Childrens Health Innovation Project

1

• Childrens Health Innovation Project
• CHIP
• Annual Conference
• Syracuse, New York
• November 15, 2007

2
(No Transcript)
3
DIR Foundation for the Future 
Strengthening Developmental Capacities
Integrating Individual DifferencesUsing
RelationshipsTo Promote Healthy Social
Emotional Development and Learning 
4

• Presented by
• Serena Wieder, Ph.D.
• Founder of ICDL with Dr. Stanley Greenspan
• Director, DIR Institute
• President, ICDL Graduate School
• www.icdl.com
• www.Floortime.org
• swieder_at_icdl.com

5
The

• DIR/Floortime
• Infant Mental Health Model
• A Developmental Roadmap for understanding and
  integrating all aspects of development.

6
Traditional Infant Mental Health Approaches Deal
With

• Attachment and relationship disorders
• Parents projections and representations
• Parents misperceptions
• Ghosts in the nursery
• Who the baby is to the mother
• Good enough parenting and holding
  environments

• Childs feelings or conflicts
• Symptoms or behavior problems
• Family patterns
• Help child put feelings into words and help child
  resolve conflicts
• Help parents refrain from undermining childs
  development

7

• What are the developmental pathways to supporting
  healthy emotional development?
• What are the developmental pathways to
  understanding challenges, difficulties and
  symptoms?

8
DIR Model

• Three dynamically related influences on
  development
• Biological and genetic influences which affect
  what child brings into his interactive patterns.
• Cultural, environmental and family factors which
  influence what parent or caregiver brings into
  the interactions.
• Child-caregiver interactions that determine the
  relative mastery of six core developmental
  stages/processes.
• Symptoms or adaptive behaviors are the result of
  these stage specific interactions.

9
DIR/Floortime Model
Family, Community, Culture
Biologically Based Individual Differences
Child- Caregiver Interactions

• Functional Develop. Capacities
• Focus and attention
• Engaging and relating
• Simple two-way gesturing
• Complex problem-solving
• Creative use of ideas and symbols
• Analytic/logical thinking

10
DIR Functional Emotional Developmental
LevelsThe Essential Foundation

• The D Emotional Developmental Capacities
• Regulation and shared attention calm and focus
  to take mutual interest in the sights and sounds
  social referencing
  03months
• Forming attachments and engaging in relationships
  with warmth, trust and intimacy later staying
  related across full range of emotions 5
  months

11
The DFunctional Emotional Developmental
Capacities

• Intentional 2-way affective communication
  purposeful continuous flow of interactions with
  gestures and affective reciprocal interactions
  9 months
• Complex Social Problem Solving able to problem
  solve through social interactions in a continuous
  flow using long sequences of gestures leads you
  to object, imitates, social play
  18 months

12
DIR Functional Emotional Developmental Levels

• Emotional Ideas able to represent or symbolize
  intentions, feelings and ideas in imaginative
  play or language using words and symbols
  (representational capacities and elaboration).
  30 months
• Emotional thinking bridges and combines ideas
  together to become logical and abstract able to
  differentiate represented experience to
  distinguish reality from fantasy, self from non
  self, one feeling from another, and across time
  and space.
  42-48 months

13
Developmental ChallengesRelated to Processing
and Regulation

• I Individual Differences
• Take into account childs
• Arousal level and sensory modulation
• Auditory processing and language
• Motor planning and sequencing
• Visual spatial processing
• Medical and biological factors
• Crosses all developmental levels.

14
The R of DIR -

• Primary Principle
• Relationships are the vehicle for creating
  learning interactions and mobilizing development
  and growth through interactions and affects
  (affect cueing).
• Childs individual constitutional differences and
  relationship - caregiving patterns together
  influence development

15
DIR Approach to Healthy Emotional Development

• Create opportunities to assist child in learning
  basic developmental capacities
• Ability to attend and focus
• Ability to engage warmly and trustingly with
  others across a range of emotions
• Ability to communicate intentionally with both
  simple and complex gestures to negotiate
  dependency, aggression, approval and rejection

16
Healthy Emotional Developmentincludes the

• Ability to problem solve through social
  interactions in a continuous flow
• Ability to represent or symbolize intentions and
  feelings in imaginative play or language
• Ability to differentiate represented experience
  to distinguish reality from fantasy, self from
  non self, one feeling from another, and time and
  space.

17
Another View

• Emotional Development

Parallels Symbolic Development and Intellectual
Development
18
DIR Model Solutions

• To understand a childs emotional development
• Look at childs self-selected symbols!

19
What is a Symbol?

• A symbol represents the real thing
• Symbols have many forms words, drama (dress up
  and role play), toys, drawings or pictures,
  movement
• All of which symbolize experiences
• Goal is to learn we have to substitute reality
  through symbols or images
• Symbolic play turns images into concepts which
  reflect the meaning of the image.
• Symbols reflect the hierarchy of emotional
  development

20
WHY BUILD A SYMBOLIC WORLD?

• Symbolic play and conversation is the safe way to
  practice, re-enact, understand, and master the
  full range of emotional ideas, experiences and
  feelings.
• Symbolic play leads to abstract thinking and a
  differentiated sense of self and others.

21
Emotional Thinking

• Each developmental stage involves the
  simultaneous mastery of both emotional and
  cognitive abilities
• Depend on sensory processing
• Take into account childs
• Arousal level and sensory modulation
• Auditory processing and language comprehension
• Motor planning and sequencing
• Visual spatial processing

22
Symbols reflect the hierarchy of emotional
development

• Emotional Development
• Parallels
• Symbolic Development
• Literal thinking is a constriction in
  symbolization
• Aggression and acting out behavior is a failure
  in symbolization

23
FloortimeBUILD A SYMBOLIC WORLD - GOALS

• Goal is to learn we have to substitute reality
  through symbols or images
• 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
• Symbolic play provides the distance from real
  life and immediacy of needs to differentiating
  self from others (through different roles) and
  self from the environment (not bound by time and
  space)
• Symbolic play turns images into concepts which
  reflect the meaning of the image.

24
Symbols Not the REAL Thing!

• Earliest Symbols
• Blankie to Teddy Bears
• Barney, Sesame Street, Pooh.
• Dora and Steve
• Farms, zoos and jungles
• Dinosaurs and Dragons

• Earliest Themes
• Comfort and reassurance
• Real life learning and feelings
• Explore and think
• Safety and danger a tiger is not a kitty cat!
• Entry to good and bad guys

25
Fairy Tales and Feelings

• Goodnight Moon
• Goldilocks and the Three Little Bears
• Three Little Pigs
• Billy Goats Gruff
• Corduroy

• Separation
• Getting lost
• Disappointment
• Fear and Danger
• Rescue and safety
• Joy
• Anger
• Sadness

26
Abstract Symbols Related to Expanding Emotions

• Good Guys
• Kings and Knights
• Princesses
• Fairy Godmother
• Wizards
• Batman
• Superman
• Power Rangers
• Etc. etc. etc.
• Real or Not?

• Bad Guys
• Pirates
• Giants
• Stepmothers
• Witches
• Joker
• Dracula

27
Developmental Anxieties and Solutions

• Strangers
• Separation
• Body Injury
• Fears ghosts and monsters
• Aggression
• Good Guy Bad Guy
• Breaking the Rules

• Co-regulated Affective Interactions
• Pre-verbal gestural
• Magical Thinking
• Control
• Logical Thinking
• Episodic reality testing
• Abstraction

28
Hierarchy of Emotions

• Dependency Themes
• Feeding, cooking, fixing, doctor, mechanic,
  builder..joy, love
• Transition Themes
• Separation, disappointment, loss, sadness, fears
  
• Assertiveness/Aggressive themes
• Control, power, competition, anger, jealousy,
  justice, morality.

29
Is your child in the symbolic world? Depends on
COMPREHENSION!

• How are symbols expressed?
• GESTURES
• WORDS
• USING TOYS
• MOVEMENT in SPACE
• ART
• MUSIC
• When are toys or words a communicative problem
  solving language?
• When do toys or words become an idea?

30

• What is the intersection between symbolic
  development and sensory perception and processing?

31
How do you climb the symbolic ladder WHEN
-to climb you must use all parts of yourself?

• you do not speak yet?
• You have the words and the memory but do not
  comprehend?
• You have an idea or wish but cannot plan or
  sequence in order to execute?
• You do not know where you are if you turn around
  or something else is moved or moves?
• You see tiny details but do not differentiate
  faces?
• You are under-reactive or self-absorbed and dont
  notice the environment visually or auditorily or
  both?

32
What to observe?Motor Planning and Visual
Spatial Capacities

• Wanders aimlessly without looking at or exploring
  toys
• Only finds toys in certain areas (.e.g., on the
  floor or table top or last seen)
• Drops objects/toys and does not pick them up
  automatically
• Plows through floor littered with toys which have
  been dropped or abandoned

33
What to observe?Pre-verbal or non-verbal
indicators of motor planning and visual spatial
challenges

• Arranges toys in certain spots but does not use
  them for play
• Lines up figures, animals, or dinosaurs
• Lines up figures one at a time to fight
  battles or contests
• Cannot arrange scene using toys to set up a
  picnic, zoo, battle, ambush, etc.
• Sets up scene but wont move any of the pieces
  for action

34
Semi-Structured Play Visual Spatial
Perceptual Motor Processing

• Does not play matching, visual discrimination,
  visual strategy - games
• Cannot find desired figures in basket of toys
• Insists on repeating same puzzles or toys
• Selects easy puzzles again and again
• Does not use trial and error or other strategies
  to rotate puzzle pieces, use cues, tries to push
  pieces in, etc.
• Avoids construction, tinker toys, Legos, etc.

35
What to observe?What is the challenge?

• Prefers dress up and live action to use of
  figures and toys which need to be moved, arranged
  in space
• Minimally uses toys to play, shifting to
  talking with minimal movement of self or
  objects
• Does not plan strategy for battles, e.g.,
  surround, divide and conquer, ambush
• Does not anticipate moves of other players and
  gets alarmed or angry with unpredictable actions
• Cannot engage in a sword fight does not track
  sword moving gets alarmed when sword comes
  towards him
• Gets absorbed looking at self in mirror when
  dressed up or trying sword

36
Emotional/Social BehaviorsAnxiety Visual
Spatial Processing

• Separation Anxiety
• Overly fearful and reactive to body damage,
  aggression, unpredictable events
• Panic reactions when s/he turns around and does
  not see parent or feels lost
• Catastrophic reactions to not finding needed
  objects or thinking something broke
• Helpless or frustrated feelings when task
  requires using space, tracking, finding parts,
  fixing things

37
Emotional/Social Behaviors Visual Spatial
Perceptual Motor Processing

• Over-reactive to unexpected social overtures,
  getting too close, being touched...lacks flow
• Under-reactive to social overtures, cant follow
  cues cant sustain flow
• Has difficulty picturing visualizing places,
  situations, people, etc. and overanxious
• Difficulty judging reality and fantasy
• Sees the trees but not the forest
• Sees the forest but not the trees

38
DIR Model for Infant Mental Health

• Provide specific types of developmental
  experiences at each stage of emotional
  development in order to foster further emotional
  growth.
• Consider infants unique individual differences
  constitutional and maturational patterns in order
  to provide these experiences.
• Enable parents or caregivers to understand their
  own characteristics and interaction patterns with
  their children to foster growth.
• Enable parents or caregivers to understand and
  deal with emotional lags, constrictions,
  deficits, symptoms and foster adaptive
  development.

39
The Foundation for the Future

• Support emotional development to support mental
  health and intellectual development
• Aggression and acting out behavior reflects the
  failure of symbolization and relationships
• Need a comprehensive model of development to
  foster the emotional, social and intellectual
  foundation for the future

40
Floortime, is a vital element of the
DIR/Floortimemodel

• a treatment method as well as a philosophy for
  interacting with children, adolescents, (and
  adultsl).
• Floortime involves meeting a child at his
  current developmental level, and building upon
  his particular set of strengths. 
• Floortime harnesses the power of a childs
  motivation following his lead, wooing him with
  warm but persistent attempts to engage his
  attention and tuning in to his interests and
  desires in interactions.
• By entering into a childs world, we can help him
  or her learn to relate in meaningful,
  spontaneous, flexible and warm ways.

41
What is Floortime?

• Floortime is the term used for those experiences
  in which you follow your childs lead in areas
  that give him pleasure, and then build on them in
  ways that expand his emotional capacities and
  tolerance for frustration helping him climb the
  developmental ladder.  

42
What is Floortime?

• It is called Floortime because it reminds
  parents, child care providers, teachers and
  therapists that a window into the childs
  emotional and intellectual world most easily
  opens when you enter into his orbit at his eye
  level and on his terms.
• With infants and young children you may actually
  play on the floor, and this evolves into other
  forms of interactions as you grow, such as
  reflective conversations.

43
DIR Model for Infant Mental Health

• Behavioral approaches or focusing on isolated
  units of behavior can obscure a larger
  developmental challenge and miss the larger
  opportunity to master critical developmental
  milestones.

44
DIR Model for Infant Mental Health

• But what if problem behavior is part of a larger
  developmental failure?
• Has not learned to relate or engage warmly to
  other people or others have not related to him
• Has not learned to empathize with someone elses
  perspective
• Has not learned to regulate or control aggressive
  impulses because he lacks capacity to see his
  behavior has consequences for others

45
DIR Model for Infant Mental Health

• Focus on behavioral control rather than
  engagement or learning relationships can be warm
  and supportive.
• Using very concrete rewards or negative
  consequences can undermine the first goal of
  creating a sense of relationship and engagement.

46
DIR Model for Infant Mental Health

• To appreciate the consequences of interaction
  need to learn that communication is causal and
  two-way and has impact on others
• Therefore child needs to learn to experiment with
  his own initiative and monitor the feedback he
  gets from others.

47
(No Transcript)
48

• www.icdl.com
• Annual International Conferences
• Annual Conference Workshops on DIR Practice
• Over 11,000 Participants from all US States and
  82 countries
• Publications Books, Videos and Journals
• DIR Networks in Atlanta, Boston, Chicago, New
  York, Rochester, San Francisco, Portland, Miami,
  Ireland, Australia, Israel, Wales, Argentina,
  Chile, Bolivia, Peru, Mexico.
• DIR Institutes in the US, Israel, Italy
• DIR Conferences in Europe, Israel, Australia,
  China, Singapore, South America
• DIR Books translated into Italian, Indonesian,
  Dutch, Chinese, Spanish, Hebrew, Croatian

49

• DIR Institute Educational Programs
• 2008 in Northern VA
• July 6-11
• DIRB for Professionals Beginning Practice
• DIRC Competency Based Certificate Program
• FTP Floor Time Players
• DIRA for Administrators and Parent Advocates
• DIR Training of Trainers Faculty/Facilitator
  Program