2. Social and Emotional Development through Floortime By Megan Heath “M.J.T.”

4. Tools of the Trade  Applied Behavioral Analysis, DTT, Lovass  PECS, Sign Language  TEACCH – visual strategies  Sensory Integration  Social Skills Training  Reciprocal Interactive Play - “Floor Time”  Theory of Mind, RDI, etc.

5. What does a D.I.R. Program look like?  Sensory Integration  Structured Instruction (ABA, TEACCH, etc.)  Applied Floor Time – Thematic Activities  Floor Time Sessions - 20 min. segments (6-8 times a day)  Augmentative Language Strategies if needed

6. What Is Floor time?  A floor time philosophy means engaging, respecting, and getting in tune with children in order to help them elaborate through gestures, words, and pretend play what is on their minds. As a technique, floor time is a five-step process that can be used by early childhood teachers and parents to help support children’s emotional and social development.

7. Broad Goals of Floor Time  To become more alert  Take more initiative  Be more flexible  Tolerate frustration  Sequence longer actions – plan and execute  Communicate gesturally and verbally  Take pleasure in learning

8. Major Differences  Developmental  Social-Emotional Approach-- Relationship-Based  Highly Individualized due to processing differences  Reinforcement comes first, then teach in optimal moment of arousal, interest, and with affect  Not Start/Stop, but Continuous Flow Model  Skills taught in functional “live” context  Process not product

9. The D in the DIR Model “Developmental”

10. Functional Developmental Roadmap 6. Building Bridges / Logical Thinking 5. Symbolic Ideas 5. Symbolic Ideas 4. Problem Solving / Two- Way Complex Communication 4. Problem Solving / Two- Way Complex Communication 3. Simple Communication / Gestures 3. Simple Communication / Gestures 2. Engagement 2. Engagement 1. Attention and Self Regulation 1. Attention and Self Regulation

11. Pretend Play Imitation Cause Effect Turn- taking GesturesSounds Facial Expressions Problem SolvingFirst Words2 Word phrases Questions Reciprocal Statements Conversation Skills Eye Contact Joint Ref

13. The I in the DIR Model “Individual Difference”

14. Individual Differences  Every child has biologically based differences in sensory processing, modulation, muscle tone, motor planning and sequencing.  Including: 1. Auditory processing 5.Motor Planning 2. Visual Spatial processing 3. Tactile processing 4. Sensory Modulation

15. Seven Senses  Visual- seeing  Auditory - hearing  Tactile - touching  Olfactory - smelling  Gustatory - tasting  Proprioceptive – input from our muscles and joints  Vestibular – Movement, balance, where we are in relation to gravity * These are all inter-related “the novacane child” - Rosemary White

16.  Sensory Integration is the organizing and processing of sensory information from the different sensory channels and the ability to relate input from one channel to that of another in order to emit an adaptive response. (Ayres, 1972)  It is the ability of the nervous system to take in and regulate various internal and external sensory stimuli.

17. The R in the DIR Model “Relationship Based”

18. Circles of Communication 1.Eye Contact 2.Facial Expressions 3.Gestures 4.Sounds 5.Words 6.Questions and Statements 7.Etc.

19. Emotions give direction to our actions and meaning to our experiences, they enable us to control our behavior, store and organize our experiences, solve problems and think. (Greenspan)

20. Emotions in Autism  Co-regulating affect signaling is difficult because of biological challenges in connecting sensations, affects and motor responses together.  Difficult to be purposeful and behaviors become repetitive, aimless or simple because there is no affective goal or intent to make actions meaningful.

21. Why a Social- Emotional Approach?  “Affect Fuels Learning” ( ex. saying Hi, more vs. less)  What we know about typical development  When do we learn best?  Affect gives meaning to the words Emotions cannot be taught solely cognitively. “we cannot understand others emotions until we understand our own” Emotions cannot be taught solely cognitively. “we cannot understand others emotions until we understand our own”  Emotions organize the mental team

22. Perseveration vs. Engagement

23. Five Step in Floor Time  Observe  Approach – Open Circle  Follow Child’s Lead  Extend and Expand Play  Child Closes Circle

24. Step One: Observation  Match the mood, tone, energy level, language abilities, sensory profile  What are they doing and why are they choosing to do it?  “Turn the Action into Interaction” by making it a ritual or a game

25. Step Two: Open Circle  Approach - Join in 1.) imitate 2.) assist – be the assistant director 3.) Playfully Obstruct  Tailor interaction to child’s differences in auditory processing, visual spatial,motor planning, sequencing and sensory modulation.  “Persist in your Pursuit”  Establish Shared Attention and then reciprocal interaction  Move child’s focus from object to you – you be the child’s favorite toy!

26. Why Follow?  “The larger and very serious game being played by the parent is to turn even what looks like random behavior into intentional acts that get a specific response, and thereby become the means of nudging the child’s crucial affective development back on track.”

27. Step Three: Follow Child’s Lead  Allow the child to initiate, set tone, and control the drama  Do NOT give commands, ask questions you know the answers to, or teach concepts. The goal is connect and establish reciprocal engagement. This takes practice. We are to be the ultimate play partner!

28. Step Four: Extend and Expand  Help the child climb as high as he can up the ladder.  Play dumb, do it wrong, pause in the interaction.  Goal to open and close more and more circles and then do it in more and more sophisticated ways.  Do something novel, add a step, “morph it”  This is the teaching moment!

29. Child Closes Circle  When the child shows interest in something else we start over again with step one.

30. Tricks of the trade for each functional developmental level

31. Becoming Engaged and Purposeful  Work on the bottom three levels simultaneously  Fill in any holes for a child with lots of skills

32. Level I: Attention and Self Regulation (Birth to 3 months) What is self – regulation? 1. Strategies one uses to increase attention and to self calm 2. One’s ability to monitor behavior in response to environmental cues 3. Impulse control, flexibility and decreased need for structure reflect self regulation. Initially the nervous system learns to regulate temperature, tone, sleep/wake, hunger etc. Next, self regulation is reflected in sensory-motor strategies to achieve appropriate state. Thirdly, it is accomplished through problem solving and using language. GOAL -- Bring the child to homeostasis and then teach them to do it to themselves

33. We can change the “R” according to their “I” to help make progress on the “D”

34. Suggestions for Attention and Regulation  Draw the child into shared attention by using the preferred sensory- motor profile.  Follow child's focus and affect  “Up regulate” the hypo- responsive child (excitement and novelty)  “Down regulate” the hyper responsive child (calm and repetitious)  Slow down speech  Use salient language  Let the child initiate movement  Use all available senses  Be animated  Attract with magic!  Playful obstruction

35. Level II: Mutual Engagement  Capacity to interact in relationships for pleasure, comfort, soothing, and later to express anger, jealousy, overcome fears etc.  Feelings of intimacy  Beginning use of joint attention  Prefer people to objects

36. Tricks of the Trade to Engage  Persist in your pursuit  Build on pleasurable interactions  Use toys to enhance interaction  Use repetition to create anticipatory games  Play dumb – wait  Encourage child initiation  Stop and let them restart preferred activities  Match language abilities “Verbal Ping – Pong”

37. Level III: Two-way Intentional C ommunication  Child conveys intentions in back and forth signaling using gestures, facial expressions etc.

38. Level III : How to…  Treat everything as intentional  Keep it going as long as you can  Help child “do to you”  Playfully obstruct  Turning around immature gestures  Add meaning – open the symbolic door.  “No talking dust”  Teach that the child's actions have power  Teach non verbal solutions to emotional triggers

39. Level IV: Problem Solving  Children learn how to solve problems with their new ability to move and use complex sequenced gestures and then words to get their needs met.  Multi-step actions and later words to express what they need or want. ( ex. Milk in the fridge)  Motor planning, or praxis, is foundational because it is the ability to create, plan, and carry out an unfamiliar motor activity

40. Level IV: Problem Solving  Extend the circles by adding steps  Add sequences and more action  Increase emotional range  Challenge child’s closure  Increase interaction across processing areas  Go for continuous flow  Use language to spotlight  Encourage imitation  Use augmentative Stratedgies as needed

41. Level V: Creating Ideas  The child begins to express thoughts and ideas through symbols using pretend play and words. The child can communicate what they imagine representing real experiences though symbols.  Problems in this area reflect difficulty adapting and expanding his plan as well as anticipating outcomes – therefore the child becomes rigid and uses scripts

42. Creating Ideas  Drama, drama, drama – Be a player!  Encourage use of ideas in real and pretend  Use ideas off child’s affect  Declarative language  “Words, Affect, Action”  Create challenges where words are necessary  Encourage all types of ideas  Help move drama along without taking over  Turn toys into ideas!  Respond to reality with symbols  Substitute one object for another  Extend, elaborate, expand

43. A World of Symbols  Goal to have a substitute reality through symbols or images  Goal to elevate impulses to the level of ideas and express through words and play instead of acting out  Symbols create a safe distance to practice for the real world

44. Emotional Themes in a Symbolic World  Jealousy  Sadness/ Disappointment  Dependency/Joy/ Separation  Anger/ Aggression  Fear  Surprise  Power/revenge  Competition  Loyalty  Justice

45. Level VI: Building Bridges  Encourage logical bridges – Who, What, where, when, why, If / then, how?  Debates, relative ideas, opinions, humor  Use special interests to create affective interest  Child needs to close all symbolic circles, throw out silly ideas to non-responses  Challenge child to connect subplots  Provide multiple choice – obvious first  Beginning, middle, end with anticipated outcomes

46. Intimacy through all Emotions

47. Challenging Behaviors Childs Action Suggested Solutions Stays stuck, doesn’t know what to do next Provide destination Give new meanings Use ritualized cues Uses scripts Join in Offer alternatives Change direction Perseverates Join, imitate, help Make interactive How many times? “special” time Protests, rejects, refuses Act sorry, play dumb, restore, blame figure, More things to say no to, give choices Says something off topic Insist on a response, notice change or bring closure

48.  The DIR model is “a framework” for a comprehensive, developmentally based approach to working with children with special needs, learning disabilities, and learning differences, as well as for promoting the development of all children, including children with special strengths.

49. Empowering Parents  Priorities  My child is not the sum of his behavior  Cost (Dr Rick Solomon PLAY project)  “I am not the cause, but I can provide a huge part of the cure!”

50. A DIR-based program GOAL Systematic Instruction Applied Floor time Floor time – Continuous flow Use Augmentative strategies as needed *See handout for comprehensive program outline

51. Further information  “ The Child with Special Needs” and others by Dr. Greenspan  New Book -- “Engaging Autism”  ABLC – The Affect Based Language Curriculum  www.floortime.org www.floortime.org Web Radio show on Thursdays @ 8:30 (MT) and archived Web Radio show on Thursdays @ 8:30 (MT) and archived  www.icdl.com Clinical Guidelines www.icdl.com  RDI by Gutstein and Sheely at www.rdiconnect.com www.rdiconnect.com  Dr. Solomon’s Play Project www.playproject.org www.playproject.org www.playproject.org  “ More than Words” Hanen Institute  Floor time message board at Yahoo groups