorders. The
following recommendation was made:
Structured assessment approaches, including sev-
eral systematic interviews and observations, are
recommended for diagnosis, with attention to the
presence of symptoms that are unique to bipolar
disorder. A comprehensive assessment, focused
on developmental level, psychosocial stressors,
parent-child relationship difficulties, and tempera-
ment is considered a “minimal standard” in the
2007 American Academy of Child and Adolescent
Psychiatry practice parameters for BPD (Gleason
et al., 2007, p. 1550).
The AACAP guidelines stress the importance of ex-
ploring age-appropriate forms of psychotherapy at the
first treatment stage, and ongoing psychotherapeutic
treatment is indicated throughout the course of treatment
for children with extreme behavioral dysregulation. They
also indicate the need to pay attention to co-occurring
disorders before continuing on the treatment algorithm.
The second stage of treatment is psychopharmacological
intervention.
The contributors to the Olfman book say a great deal
about misdiagnosis and mis-medication. They do not,
however, provide an unbiased picture of medication and
certainly do not say anything about the value of using
medication. Schloesser, Huang, and Manji (2008), for
example, discuss recent findings of the neurotrophic/
neuroprotective effects of lithium in neurodegenerative
disorders. This is not to say that we should use medica-
tions recklessly, but to say that we are in the early stages
of some exciting and potentially important discovery.
The contributors also emphasize the need to train pro-
fessionals to help them make valid diagnoses as well as
doing thorough evaluations to make correct diagnoses.
These are valuable recommendations.
This title Diagnosis and Misdiagnosis of Childhood
Disorders would have provided a more accurate picture
of the content of this book. The information about bipo-
lar disorder, however, is superficial and simplistic, based
on non-specific behavioral symptoms. One is drawn in
with the anticipation of learning much about childhood
bipolar disorder, but this book does not meet its promise
in this respect. It may lead parents who read it to miscon-
 Bipolar Children: Cutting-Edge Controversy, Insights, and Research
ceptions about pediatric bipolar disorder and dissuade
families from getting critical help.
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Book Essay

Dorothy Justus Sluss

Early, Elementary, & Reading Education Department
College of Education
James Madison University
slussdj@jmu.edu

Dangerous and Daring Books for Boys and Girls

Artifacts of the Changing State of Childhood

The bookstores in malls are filled with The Dangerous
Book for Boys by Conn and Hal Iggulden (2007) and The
Daring Book for Girls by Andrea J. Buchanan and Miriam
Peskowitz (2007). These books line the top of the racks in
major airports. Indeed, the first of these books has made it
to the New York Times best sellers list and the second is
not far behind. What has contributed to the success of
these dangerous and daring books? Is it just nostalgia as
the New York Times suggests in their November 4, 2007
editorial, “Childhood for Dummies”? Or is it a reflection
of a major transformation in our society that is impacting
how children play and experience childhood? This article
seeks to explore the major themes found in these two
books and to consider the implications for today’s child
and the state of childhood in the United States.
Nature of Childhood
Waves of nostalgia rush over anyone older than thirty
who reads either book. A longing for a childhood that is
different from the one that today’s child experiences oc-
curs as the reader looks at pictures of paper airplanes, mar-
bles, and tree houses. Does the reader long to be young
again? Even if the reader could enter a time machine and
suddenly become a ten-year-old again, the world would be
different. Today’s child experiences a childhood that is
vastly different from the one described in the books. The
childhood longed for can be found only within the pages of
these books. So, why the interest in the experiences de-
scribed in these books? Can it be linked to our memories
of childhood or is it tied to our notion of childhood? Al-
though it is impossible to set up an experiment to compare
the childhood experience of one generation with that of an-
other, our different perspectives of childhood can be exam-
ined. Three major views of childhood are explained in the
following section: a classical or positivist perspective, a
postmodern point of view, and an approach informed by
contemporary research and scholarship. Examining these
views may provide insight into the popularity of these
books and provide a better understanding of the changing
state of childhood in America.
Romantic View of Childhood
The idea that childhood should be a period of time
that is filled with exploration, invention, and play was
first promoted by Jean-Jacques Rousseau (1712–1778),
an eighteenth century French philosopher (Rousseau,
1979). His romantic view of play continues to influence
the Western world’s view of childhood (Cannella, 1997;
Trafi, 2008). Both The Dangerous Book for Boys and The
Daring Book for Girls capture this idealized state. In their
book for boys, Conn and Hal Iggulden write:
In this age of video games and cell phones, there
must still be a place for knots, tree houses, and
stories of incredible courage. The one thing we al-
ways say about childhood is that we seemed to
have more time back then. This book will help
you recapture those Sunday afternoons and long
summers—because they’re still long if you know
how to look at them. (p. xi)
Their sentiments are echoed by Andrea J. Buchanan
and Miriam Peskowitz:

66
 Dangerous and Daring Books for Boys and Girls 67

We were girls in the days before the Web, cell not have certain experiences” (p. 87-88). Many who
phones, or even voicemail. Telephones had cords share this perspective refer to children as young humans
and were dialed by, well, actually dialing…Con- and suggest that the terms children and childhood not be
sider the Daring Book for Girls a book of possibil- used as descriptors. Using this perspective, both books
ities and ideas for filling a day with adventure, emphasize a romantic view of childhood and contribute
imagination—and fun. (p. vii) to hegemony that involves the marginalization of chil-
dren by adults.
These books depict the innocence and fun of child-
hood. The authors of both books believe that activities
described in the books are fast disappearing and should
be preserved for future generations. Contemporary View of Childhood
For over two thousand years, children born in affluent
Recent studies have looked at places where children
families enjoyed education, play, and to some degree, a
could play and have found vacant playgrounds, empty
protected childhood (Frost, Wortham, & Reifel, 2005).
neighborhoods, and school grounds void of children
Children of the less affluent worked in sweat houses or
(Goodenough, 2003, 2007). Joe Frost (2007), a recog-
on farms and play occurred whenever and wherever chil-
nized play scholar, notes that “A ‘perfect storm’ of safety
dren were not working (Frost, 2007). Only within the
standards, law suits, high-stakes testing, techno play or
mid to last part of the twentieth century have low- and
entertainment, children’s sports, and ‘pay-for-play’ ven-
middle-class children experienced education, play, and a
ues merged to replace free, spontaneous outdoor play” (p.
reasonably safe childhood similar to that reserved for
22). A concern exists that childhood is disappearing and
more affluent children of previous years. With increased
that instead of a silent spring (Carson, Wilson, & Leer,
prosperity, American children have access to education
1962), we may encounter a silent summer—void of chil-
and social service agencies provide special protection for
dren’s voices. Several organizations such as the Interna-
children of poverty. Today, laws are in place to protect
tional Play Association–USA and National Wildlife Fed-
children from unsafe homes and communities. American
eration are equally concerned about the decrease in
children should experience a safe childhood filled with
outdoor play in natural environments (Frost, 2007). The
innocence, play, and fun. Unfortunately, some children
Alliance for Childhood (Almon & Miller, 2008), an orga-
live in homes with physically or emotionally abusive par-
nization committed to protecting childhood, also em-
ents or caregivers that avoid detection. Additionally, neg-
braces this view. The notion that children need time and
ative influences may seep into the home via the Internet,
places to play is also shared by the authors of the danger-
television, advertising, electronic entertainment, and peer
ous and daring books that depict play as a major compo-
influences. The confluence of these factors can and does
nent of childhood.
affect the quality of life that children experience and this
The volumes under discussion provide a window on
can quietly erode Rousseau’s concept of an innocent
how adults remember childhood or, for those who reject
childhood.
the very concept of childhood, the period of life experi-
enced as young humans, and is worthy of additional
Postmodern View of Childhood study. Themes that permeate both texts have been ex-
plored previously by scholars of human development
Postmodern theorists disagree with Rousseau’s ro- (Maslow, 1943) and continue to be important to parents
mantic view of childhood and even question the very ex- and older adults: safety, natural environment, language
istence of childhood and subsequent special treatment of usage, play, sources of knowledge, and competency. Ex-
young humans (Cannella, 1997). Advocates of this ap- ploring the treatment of these themes may add to our un-
proach believe that identifying childhood as a special pe- derstanding of changes that have occurred in how chil-
riod facilitates the adult’s ability to analyze, study, and in- dren experience childhood.
vestigate young children through a special lens that
dehumanizes the child and places the child in a separate
sub-category of humanness. Cannella writes, “A belief in Themes in Children’s Play
early experience as defining the life of the child is both
deterministic and fatalistic. Not only do we believe that Physiological and Psychological Safety
as expert human beings we can determine what is appro-
priate for those who are younger than us, but we can iden- The most obvious difference between the childhood
tify those who are most likely to be lost because they did described by the authors and the childhood currently
68 DOROTHY JUSTUS SLUSS
experienced by American children is safety. It is paradox-
ical that the authors include the words dangerous and dar-
ing in their titles when the childhood described is void of
danger. The authors discuss playing in forts or tents in the
backyard, fishing in streams, and skipping stones. Given
the context described, none of these activities is danger-
ous or poses a major safety risk. Realizing the litigious-
ness of today’s society, the authors of both books respond
with wit and humor: The Iggulden brothers write, “It re-
ally is a good idea to let an adult cut the wood for you, es-
pecially if power tools are involved. If you ignore this ad-
vice and cut off a finger, please do not send it to us in the
mail as proof” (p.79). Buchanan and Peskowitz state
“Climbing walls at gyms are a great place to practice.
Keep climbing, but remember once you go up, you still
have to figure out how to safely get down” (p. 158).
American children have always faced dangers such as
disease, industrial work accidents, wild animals search-
ing for prey, or depraved adults. Today, children live in a
world that is not considered safe by the parents or older
others (Children’s Welfare League of America, 2007;
Levin, 2003). Beginning at an early age, children are
warned of the dangers of straying far from a parent in a
store, playing alone in the front yard, or even walking to
a bus stop alone. A visit to any local school will amaze
anyone as he encounters the level of security required to
walk into the school and watches teachers lock and un-
lock classroom doors or count the number of cars that
transport children to and from school on a daily basis.
Children who are in such schools are aware of the safety
measures and are warned to talk to the teacher if they see
anyone carrying a gun at school. The authors of the girls’
book acknowledge the difference, “. . . we did daring
things like walk to school by ourselves. Ride our banana-
seat bikes to the local store. . . Spend hours on our own,
playing hopscotch or tetherball, building a fort in our
rooms, or turning our suburban neighborhood into the
perfect setting for covert ops, impromptu ball games, and
imaginary medieval kingdoms” (p. viii).
Local environs are not the only source of danger.
Technology provides a pipeline for international preda-
tors who troll the Internet looking for victims. Media vi-
olence exposes children to murders, kidnappings, and
rape every day (Huesmann, Moise-Titus, Podolski, &
Eron, 2003). The average American child experiences six
to seven hours of media daily and will see over 8,000
murders and 100,000 other acts of violence by the time
she finishes elementary school (Donnerstein, Slaby, &
Eron, 1994). The effect of repeated exposure to media vi-
olence has been well documented over the past fifty
years. Children become fearful, aggressive, and desensi-
tized to violence (Murray, 2006). Older adults who seek
to provide a safe childhood for young children must ac-
tively monitor the influence of the media on a daily basis.
As the authors take us to a world void of safety issues or
continuous media violence, they remind us that child-
hood should be a time of innocence and enjoyment,
“There is usually not much slumber involved in your typ-
ical slumber party. Instead, pajama-clad girls stay up into
the wee hours talking, watching movies, playing games,
telling stories, having pillow fights, and giggling”
(p.102). These girls are not concerned about the predators
that may lurk in their neighborhood or on the Internet.
They are enjoying the immediacy of childhood.
In the past, children and families were not always
aware of potential dangers. Now, when a child is hurt or
killed in California, everyone in America and around the
world knows about the incident within minutes. The
media sensationalizes child abductions and even though
the real number of abductions is very low, parents believe
it is much larger and, therefore, eminent (Zaradic &
Pergams, 2007). To return to a time when parents were
not as concerned about the day-to-day safety of their chil-
dren, when children could attend school or play without
the multitude of constant fears that surround them now,
and when they experienced a physiologically and psy-
chologically safer world is appealing to adults. Ratio-
nally, we know we must be vigilant in protecting our chil-
dren from potential danger. It may be less clear that we
need to ensure that issues of safety do not themselves be-
come the predator. In protecting our children from inter-
nal and external dangers, they may lose something that is
even more important: a sense of innocence and safety.
Reclaiming Natural Environments
Another theme involves the interaction of children
and nature. The authors urge boys to hunt, skin a squirrel,
and fish while girls are encouraged to watch birds and
plant seeds and flowers. This parallels the advice from
Leopold Aldo, the great conservationist, who urged the
young to plant gardens so they understand the source of
food (Leopold, 1989). American children spend eight
hours a day indoors at school and then many children
spend an additional six hours after school playing video
games or watching television. It is not surprising that as
more and more children, especially boys, are placed in
sedentary indoor environments for long periods of time,
the number of children diagnosed with emotional or be-
havioral issues that warrant medication steadily increases
(Zaradic & Pergams, 2007). Children need outdoor play.
A study by Zaradic and Pergams (2007) found a correla-
tion between the increase in the use of electronic enter-
 Dangerous and Daring Books for Boys and Girls
Table 1.
Comparison of Essential Gear for Boys and Girls.
For Boys
Swiss Army knife
Compass
Handkerchief
Box of matches
A shooter (favorite marble)
Needle and thread
Pencil and paper
Flashlight
Magnifying glass
Band-aids
Fishhooks
tainment media and the decrease in the number of family
visits to national parks. Children must explore and inves-
tigate their natural world and this is encouraged in both
books. For example, materials listed as “Essential Gear”
are found in both books and promote invention and ex-
ploration in a natural environment. See Table 1.
Using natural materials such as water was emphasized
by the authors of both books. The boys’ book includes
fishing and throwing rocks and the girls’ book lists pad-
dling a canoe, making fishing nets, and reading ocean tide
charts. Encouraging children to spend more time outdoors
during the day and night is appealing and the girls’ book
captures this best: “Whether you are in your backyard or
the Rocky Mountains, remember the whole point of
sleeping out is to breathe in the night air, listen to nature’s
songs, and drift off to sleep under the stars” (p.118). Al-
though other reasons such as the risk of skin cancer may
cause parents to limit the time children spend outdoors,
providing a healthy childhood involves setting aside time
for children to interact with their natural world and both
books are replete with this message.
Redefining and Sanitizing Language
Language is powerful and the authors of both vol-
umes unabashedly encourage children to claim that
power through the acquisition of Latin and Standard En-
glish. In the boys’ book, the authors note, “It’s strange
how satisfying it can be to know right from wrong.
Grammar is all about rules and structure” (p.39).
The language that both books recommend contrasts
sharply with the language that children hear daily. Many
American children are exposed to a world filled with
music, media, and video games that are filled with lan-
guage that debase humans through vulgarity. Adults who
69
For Girls
Swiss Army knife
Compass
Bandana
Duct tape
Hair band
Rope and twine
Journal with pencil and a back-up pen
Flashlight
Bungee cord
Safety pins
Deck of cards or good book
Patience
attempt to monitor the language in the home are still
faced with news programs and commercials that present
issues that should not be a part of a child’s world. Both
books present a sanitized view of the world through lan-
guage. For example, no vulgarity is used in either book.
Specifically, the boys’ book reminds them to: “Avoid
being vulgar. Excitable bouts of windbreaking will not
endear you to a girl, just to pick one example” (p. 110).
While general grammar usage is declining in the pub-
lic venue, these volumes foster a deep knowledge of
grammar, linguistics, and vocabulary. Following the lead
of the first book, the girls’ book also emphasizes language
usage, “But daring girls are never afraid to drop a spectac-
ular multisyllabic bombshell when necessary” (p. 187).
The focus on language and linguistics in both could start
the pendulum swinging in a different direction—toward
more formal language usage by children.
Play Revisited
Play is the essence of childhood (Sluss, 2005). Rogers
and Sawyers (1988) note that it is what the young of the
species do as they grow and develop. Frequently, play has
been idealized by writers and artists (Johnson, Christie, &
Wardle, 2005). In both books, a romantic view of play is
proffered that deemphasizes electronic entertainment and
youth sports. The Igguldens acknowledge this approach
in their introduction, “Is it old-fashioned? . . . When
you’re a boy . . . you want to learn coin tricks and . . . and
find your way to the stars . . .” (p. xi). They emphasize en-
joyment and fun while deleting memories of pain that ac-
company serious play (Sutton-Smith, 1997).
The play described is appealing because it is positive,
open-ended, and provides a venue for creativity. For ex-
ample, play with paper has been popular since paper was
70 DOROTHY JUSTUS SLUSS
invented and continues to hold a certain amount of fasci-
nation for all children. Directions for making the Bulldog
Dart and The Harrier (p. 2–3) are described in the boys’
book and instructions for creating Cootie Catchers
(p. 257–259) are explained in great detail in the girls’
book. Even pranks such as stink bombs, short-sheeting
beds, and faux blood provide an outlet for creativity and
social interaction for girls (p. 194). On page 158 of the
girls’ book, the authors write, “Jo March, the heroine of
Little Women, declares that no girl can be her friend who
refuses to climb trees and leap fences.”
Although games are not new, organized competitive
sports for children are a recent occurrence. For many
years, children played games when they finished their
chores or had a bit of extra time (Mergen, 1982, 1986).
With the growth of sports for adults, organized sports for
children have grown exponentially. The book for boys in-
cludes seven games or sport activities including poker,
chess, and marbles. Some might argue that a book that in-
cludes instructions on poker is indeed dangerous,
whereas others might argue that playing cards provides
an avenue for learning mathematics.
Additionally, the book for girls includes seventeen or
twice the number of games and sport activities. Many of
these involve fine motor skills such as jacks, darts, or
handclap games, but others also involve gross motor
movement such as yoga, roller skating, softball, or bas-
ketball. Differences in play recommended for boys and
for girls are significant. Boys are encouraged to make
water bombs, play poker, and throw rocks in the water
and girls are encouraged to make fish nets, plant gardens,
and play games that focus on finding a mate. The mes-
sages are clear. Boys and girls are not alike and they play
differently. A comparison of book topics confirms that
the authors have purposely attempted to include activities
for boys or girls, not both. See Appendix A for a complete
list of topics and activities for boys and girls.
Source of Knowledge
The amount of knowledge accessible to American
children is overwhelming. With a click of a computer
key, access to the great museums and libraries of the
world is granted. So, where should children begin? Both
books provide a starting point grounded in a liberal arts
approach. A major portion of both books is composed of
factual historical, scientific, and geographic information.
The boys’ book includes the seven wonders of the ancient
and modern world, stories of extraordinary individuals or
heroes, battles, history of artillery, the Declaration of In-
dependence, and the history of the establishment of
America. A militaristic approach is evident in the boys’
volume and narratives of battles depict winners as heroes.
The girls’ book contains the Bill of Rights with an ex-
planation of the Amendments that gave women the right
to vote along with an explanation of the failure of the
states to ratify the Equal Rights Amendment. Although
the titles of many of the topics such as Daring Spanish
Girls, Women Spies, and Famous Queens appear to be
very frivolous, they present the lives of outstanding
women. The focus on Olympic record setters, explorers,
and leaders provides positive role models for girls.
The demonstration of character and honesty in the
face of adversity was exhibited by the main characters in
the stories found in both volumes. Passages identified as
“Seven poems every boy should know” (p.185) or
“Books that will change your life” (p. 274) provide the
starting point mentioned in the first paragraph of this sec-
tion, that is, a point of departure for a young scholar.
Science. The amount of science in the books is im-
pressive. The focus on inquiry rivals that of many text-
books. For boys, activities range from dinosaurs, insects,
and spiders to clouds and the universe beyond. For girls,
a few topics are the same, such as clouds and electricity.
Given the complexity of the world, understanding how
some basic machines work is appealing. The desire to
take apart and rebuild—to make sense of complex
world—is characteristic of children and both volumes ad-
dress this need.
Geography. Maps are interesting to many young
children and a map of the United States is included in
both volumes. The book for boys includes a list of moun-
tains and the book for girls includes additional informa-
tion about the South Seas, Africa, and Canada. Although
two clicks on a computer mouse would provide a map of
the world, including a map of the United States projects
the message that knowing the states in their country is
knowledge that children should own. In a complex global
community, providing a starting point and a list of what
is important to know gives direction to the young learner.
It sends the message that knowledge acquisition is impor-
tant and that certain information and experiences should
be a part of childhood for boys and girls.
Competency and Competition
Competition is a part of childhood in the United
States. As children face tests at school, contests in youth
sports, and Saturday classes filled with activities that bet-
ter prepare them for a global marketplace, competitive-
ness becomes a key component in their day-to-day real-
ity. During the school day, children face pre-test and
 Dangerous and Daring Books for Boys and Girls
post-test analyses, grade level tests, and state tests at the
end of the year. Although some competition is healthy,
the hurried child described by David Elkind (1981, 2001)
has become the tested child.
An overarching theme in the book is the non-
competitive nature of the childhood described in both
volumes. Competency and highly developed skills are al-
ways the mandate. Boys should know and understand
trees, knots, hunting, construction skills, and first aid.
Girls are also encouraged to learn first-aid, use tools, and
tie knots. Competency is derived from being able to tie a
knot or make fishing nets. Children are not instructed to
tie a knot that is better than others or pass a test on how
many fish can be caught in a specialty net. Competency
is derived from the experience itself. The badges in the
book are achieved when the task is accomplished, not
when someone else is bested. The focus on competency,
not competition, is a key component in both books.
Implications for Children and Childhood
Cultural transmission. The first heading in the boys’
book, “I didn’t have this book when I was a boy.” fol-
lowed by “The stories of courage can be read as simple
adventures—or perhaps as inspiration, examples of ex-
traordinary acts by ordinary people…they’re part of a
culture, a part we really don’t want to see vanish” (p. xi)
suggests that this book is designed to transmit a particu-
lar type of knowledge and serve as a tool for social trans-
mission (Vygotsky, 1978). In this way, the book serves
the same purpose as building a community snowman—
the novice learns from the expert. The Iggulden brothers
expressed their concern that play they experienced as
children will not occur in the future. In the past, the moral
code of the community was transmitted through games
and play that occurred among children in the community
(Piaget, 1965). For example, games of touch football or
tag had rules that players knew and followed. Children
who failed to follow the rules were not allowed to play
and children would make up rules such as “You can’t say
you can’t play” (Paley, 1993). In this way, the rules of the
community were established and transmitted from gener-
ation to generation through oral conversation and face-to
face interaction. American children do not play outdoors
in neighborhoods. In one study, Hofferth and Sandburg
(2001) reported that children under 13 in the United
States spend less than thirty minutes a week engaged in
outdoor activities. If children do not pass their culture to
the next generation through games and outdoor play in
neighborhoods, then books and electronic media will fill
the void. Created materials ensure that a record of child-
71
hood experiences and activities is maintained and shared
with the next generation. These books serve this purpose
well. A major caveat is that the books fail to capture
childhood activities specific to geographic areas or cul-
tural groups. Other books should follow.
Gender differentiation. When the authors titled their
books, The Dangerous Book for Boys and The Daring
Book for Girls, they may have been referencing the fact
that they targeted either boys or girls, but not both. In a
postmodern world, this is a welcome change. Are the au-
thors sexist? Have they engaged in gender bias? Do they
encourage homophobia? The answer is no. The materials
are designed for either boys or girls—not both. Boys and
girls have biological differences that result in specific so-
cietal treatment and expectations. In an effort to ensure a
society that enables females as well as males, many an-
drogynous materials developed for children meet the
interests of neither. Beginning at birth, differences exist
between boys and girls. Studies such as the one by Lutch-
maya, Baron-Cohen, and Raggatt (2002) have found real
differences between the level of testosterone in amniotic
fluid and vocabulary abilities at 18 to 24 months. Other
studies have found that from a very early age, boys and
girls exhibit different play behaviors (Sluss, 2002). In re-
sponse to the findings on gender differences, some
schools offer classes to only boys or girls so they can tar-
get their strengths and interests (King & Gurian, 2006;
Van De Gaer, Pustjens, Van Damme, & De Munter, 2004).
These volumes send a message that materials can be
created that address the interests and needs of both
groups while valuing and responding to their unique
traits and interests. A look at Appendix A shows that
while the topics may be the same for both genders, the ac-
tivities are uniquely designed for boys or girls.
Preserving childhood. These books present a won-
derful blueprint for ensuring that children know how to
engage in play that their parents and grandparents en-
joyed. From the interactions with nature to creating
paper, the books are filled with directions and instruc-
tions for designing materials that enrich life. Parents and
older others can use the activities and recipes in the books
as a springboard for evaluating their child’s quality of
life. Children can select the activities that interest them as
they develop their personal skills and identity. The con-
text has changed, but many of the recommendations can
be modified to preserve and reclaim childhood.
Summary
The Iggulden brothers state that “The tales must be
told and retold, or the memories slowly die” (p. xi). An
72 DOROTHY JUSTUS SLUSS
equally urgent concern is not that the memories die, but
that childhood as a safe, unique period of development
ceases to exist anywhere but in a book. The stories told in
the first volume designed for boys reflect games and
sports, survival skills, role models, and military knowl-
edge with a liberal arts focus. Themes found in the vol-
ume for girls include games and sports, creating projects,
role models, and personal/professional development pro-
jecting a liberal arts perspective. After examining both
volumes, neither is dangerous or daring. They are gender-
specific, sanitized memories of childhoods filled with
play, books, and activities that include a liberal arts view
of the world. Perhaps the most perilous aspect of these
books is that they are designed specifically for boys or
girls. Even though gender bias and gender discrimination
are abhorrent, androgynous materials are often interest-
ing to neither boys nor girls. The authors of these books
dared to write books that are designed around the per-
ceived interests of boys and girls.
The most powerful take-home message from the pub-
lication and popularity of these books is not that children
do not know how to play, it is that play and childhood
have changed dramatically. To ensure that childhood re-
mains a unique period of growth and development when
children receive protection from parents and older others,
we may need to reconstruct our view of childhood. We
must guarantee that children are safe but that safety does
not consume; that children can compete but that compe-
tition does not destroy; that children use language to
communicate, not debase or humiliate; and that opportu-
nities for play occur in the natural world, not an unnatu-
ral, pay-for-play environment. These two books serve as
reminders of what we have lost and what may be at risk
in the future—not a silent spring, but a silent summer.
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Appendix A.
Comparison of topics and activities in The Dangerous Book for Boys and The Daring Book for Girls
The Dangerous Book for Boys The Daring Book for Girls
by Conn and Hall Iggulden by Andrea J. Buchanan & Miriam Peskowitz

PLAY PLAY
1. Play with Paper 1. Play with Paper
Airplane Airplane
Pen and paper games Cootie catchers, (origami fortune tellers)
Table football
2. Games/Sports
2. Games/Sports Basketball
Chess Netball
Marbles Cards (hearts and gin)
Poker Tag
Role-play games 4 square
Rules of soccer Chinese jump rope
Rugby Double Dutch jump rope
Stickball Hopscotch, tetherball, and jump rope
Softball
NATURAL MATERIALS Bowling
3. Water Slumber party games
Fishing Handclap games
Skipping stones Jacks
Making a paper hat, boat, and water bomb Darts
Roller skating
4. Nature/ Basic Survival Climbing trees and ropes
Knots Yoga
Tree house
Trees NATURAL MATERIALS
Bow and arrow 3. Water
Hunting and cooking a rabbit Reading ocean tide charts
Tanning a skin Paddle a canoe
Workbench Make a Seine net
Grinding
First aid 4. Nature/Basic Survival
Whistling
ENCYCLOPEDIA-TYPE INFORMATION Bird watching
IN CONTENT AREAS Knots and stitches
Clubhouses and forts
5. History
Every girls tool box
Timeline of America
74 DOROTHY JUSTUS SLUSS

Appendix A. (continued)
Declaration of Independence Sleep-outs (camping)
Seven Wonders of the Ancient World Build a camp-fire
Seven Wonders of Modern World Three sisters (growing vegetables)
Extraordinary stories (heroes/role models) Karate moves
History of artillery First aid
Battles
ENCYCLOPEDIA-TYPE INFORMATION
6. Science IN CONTENT AREAS
Inquiry
5. History of Women
Making a battery
Bill of Rights
Clouds
Daring Spanish girls
Fossils
Princesses today
Dinosaurs
Queens of the Ancient World
Timers and trap wires
Explorers
Electromagnets
Abigail Adams
Insects and spiders
Women spies
Making crystals
Cleopatra
Growing sunflowers
Modern women leaders
Moon
Women in first aid
Astronomy
Queen warrior
Charting universe
Women Olympic firsts
Solar system
Queen Zenobia
Star maps
Pinhole project
6. Science
Light
Lemon-powered clock
Weather
7. Geography
Clouds
Map of the United States
Periodic Table of Elements
Fifty states
Vinegar and baking soda
Mountains of the US
Secret garden
Women inventors and scientists
8. Math
Lamp, lanterns, and flashlights
Standards and metric measurement
Bird watching
9. English/Linguistics
7. Geography
Grammar
South Sea Islands
Origins of words
Going to Africa
Latin phases every boy should know
Fifty states
Poems every boy should know
Map of the US
Books every boy should read
Canada
Sampling Shakespeare
8. Math
SOCIAL KNOWLEDGE
Math tricks
10. Social Knowledge God’s eyes/Ojos de Dios
Essential gear
Girls 9. English/Linguistics
Baseball’s most valuable players Writing
Ten Commandments Greek and Latin origins of words
Badges Writing letters
 Dangerous and Daring Books for Boys and Girls 75

11. Transportation Words to impress

Go-carts Telling ghost stories (Hamlet)
Navigation Books that will change your life
Piracy
Periscope SOCIAL KNOWLEDGE
10. Social Knowledge
CREATIVE ACTIVITIES
Essential gear
12. Creative/military Boys
Wrapping a package with paper and string Three silly pranks
Marbling paper Guide to daring
Knots Badges
Codes and secret inks
Marbling paper 11. Transportation
Spies, codes, and ciphers Make a scooter
US naval flag codes Female pirates
Navajo code talkers Change a tire
Make cloth fireproof
CREATIVE ACTIVITIES
MAGIC
12. Creative
Tricks and magic
Spies and secret codes
Juggling
Watercolor painting
Dog tricks
Make a Seine net
Coin tricks
Make a garden
Make a willow whistle
The major themes focus on games and sports, survival
Make a friendship bracelet
skills (securing food and fighting enemies), role models,
Make a sit upon (cushion)
and military knowledge.
Make a daisy chain
Make a scooter
Make a tree swing
Make a peach pit ring
Make a pegboard game
Make a cloth covered book
Make a quill pen
Make paper

PERSONAL GROOMING
Hair with a pencil
Bandana tying
Tie a sari
Fold a Japanese t-shirt

PROFESSIONAL DEVELOPMENT
Robert’s Rules of Order
Finance
Negotiate a salary
Public speaking

The major themes focus on games and sports, creating

materials and personal grooming, and role models.

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