Reference & Regulate
Learn more about what we do
What is R&R?
Reference and Regulate is a developmental program designed to support Autistic children as they develop foundational communication skills. This program helps children learn to be calm, flexible, and social by focusing on engagement, regulation, and social referencing.
Our sessions are play-based and child-led. This means that we meet the child where they are in terms of development, skills, and preferences. We play to provide intrinsic motivation that promotes spontaneous use of skills. Children first learn to imitate in play and then carry these skills over to eventually language.
What is Engagement?
When we talk about engagement, we are referring to joint engagement, or two people paying attention to each other and participating in the same activity or with the same object. This is not forced, but happens when both people feel connected with each other and interested in the activity or object. Joint engagement supports relationship building and establishes trust between the child and the interventionist.
We know that language skills and joint attention are linked, and especially so for autistic children (Bottema-Beutel, 2016).
One study found that joint attention and sensory regulation skills in 1-2-year-old autistic children predicted their language abilities in preschool (Nowell, et al, 2020).
Another study found that social orientation, seeking, and maintaining (constructs related to joint attention) uniquely predicted later functional spoken language (Su, et al., 2020). .
Data additionally seems to show that responding to joint attention is predictive of a faster expressive language growth trajectory for autistic children who are early users of spoken language (Frost, et al., 2024)
What is Regulation?
Regulation refers to the ability to attain and/or maintain the optimal level of arousal to initiate or maintain participation in activities. Children are ready to learn once they are regulated.
Stages of Regulation
Children move through 3 stages of regulation
Dysregulated/externally regulated
• Children at this stage need significant adaptations and very limited change to maintain engagement; the interventionist accommodates the child’s interests 90% of the time.
•The child uses physical activities, sensory input, or music to facilitate their engagement with others. Up to 90% of new engaged activities include proprioceptive and vestibular activities (e.g., jumping, chasing, tickling, swinging, etc.).
Minimally self-regulated
•A child at this stage is able to accommodate small changes within intervention sessions; the interventionist accommodates the child’s interests 50% of the time.
•The child is able to maintain interest with a mix of sensory and sedentary tasks; 50% of new engaged activities included proprioceptive and vestibular activities (e.g., jumping, chasing, tickling, swinging, etc.).
Self-Regulated
• The child is able to accommodate up to 90% of the adult’s interests within intervention sessions, home, and childcare settings.
•The child is able to maintain interest regardless of the tasks, only 10% of new engaged activities include proprioceptive and vestibular activities (e.g., jumping, chasing, tickling, swinging, etc.).
What are the social referencing stages of R&R?
The 5 stages outlined below follow the trajectory of neurotypical development of social referencing milestones. We provide our clients with the support that they need in order to reach each milestone. The child will advance to the next stage upon the team leader’s or consultant’s determination of mastery in three activities over the course of four sessions.
Stage 1
Visual Referencing: Looking for needs to be met
NEUROTYPICAL DEVELOPMENTAL MILESTONES
• Newborns: demonstrate a preference of faces over other visual input
• Age 2 months: engage in exchanges of facial expressions and focus their attention on the area around the eyes
• Age 4 months: discriminate gaze direction
WHAT DO WE TAKE DATA ON?
• Frequency – looking often
• Latency – looking quickly
• Duration – Looking for a longer time
Stage 2
Point/Gaze Following: Looking for Information
NEUROTYPICAL DEVELOPMENTAL MILESTONES
• Age 6-9 months: Mastering point following
• Age 6-10 months: Showing preference for people who help them
• Age 9-12 months: Mastering gaze following; joint engagement with adult and object emerges; children begin to “show objects”; alternate gaze between object and parent instead of pulling to request
WHAT DO WE TAKE DATA ON?
The child references us and then follows our point or gaze to an object that is increasingly ambiguous. We are also looking for “check back” by the child referencing us a second time.
• Almost touching the object
• Near to the object without distracting objects
• Near to the object with 3 distracting objects
Farther away/hidden or among 5 or more distracting
Stage 3
Other’s Perspectives and Problem Solving : Referencing for Social Purposes
NEUROTYPICAL DEVELOPMENTAL MILESTONES
• Age 12 months: begin to imitate novel actions & take other’s perspective (Campos)
• Age 18 months: Take other’s perspective (know what is novel to adult – imitate intentional actions more than accidental, imitate goal oriented action even when model fails)
• Other’s Preferences – 14 month old chooses their favourite food to give to others, but by 18 months recognizes other’s favourite food (Meltzoff, Disc 1 4036)
WHAT DO WE TAKE DATA ON?
• Recognizes/Responds in Functional Play ( 1 step problem solving)
• Adapts in Functional Play (1 step problem solving, solution must be physically present)
• Adapts in Sequential Play (solution does not need to be physically present)
• Adapts in Narrative Play (e.g., sociodramatic/thematic play) Adapts through verbal problem solving, solution is not physically present
Each level of stage 3 is targeted by offering a significant cue, progressing to a pause in speech then the child spontaneously displaying the skill.
Stage 4
Converstation
NEUROTYPICAL DEVELOPMENTAL MILESTONES
• Their Perspective – children will look at you for your reaction to their topic, often will monologue because they don’t read your signs that you are not interested, want a turn, etc.
• Your Perspective – children later look at you during your perspective on their topic, interested in what you think.
This develops alongside the milestones for Stages 3 and 5
WHAT DO WE TAKE DATA ON?
• Own Topic
• Closely Related Topic
• Others’ Topic
Each level of stage 4 is targeted by offering a significant cue, progressing to a pause in speech then the child spontaneously displaying the skill.
Stage 5
Peer Play
NEUROTYPICAL DEVELOPMENTAL MILESTONES
• Age 2 years – no collaboration, need adult support and supervision
• Age 3 years – cooperative play without mediation – attempt to negotiate sharing (temperament influences outcome)
WHAT DO WE TAKE DATA ON?
• Engagement
• Initiation
• Mediations and negotiations
• Responsiveness
• Social Play
• Object Play