child caregiver relationships an interdisciplinary...

Shoreline Special Needs PTSA January 24, 2018

Child Caregiver Relationships

An Interdisciplinary Presentation

Rosemary White, OTR Alek Adams, MA MHP LMFTA

Pediatric PT and OT Services Shoreline, WA

Rosemary is an Occupational Therapist who brings in her work in Neurodevelopmental Therapy, Sensory Integration and DIR Flooritme. Alek a Licensed Child & Family Therapist Associate who studied at Antioch, brings Family Systems Therapy into her work with children and their caregivers. She also has worked in homes and schools embracing the DIR Floortime Philosophy in interactions in these settings.

n Rosemary will address the sensory and motor profile and how to tailor interactions to support you and your child.

n Alek will bring the reflective component related to the caregiver’s

experiences, enabling the caregiver to be present in the moment with each and every child.

RELATIONSHIPS

The foundation for life is built on the ability to attain & sustain a

co-regulated interaction.

Relationships are the vehicle for creating multiple opportunities for learning & understanding people & the world…

Thus creating every individual’s unique & meaningful perceptions & memories…..

Pediatric PT & OT Services The Offices of Rosemary White & Associates

Social and Emotional Development

Social and Emotional Development is a turbulent journey that begins at birth and continues through the entire lifespan.

Learn to communicate and express feelings. Learn to engage and manage feelings. Learn to understand and respond to other’s feelings.

Social and Emotional Development does not happen on its own it is cultivated through important relationships in life (parents, teachers, and other caregivers).

Self Awareness and Engaging in Relationship

As a parent and/or a teacher it is crucial to begin the practice of introspection.

Introspection can be defined as ‘the

examination or observation of one’s own mental and emotional process.’

So why is this important as a parent, teacher,

or caregiver?

Being with and working with children elicits huge emotional responses both good emotions

and hard emotions.

How we parent and teach is influenced by what was modeled for us, our culture, and how we

think and feel both emotionally and physically.

If we are not aware of our own emotional tags and triggers then we are going to find it

challenging to support our children with their big emotions and subsequent behaviors.

DIR® Floortime is a treatment philosophy for

parents & professionals that supports

the development of children who have challenges in

relating & communicating, including autism.

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Developmental, Individual Difference, Relationship Based Model

“R” Affective Interactions

MH

-  Understandng the “R”

Part of the “I”

“I” Biologically Based Differences Bio-Medical (MD, DO, ND)

OT/PT

Speech & Language

“D”

Functional Emotional Development - Levels 1 - 9

“R” Relationships

“D” Emotional

Level

“I” Individual Differences


DIR®/Floortime MENTAL HEALTH & DIR®

Affective interactions “R” part of the “I” Development of relationships - child/caregiver interactions, - family patterns, - child/peers

Emotional range, Symbolic capacities, Abstract thinking Creativity relative to oneself & to others.


DIR®/Floortime OT & DIR®

Neurobiological Factors: • Sensory Processing – sensory discrimination,

modulation & regulatory capacities, interconnectivity & perceptions

• Motor Control – muscle tone, righting & equilibrium,

gross & fine motor skills • Praxis Including motor planning & adaptation • Visual Spatial Capacities - Ability to visually attend,

share visual attention, assess visual figure-ground & integrate visual with other sensory stimuli


The Sensory Systems

•  Vision

•  Hearing

•  Smell

•  Taste

•  Touch

•  Movement/Vestibular

•  Proprioception

•  Visceral

•  Affect/Emotion

Touch, smell, movement, proprioception, visceral & affect senses dominate early in life & continue to exert influence in critical ways as the visual & auditory systems gain

ascendancy.

DIR®/Floortime COMMUNICATION & DIR®

Communication depends on the capacity to:

• Share Attention • Read & Use Gesture • Use Vocalization • Use Tone of Voice • Use Language to Communicate


DIR®/Floortime FOUNDATION FOR COMMUNICATION & DIR®

Capacity for Shared Attention & Engagement •  Share attention & respond to sound, & later, use gesture, tone of voice &

verbal communication •  Engage in fun, playful, interpersonal interactions

Intentionality •  Show intent through gesture, vocalizations, words Shared Meaning

•  Understanding & creating new ideas & meanings

Comprehension •  Understanding the meanings of others Production •  Use gestures, vocalizations, & later, words & language for communication

Pediatric PT & OT Services

The Offices of Rosemary White & Associates

DIR®/Floortime EDUCATION & DIR®

Brings DIR & the “lens” of all of the disciplines into the Education Setting & Every Learning

Moment • In the classroom • In the lunch room • In PE • In Music • At recess

& Social Interactions Throughout the Day


We learn from the Interdisciplinary Team!!

Understanding the “I” from each member of the Interdisciplinary Team is essential

to support everyone (parents/play partners & providers)

to “tailor affective interactions”

to engage to strengthen everyone’s developmental capacities in their

relationships.


Changes in Arousal over Time

Optimal Level of Arousal

Low Arousal

Behavioral Disorganization

Sensory Events Over Time Wilbarger & Wilbarger, 1991

Narrow Range of Optimal Arousal

Optimal Level of Arousal

Low Arousal

Behavioral Disorganization

Sensory Events Over Time Wilbarger & Wilbarger, 1991

Anxiety Feedback Loop

Challenging Sensory Processing

Physical Symptoms

Challenging Sensory Processing

Poor Comprehension Situation

Poor Motor Planning

Anxiety

Physical Symptoms

Mental Symptoms

Emotional Symptoms

Tantrums

Repetition (calming)

Self Absorption Aggression

Bolting

Add fuel to the

fire

Environmental influences

Ricki Robinson MD

Joseph LeDoux, The Emotional Brain

Memories =

Sensory

Memories =

Sensory fragments Low Road sensory with emotional stimulus goes directly to the Limbic System & emotional response is to the single sensation.

High Road sensory with emotional passes through the sensory cortices & interconnectivity between the cortices supports a comprehensive perception


The Limbic System is the Road to the Prefrontal Cortex

n Limbic system: • Reading nonverbal

signals. • Emotions • Gut responses • Assessment of safety • Long-term memory

n ‘When your child feels connected and protected, his/her limbic system can do another job—coordinate communication between all parts of the brain.’ (Wipfler, Schore, 2016) n Again there is a parallel process going on for child and the caregiver.

AFFECT, FEELING, EMOTION ARE RELATED

BUT

SOME INDIVIDUALS ARE PRIMARILY RESPONDING TO…..

n The Emotion, the broadest concept & most abstract concept •  the physiological response, •  The trigger of awareness in consciousness •  The emotions around the experience •  The association of past experiences & memories When affect, feeling and emotion are synchronous we experience…... •  sensory, •  awareness •  emotion •  memories

Thinking in the moment!

Al Gil Foley, 2012


Yeal Bruck Binya, OTR/L, Head of DIR Israel Yana Peleg, PhD., Clinical Psychologist, Israel

THIS IS A DYNAMIC PROCESS FOR ALL OF US…….

“Observation of behavior in response to the sensory environment”

guides us, parents & clinicians, to understand an individual’s sensory profile.

As a human being, it is important to “KNOW HOW TO READ EACH INDIVIDUAL”

As we interact with the children & families…..

The understanding of their UNIQUE INDIVIDUAL PROFILE will inform us…..

How to tailor our interactions to support the relationship…. & their functional emotional development

27 Pediatric PT & OT Services

The Offices of Rosemary White & Associates

LIKE US ON FACEBOOK

Rosemary White, OTR/L & Associates Pediatric PT & OT Services ww.pedptot.com Pediatrics · Shoreline, WA · 5.0 �

https://www.facebook.com/pedptot?fref=ts


n Profectum comes from the Latin for “advancement or progress,” & Profectum Foundation is dedicated to advancing the development of all children, adolescents & adults with autism & special needs.

n Our work builds upon the DIR Model -

Developmental, Individual Differences, Relationship model developed by the late Stanley Greenspan & Serena Wieder which is central to all our work. We also believe that the interventional approaches that parents & practitioners use to help individuals with special needs must advance & evolve to incorporate new ideas, new knowledge & reflect the most up-to-date research & neuroscience – they should never be static & must grow as our population grows.

n Profectum Foundation records most conference presentations & other sessions & makes them available as webcasts so that they can be more accessible to a larger audience. Profectum has over 200 video resources from our conferences & lecture series.

www.profectum.org 30

Training Opportunities for Professional

n Profectum Online Training www.profectum.org Online Basic Certificate Online Fellows Certificate Online Trainers Certificate Online Clinical Seminars

n ICDL www.icld.com Online training – 4 stages

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