I’ve been fascinated by engagement for many years, and not the married kind. I mean the human neurobiological functional kind. I’ll discuss the hard task of defining engagement shortly. I think my fascination began when shortly after completing my SI certification, I started to notice that my clients were not “performing” or outwardly attaining an “official” next level adaptive response yet I knew they were getting close. They were rising “above” their default/baseline level of function and it seemed to me as though, they were somehow “prepping” for the next level. I then learned more and I am still learning, about motor planning in regards to development, projected action sequences, anticipatory recruitment of upper extremity and lower extremity muscle groups and the role that our sensory systems and the autonomic nervous system play in influencing action (Kourtis et. al 2010; Ferri et. al 2013; Southgate & Begus, 2013; Collet et. al, 2013; Borgomaneri, 2015; Barthel, 2021; Mannell, 2022; Stackhouse, Dundon & Maunder, 2022). I notice “approach and avoidance” and using a Polyvagal lens, wonder about all the factors contributing to approach and avoidance during everyday activities. I believe this is an area of study in human function to which we as occupational therapists may be able to make a unique contribution.

Throughout this wondering and my learning journey, I’ve been acutely aware that observing for an adaptive response is me imposing my ideas of what the next best step might be, and that in this scenario, I am the one defining “best,” yet my client has an internal sense of what is “just right” for them. I just might not know what they know/sense. In recent years I’ve tried slowing down in the moment during sessions, to allow more space and time in an interaction which I hope affords my client the opportunity to let “their best level” response unfold. I don’t have to know “the next level” or what that will be, in order to help them make it happen.

Engagement is needed for action and adaptive responses. At times engagement is sustained yet it may also be fleeting. I am now fascinated with the notion that objects in our environment (affordances) and how they are presented (by us or others) can have a significant impact on level of arousal and thus engagement. With this in mind, I am curious about the role that objects might play in maintaining or hindering engagement and suspect that objects themselves may present as cues of threat for any given task. I am now pre-occupied with further study of engagement, defining engagement and how to measure it/observe for it, so that we as occupational therapists using activity as our primary modality, can be intentional about our therapeutic interactions with clients, including how and when we use objects during our treatment sessions. Here are some learnings thus far (noting of course references above and below are but a sampling of those available…this is not a formal lit review of the subject area it’s a blog post):

1. Objects have an observable impact on spontaneous action (Atmodiwirjo, 2014)
2. Dopamine plays a significant role in spontaneous action (Friston et. al, 2012; Barthel, 2022)
3. Dopamine levels are highly influenced by many variables such as movement, genetics, and stress levels/autonomic arousal (too many references to cite)
4. I still don’t know how to “accurately” define or articulate “engagement” for practical application.

Is it intention to act? Is it anticipation? Is it motivation? Is it the result of co-regulation? I think all of these things support engagement and vice-versa but are not purely engagement in and of themselves.

Vulnerably, I am sharing my current working definition and I hope you will inform my understanding and thoughts with your own…

“Engagement is maintaining capacity for action and interaction, with objects and people in one’s surrounding environment.”

I can now more clearly articulate what I see that helps me to infer when a child is “engaged”:

• Visually referencing a person or object
• Maintaining visual contact with an object or a person
• Physically turning their body away or toward a person or object
• Physical movement, i.e. getting closer or further away in distance from a person or an object
• Manipulating an object with some part of their body
• Changing their actions or facial expressions based on interaction with an object or person, when the change results repeating actions and interactions or builds upon them
• Facial expression indicates emotion or change in emotion

Just like some sympathetic arousal is needed for function, we can’t always expect engagement to be the type of engagement WE want. I have learned that engagement may, at times, be uncomfortable for others in a child’s environment because a child may not be engaging in ways that are desirable by those around them or their level of engagement may not be obvious to others. Yet when we orient toward and join in whatever way a child is engaging, we have more potential to connect and thus more potential to redirect or influence engagement so that it’s mutually purposeful and more mutually satisfying. Dr. Dan Siegel speaks of the neurobiology of “connect and redirect”. Mutual engagement and satisfaction is the cornerstone of relationship, with people and with objects in our environment.

We can support a child’s engagement (and thus potential for interaction and mutual relationship) by:

• Putting ourselves or objects within their visual field and within their physical space, but saying nothing
• Acting upon the objects with which they are interacting or that they are visually referencing
• Moving ourselves or objects away from them when they move or look away from us or the object
• Allow opportunity for moving away from us or the objects we are using and wait for them to re-engage IF they re-engage (pacing)
• Combine objects with our action(s) in repetitive ways; repetition builds familiarity and predictability
• Mirror their actions without interacting with them

I would be remiss if I didn’t address the subject of “stimming.” The notion of stimming behavior often comes up alongside this discussion of defining purposeful engagement. Without belaboring or getting too off topic, I want to say that I consider stimming purposeful for the child who is doing it, and thus consider them engaged while stimming. What we as therapists do in response to that stimming and why we might consider intervening is up for much more discussion and will vary with each individual client and their relative situation as well as their reasons for seeking intervention. For these reasons I consider more discussion on this topic as beyond the scope of this blog post.

The nuances of therapeutic intervention and interaction are vast, yet for me it comes down to one simple principle, so clearly and so well articulated by Polyvagal Theory; we are wired for safety… connection supports a felt sense of safety. Our job is to connect and to facilitate connections…between the person and their people, between the person and the objects they need for function, and to create an environment that helps those connections continue to flow. I see this as engagement and this is our job; from engagement comes potential for function.

*If you are an occupational therapist interested in diving deeper into concepts related to Polyvagal Theory consider enrollment in The Sensory Collective. We’d love to have you join us as we learn together.