Transcript BASIC CONCEPTS IN FLOORTIME ™ INTERVENTION AND THE

BASIC CONCEPTS IN FLOORTIME ™
INTERVENTION AND THE DEVELOPMENTALINDIVIDUAL DIFFERENCE- RELATIONSHIP BASED
(DIR) ® MODEL
Presented for Cal Lutheran University
April 13th, 2009
Dr. Jonine Biesman
STANLEY GREENSPAN, M.D.
Founder of the DIR ® Approach
Leading developmental theorist and interventionist
Specializes in conceptualizing and working with children with special needs
Degrees:
• Harvard, A.B., cum laude, 1962
• Yale Medical School, M.D., 1966
Dr. Greenspan is a practicing child and adult psychiatrist and
psychoanalyst,Clinical Professor of Psychiatry and Behavioral Sciences and
Pediatrics at George Washington University Medical School; a supervising
Child Psychoanalyst at Washington Psychoanalytic Institute, serves as chair
of the Interdisciplinary Council on Developmental and Learning Disorders
(ICDL) and co-chair of the Council on Human Development.
EXCERPTS FROM THE CHILD WITH SPECIAL NEEDS
(Greenspan and Wieder, 1998 pp. 123, 110-111)
“Relationships are critical to a child’s development. Through interactions,
you can mobilize a child’s emotions in the service of his learning. By
interacting with a child in ways that can capitalize on his emotions, you can
help him want to learn to attend to you, you can help him want him to learn
how to engage in a dialogue; you can inspire him to take initiative, to learn
about causality and logic, to act to solve problems even before he speaks
and moves into the world of ideas. As together you open and close many
circles of communication in a row you can help him connect his emotions
and intent with his behavior (such as pointing for a toy) and eventually with
his words and ideas (“Give me that!). In helping him link his emotions to his
behavior and his words in a purposeful way, instead of learning by rote, you
enable your child to begin to relate to you and the world more meaningfully,
spontaneously, flexibly, and warmly. He gains a firmer foundation for
advanced cognitive skills.” p. 123
• “Throughout history we have believed that emotions were
subservient to thought or reason, but an emerging body of
observation and neuro-scientific research suggests this view is
inaccurate. Rather than being separate and subservient to thought,
emotions seem to be responsible for our thoughts. Because
emotions give directions to our actions and meaning to our
experiences, they enable us to control our behavior, store and
organize our experiences, construct new experiences, solve
problems and think. The emotional component of each experience
make the experience meaningful…” pp.110-111
What is the “D” in DIR?
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The D in DIR represents social-emotional developmental milestones that are
essential to intellectual growth and overall healthy development. They serve as the
foundation for communicating, relating, and thinking independently within the context
of the greater social world. There are nine “Functional Emotional Developmental
Levels”:
1) Shared Attention and Regulation (begins 0-3 months)
2) Engagement and Relating (begins 2-6 months)
3) Two-way Purposeful Emotional Interactions – 2-way gesturing (begins 4-9
months)
4) Shared Social Problem-Solving (begins 9-18 months)
5) Creating Symbols and Ideas (begins 18-30 months)
6) Building Logical Bridges Between Ideas: Logical Thinking (begins 30-48 months)
7) Multi-Cause Thinking
8) Gray-Area Thinking
9) Reflective Thinking with a Sense of Self and Internal Standard
SOME GENERAL PRINCIPLES
 Affect is the glue for functional emotional development. Affect plays a
central role in all learning. The child has to invest affectively. Relationships
and pleasure are essential for learning to be meaningful. Emotion and
motivation drive cognition and motor development.
 Individual differences are the norm.
 Children learn best through active learning and interaction (follow the child’s
lead to find out what is meaningful to him/her). When meaningful
connections are not emphasized, a child learns to comply with external
demands but lacks the internalization that leads to self-initiation, empathy,
and abstract thinking.
 Incorporate all sensory and processing modalities.
SHARED ATTENTION AND REGULATION
The foundation.
Necessary for engaging and relating in the world.
Ability to remain calm and attentive to the world in the face of multiple sensory stimuli
and to self-soothe.
Congruence between a caregiver’s approach and child’s calming behaviors help the
child to develop internal regulation and control of his/her behavior.
Ability to achieve homeostasis
Infants instinctively turn toward a pleasant or familiar voice very early on. Use
pleasant sensations from others and from their environment to calm themselves.
The ability to attend to others and what is going on in the world.
ENGAGEMENT
Falling in love!!!!!
-Wooing
-Intimacy
-Enjoying the presence of another
-Mutually enjoyable shared experiences such as smiles and gazing
-Warm mutual feelings
-Helping the child to experience a range of feelings while staying engaged and
related
-Building trust
-The foundation for long-lasting relationships
-”Insure that your movements and voice are sensitive to the child’s individual
sensory profile so that you can woo them and they can woo you – always be
affective but for the under-responsive child be up-regulating and for the overresponsive child be down-regulating.” -Rosemary White, OT
TWO-WAY COMMUNICATION
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Use of gestures to communicate – pointing, reaching to be picked up, purposeful
noises, responding to people talking by making sounds, faces, initiating gestures
(wiggling, gurgling), back and forth affective signaling to convey intentions, reading
body posture and facial expression
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Mommy smiles, baby smiles back; Daddy rolls the ball, baby happily rolls it back.
Dialogue without words.
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First sense of cause and effect and establishing a sense of self, separate from the
caretaker. My intents and actions create results.
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Foundation for more sophisticated communication
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Beginning of opening and closing circles of communication – help the child use
affect and emotion to communicate intent, wishes, and needs (use of hands, face,
body)
COMPLEX COMMUNICATION AND SHARED
PROBLEM-SOLVING
 Organizing behavior to solve problems
 Continuous flow of affective interactions with people for shared social problem-solving
(e.g., may take caregiver by the hand, lead to the refrigerator, bang on door, point to
or say milk – sequencing of actions)
 Beginning to communicate ideas through words.
 Development of a more complex sense of self
 Stretch out exchanges for as long as possible. Don’t be too compliant and facilitative.
 Shared problem-solving is an essential skill for functioning with peers, in school, and
beyond. Insure the problem-solving is in an interaction
IDEAS AND SYMBOLIC PLAY
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Beginnings of fantasy play and the child representing the world in which he/she lives,
the conflicts faced, through play or symbolism
Exploring a range of feelings and themes (good guys, bad guys)
Making sense of a complex world
Increased use of language to indicate wishes and interests
Functional use of ideas (“Me hungry”, “Juice please”; feeding dollies, racing cars)
Representational capacity, forming mental pictures to form ideas about wants and
needs
Ability to use imagination
Experience the idea of an emotion
Symbols are necessary to express thoughts and feelings and to resolve conflicts
When we look at symbolic development we’re looking at emotional development.
Symbols provide clues into the child’s emotional world.
The goal is to elevate all feelings and impulses to the level of ideas and express them
through words and play instead of acting out behavior
BUILDING LOGICAL BRIDGES BETWEEN IDEAS
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Stringing together a logical sequence of ideas.
Moving toward more reality-based thinking
Providing explanations: Why?
Linking ideas and feelings to begin to form a logical understanding of the
world
The child learns to differentiate what is inside him from the outside world, to
understand himself and his world better.
Running dialogue, linking of the child’s action and ideas with your own
Closing of a multitude of symbolic circles, interaction of ideas
Be even more interactive, engage, question, challenge, collaborate, talk
about – but let the child take the initiative
Combine action, words, and affect!
Thinking conceptually, reflecting on motives, making predictions
THE IMPORTANCE OF APPRECIATING INDIVIDUAL
DIFFERENCES
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KNOW THE CHILD’S INDIVIDUAL PROFILE. NO TWO CHILDREN ARE
ALIKE
IMPORTANT AREAS TO ASSESS ARE LANGUAGE (EXPRESSIVE AND
RECEPTIVE), SENSORY PROCESSING, REACTIVITY, AND
MODULATION, VISUAL SPATIAL PROCESSING, AUDITORY
PROCESSING, MOTOR PLANNING (PRAXIS), PROPRIOCEPTIVE, AND
VESTIBLAR SENSES – THESE AREAS CAN CHALLENGE PROCESSING
AND REGULATION
OTHER AREAS ARE TEMPERAMENT, FRUSTRATION TOLERANCE,
COGNITIVE ABILITIES, EXECUTIVE FUNCTIONING, ATTENTION,
PERSONALITY TRAITS, BEHAVIOR
UNDERSTAND THE CHILD ACROSS SETTING
MODIFY THE ENVIRONMENT. REMOVE THE ENVIRONMENT FROM
THE CHILD; NOT THE CHILD FROM THE ENVIRONMENT
MODIFY THE WAY IN WHICH YOU INTERACT WITH EACH CHILD.
RELATIONSHIPS ARE THE CORE
ESSENTIAL LIFE LINE
 Relationships organize the child’s experience and support all domains of
development
 Rich synchronicity that occurs between child and parent in typical
development
 Flooded with positive emotional energy to glue to parent
 Holding image of parent when play peek-a- boo, baby can remain regulated
with just the image of mommy
 Evidence of dormant mirror neurons (fire in the prefrontal cortex when we
see someone doing an action we have performed) in individual’s with
autism
 Maintaining and sustaining co-regulated interactions
 FEAS – an assessment instrument designed to assess a child’s functional
emotional and social capacities in the context of the relationship with the
caregiver
RELATIONSHIPS (CONT.)
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Essential to consider family dynamics, parenting styles, family stress,
patterns of interaction, capacity to woo and engage
Assess parents priorities and conceptualizations
Understand parents own experiences and feelings regarding play
Parents capacity for handling aggression and other difficult behaviors
Parents view of their child once diagnosed
Available support for the family system including siblings
Genetic propensities
Can not underscore the need for AFFECT in the family. Affective
interactions help the child regulate around sensory experiences, to draw
meaning, helps the brain to create connections between different
developmental domains (e.g., motor, cognitive, visual-spatial)
SOME RESOURCES
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ICDL.COM
STANLEYGREENSPAN.COM
COPING.ORG
CELEBRATE THE CHILDREN.ORG
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Books by Stanley Greenspan, Serena Wieder, and other contributors:
The Child with Special Needs
Engaging Autism
The Challenging Child
ICDL- DMIC (Diagnostic Manual for Infancy and Early Childhood)
Psychodynamic Diagnostic Manual (PDM)
Clinical Practice Guidelines
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The Out of Sync Child (Kranowitz)
The Boy Who Loved Windows (Stacey)
The Developing Mind (Siegel)