Treatment Approaches

1
Treatment Approaches

• Integration of sensory integration, parent-child
  interactions, and parent guidance

2
Overall model

• Parent guidance focus on sleep, feeding, and
  behaviors at home
• Child-Centered activity fostering healthy
  parent-child interactions
• Sensory integrative therapy for organized
  attention, adaptive behaviors, and responses to
  sensory input

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Underlying Assumptions

• There is no one right way to work with families.
• Understanding developmental tasks is important to
  the helping relationship
• This parent and child belong together
• Recognize counter-transference

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Underlying Assumptions

• This parent and child do have it within them to
  find the answers
• Respect the unconscious and defenses that might
  be there for parent and child.
• Strong feelings should be elicited in a therapist

5
Parent Guidance

• Begin with parents concerns
• Provide parallel treatment to support parent and
  childs individual emotional development
• Support both parent and child through negative
  feeling states and distress

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Parent Guidance

• Help parents separate their needs and emotional
  states from their childs
• Labeling feelings and states
• Reframing behaviors that may be construed as
  negative
• Reflecting and empathizing

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Parent Guidance

• Talk through child to increase parental awareness
  of childs feeling states
• Help parents read childs cues and develop an
  observing response as opposed to reacting
• Use of self (staff) to highlight different
  feelings and appropriate responses

8
Parent Guidance

• Increase parental self-esteem and competence
• Make mother and father unique- special tasks that
  only they can do for child
• Admire the parent
• Empower parents with information about childs
  developmental states

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Parent Guidance

• Provide direct, concrete, and emotional nurturing
  to parents
• Allow parent and child to not interact when
  parent needs a break or feeling agitated
• Structure and routinize contact and limit setting

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Principles of Sensory Integration

• Desensitize hyperreactivities
• Organize sustained attention less is better!
• Facilitate organized, purposeful activity
• Promote self-calming and modulation of arousal
  states through sensory inputs

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Principles of Sensory Integration

• Childs interest and motivation guide how the
  sensory tasks are provided
• When tactile hypersensitivities are present use
  firm-deep pressure and proprioception (heavy
  objects, firm contact) and self-initiated
  exploration of textured objects
• Override tactile system with highly visual tasks
  or movement

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Guidelines for tactile input

• For tactile problems- always let child
  self-initiate the touch when possible
• For severely tactually defensive child- may have
  to intervene to help child overcome problem
  through techniques like brushing program,
  swaddling in comforter, dimly lit pup tent with
  pillows

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Guidelines for Vestibular Stimulation

• Child should be actively involved.
• Movement should be purposeful or else it will be
  disorganizing.
• Generally, child with gravitational insecurity
  needs a slow, gradual approach with linear
  forward-back or side-to-side orbital spinning
  couple with firm deep-pressure

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Guidelines for motor planning

• Develop conceptual organization of skill or task
  by having child initiate purposeful action
• Develop plan or program of action- what he wants
  to do getting ready
• Executing plan use verbalization and
  visualization to help

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Child-Centered Activity

• Experiential approach
• Form of infant-led psychotherapy adapted to
  sensorimotor phase of development
• Based on ego psychology as described by Greenspan
• Uses an object relations framework in recognizing
  projective identification of parent-child

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Child-Centered Activity

• Focuses on dynamics of parent-child relationship
• Insights gained by parents about their
  relationship with child and issues from their
  past
• Focuses on emotional needs of parent and child
  during interactions

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Child-Centered Activity

• Parent engages in Watch, wait, and wonder
• Child initiates interactions (except in child
  with PDD- structure 1st, then let child
  self-initiate)
• Parent discovers what child is seeking and
  needing, becoming attuned to childs
  constitutional and emotional needs

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Child-Centered Activity

• Help parent and child read one anothers signals
  and become attuned
• Pace and timing of interaction will depend in
  part on childs processing speed
• Help parent recognize projective identifications
  with child

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Goals of CCA for child

• Provide child with focused, nonjudgmental
  attention from parent
• Facilitate self-initiation and problem solving
• Promote sustained, focused attention
• Refine signal giving
• Enhance mastery of sensorimotor development

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Goals of CCA for child

• Broaden repertoire of parent-child interactions
• Develop secure attachment with parent

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Goals of CCA for parent

• Develop better signal reading of childs cues and
  needs
• Become responsive to child, allowing them to take
  lead
• Develop sense of parental competence as
  facilitator rather than director of childs
  activity
• Take pleasure in child

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Goals of CCA for parent

• Appreciate childs intrinsic drive for mastery
• Change parents internal representation of self
  and child to competent parent and child

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Instructions for CCA

• Provide 20 minutes/day
• Set out 2 sets of toys for young children use
  toys that have open-ended purpose
• Tell child it is special time
• Let child take lead and initiate what happens
• Watch, wait and wonder what child is doing

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Instructions for CCA

• Watch child to see what he is seeking and
  needing select materials accordingly
• Avoid cleaning up until finished so child can
  return to toys
• Talk about what child is doing
• Have fun!
• Special time is not for teaching skills

25
Instructions for CCA

• Avoid praising child motivation should come from
  child and pleasure of interaction
• Make clear when Special time is over.
• Do with siblings too.

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Research on CCA

• Muir and Cohen more organized and secure
  attachment relationships gains in cognitive
  development and emotion regulation
• Mothers reported greater parent satisfaction and
  competence and decrease in depression

27
Research on CCA

• Contrast between CCA and structured developmental
  guidance for 24 infants (14-30 months) with high
  irritability, sensory hypersensitivities, and
  short attention span
• Group 1 and 2 - 6 weeks of each intervention,
  followed by retest 4 months after intervention
  one group had no treatment

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Research on CCA

• CCA was more effective than structured
  intervention and no treatment for treating
  inattention and irritability
• 75 resolved in attentional problems after CCA
  37.5 after STR 0 after no RX
• For irritability 57 resolved after CCA 28
  after STR, 0 after no RX

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Research on CCA

• Prospective study on 39 infants with RD 13
  untreated, 26 treated, 11 controls
• Treatment provided 12 weeks when problems first
  identified
• Treatment focused on parent-child interactions,
  SI, and self-regulation
• Retest at 3 years

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Fussy babies To treat or not

• Treated group at onset at more developmental,
  feeding, motor and SI problems than untreated
  group
• Treated group had mothers who rated themselves as
  depressed an felt less attached may be reason
  they picked treatment

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Fussy babies to treat or not

• At 3 year retest Emotional and behavioral
  problems present in 23 of treated group and 53
  of untreated group
• Treated group still had more developmental, SI
  and motor problems at 3 years compared to
  untreated group

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Moral of story

• Short-term treatment during infancy may not
  change constitutional problems, but it may change
  the parent-child relationship and prevent later
  emotional problems, particularly in children at
  high risk for these