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Tal Baz MS OTR/LRosemary White OTR/L

Rebecca Shahmoon Shanok Ph.D

The Dyadic Space -Where Affect and Sensory

Merge

Rhythms of Dialogue in Infancy

2001

Joseph JaffeBeatrice BeebeStanley FeldsteinCynthia L. CrownMichael D. Jasnow

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At four months old

• Eighty-eight mother-infant pairs were assessed in three partner configurations, in two different settings:

1. Mother-infant (home and lab)2. Stranger-infant (home and lab)3. Mother-stranger (home and lab)

At twelve months old

• Infant cognition was evaluated at home with the Bailey Scales

• Infant attachment was assessed in the lab using the Ainsworth Strange Situation

A-avoidantB-secure C-anxious-resistantD-disorganized

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Background facts…

• Discrimination of duration is one of the most basic functions of the auditory system.

• Infants perceive time and estimate duration of events – even in the fetus.

• Within the first month of life infants can discriminate uni-modal auditory duration changes of 20 ms’, and perceive synchrony.

• By age 4-5 months infants can discriminate duration, rate, and rhythm.

Definitions:• Vocal states:

1. Vocalization: a continuous utterance of one individual containing no silence greater then 250 ms, or 1/4 of a minute (V)

2. Pause: a joint silence greater then or equal to 250 ms (P)

3. Switching pause: a joint silence greater then or equal to 250 ms initiated by the turn holder, but terminated by a unilateral vocalization of the partner. It regulates the turn taking. (SP)

4. Noninteruptive simultaneous speech: begins and ends while the partner who holds the turn vocalizes continuously (NSS)

5. Interruptive simultaneous speech: initiated by the listener while the turn holder is vocalizing, but then continues after the turn holder stops (ISS)

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Tempo: the vocalization + pause cycle for each turn holder. It is measured by seconds per cycle and defines the “beat”.

…Rhythm is a recurrent temporal patterning of events, or nonrandom variation, which may or may not be strictly regular. There are Periodic Rhythms (heartbeat, breathing, etc.) and Non-Periodic Rhythms (communication).

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Coordinated Interpersonal Timing (CIT)

1. Match between temporal ranges of infant auditory discrimination (0.4-1.6 s) and sound-silence durations of adult-infant interaction (largely less then 1 s) – this reflects a coherent perceptual-motor system

2. A ratio of 1:2 of vocalization to silence has been found to occur regardless of tempo –this is considered a method mothers use to keep the infant from habituating

3. Bi-directionality of CIT:

– The degree of CIT was a powerful predictor of outcomes

– Midrange CIT values, especially with mother at home, predicted secure attachment

– Low and high CIT values predicted insecure attachment

– High CIT for infant-stranger in the lab predicts cognition – response to novelty

– Predictions of attachment and cognition were most correlated with the switching pause which is uniquely dyadic

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4. Modes of turn regulation: matching of switching pause durations make the exchange more predictable

5. Optimum lag: at any particular moment, on average, each partner was most contingent on what the other did 20-30 seconds before

What does this all mean, and Why is it

so important?

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• Vocal timing… is synchronized with various kinetic features, such as facial expression, head movement, and gaze patterns, so that it potentially indexes the whole communication “package” (stern, 1994)

Sensory Integration

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• The repetitions of vocal and/or kinesic patterns with minor variations are ideally suited to create expectancies, avoid habituation, maintain the infant’s attention, and create subtle nuances for the infant’s affective experience (nonperiodic rhythms).

Attention

• Sensitivity to time necessarily involves sensitivity to affective and cognitive information.

Affect and Cognition

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• Timing and rhythm are basic organizing principles of all communication, and rhythm underlies all behavior (Lenneberg, 1967)

Communication and Behavior

• In communication – as it is defined from a dynamic systems view –each person’s behavior is created in the process of joint co-ordination.

Co-Regulation

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UMA...

INITIAL EVALUATION

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DMIC: A Multi-Axial ApproachAxis 1: Primary Diagnosis

100. Interactive Disorders200. Regulatory-Sensory Processing

Disorders300. Neurodevelopmental Disorders of

Relating and Communicating400. Language Disorders500. Learning Disorders

With a consideration of contributions from the following Axes

Axis II

FEDL

Axis III

Reg.-Sens.

Axis IV

Lang.

Axis V

VisuoSpat.

Axis VI

Stress

Axis VII

OtherMed.

Axis VII

FamilyPatterns

Diagnosis – Axis I: Neurodevelopmental Disorders of

Relating and Communicating

301. Type I: Early Symbolic with Constrictions

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Diagnosis – Axis II: Developmental Stages

• Constrictions in all 6 functional developmental levels

Diagnosis - Axis III: Regulatory-Sensory Processing Capacities

Sensory Modulation Disorder (Type I) with Over-Responsivity, Fearful, Anxious Pattern (201)

Sensory Discrimination (Type II) and Sensory Based Motor Disorder (Type III) (205.4)

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Diagnosis – Axis IV: Language

Constrictions in all levels of language functioning, in both comprehension and production (401-406)

* Self regulation and Interest in the World * Forming Relationships: Affective Vocal Synchrony * Intentional Two-Way Communication * First Words: Sharing meanings in gestures and

words * Word Combinations: Sharing Experiences

Symbolically* Early Discourse: Reciprocal Symbolic Interactions

with Others

Diagnosis – Axis V: Visual-spatial Capacities

1. Body Awareness and Sense2. Location of Body in space3. Relation of Objects to Self and

Other Objects and People4. Conservation of Space5. Visual Logical reasoning6. Representational Thought

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Diagnosis – Axis VI:Caregiver and Family Patterns

History:• Parents for first 4 m’• Nanny between 4 and 18 m’ – 40 hours a week• In India between 18 and 25 m’• Started pre-school at 27 m’ (8 h’ a day)• Switched to another pre-school at 40 m’• Switched to integrated pre-school at 45 m’• Currently stays in school only for 5 h’ a day,

Mom or sitter pick her up.

Diagnosis - Axis VII: Stress

Uma

• Internal discomfort• External sensory

bombardment• “was assailed by

extreme stress and social anxiety in unfamiliar homes or with new people… cried, begged to be taken home… and was echolalia”

Parents

• Fear of meaning of diagnosis for her and for them

• Professional uncertainty

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Diagnosis – Axis VIII: Medical and Neurological Concerns

• One paternal uncle has depression/ADD, the other is socially awkward•Paternal grandfather may have had serious undiagnosed mental illness.•Both parents, and maternal grandparents have mild chronic depression.•Uneventful pregnancy. Mother stayed on a maintenance dose of Zoloft throughout.•Uneventful delivery, APGAR of 9•Mom produced little milk and stopped nursing altogether very quickly.•Was fed a cow’s milk formula for several months, and switched to soy based formula due to gas-related irritability and fussiness•Had 2-3 ear infections•M-CHAT was administered in her 3rd year check up•Neuropsychological eval. Followed leading to a PDD diag’

WITH MOM AT HOME

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BLUE OR YELLOW MAMMA

THERE ARE 2 UMA’S

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HI UMA, HI TAL

5 LITTLE MONKEYS

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SINGING CHICKA CHICKA BOOM BOOM

PRETENDING CHICKA CHICKA BOOM BOOM

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TOO MUCH TIME ON KNEES

BEING SAD AND FEELING LOVE