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Learning to Pretend: Part 2: Enriching Play and Addressing Individual Differences

7/18/2019

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​Take a role in the play
 
Rather than stay on the sidelines as an appreciative observer or narrator of the play it’s important to take a direct role as you engage with your child. In a complementary role in simple pretend play (for example, if the child has just begun to pretend and use objects in expected ways such as using a brush to brush a doll’s hair or pretending to stir “soup” in a pot) you can ask to taste the “soup” the child is repeatedly stirring and, after tasting, ask her to pour some into your dish.  
 
As the child’s play begins to evolve and he begins to understand and take on more varied and complex themes, you can assume a range of roles such as a customer in a restaurant in which she is acting as a cook or server, a patient in the doctor’s office, a passenger in a plane he or she is piloting, or a complementary role in a favorite movie, story, book, or TV/video series. In your role you can take on a voice to distinguish your character from yourself or speak for and animate a stuffed animal or puppet character. You can take on more than one role in the play by, for example, pretending to be the mean stepmother and later taking the role of the Fairy Godmother as your child pretends to be Cinderella. In a pretend car race you can be both an audience member cheering on the child’s racecar and the announcer declaring the start of the race and the winner. Try to vary your voice as you play the different characters or roles. You can also make suggestions to thicken the plot (see next section) from within your role(s) or revert back to yourself and use a “stage whisper” to distinguish yourself from your character to provide support or make a suggestion. 
 
Thicken the plot
 
By gradually introducing new elements into play we support the child’s ability to think in a more complex and flexible way. Some examples: (1) After exploring the planet her spacecraft has landed on, add a new twist by pretending to examine a fuel gauge and announcing that it’s out of fuel; (2) Have your character ask for a ride on the train the child is repetitively pushing around the train track. Add details by asking if the train stops at “Whoville” (or wherever you choose) and if you can buy a ticket to travel there. 
 
In addition to supporting more complex and flexible thinking, thickening the plot is an important strategy to incorporate if play becomes repetitive or if the child has a tendency to engage in scripted play based on a memorized story or video script. Do join in with scripted play by commenting on the characters and actions. Some children are very sensitive to their partners’ attempts to steer scripted play in a different direction. I recommend very gradually offering new ideas that diverge from the script. These can be very slight divergences from the actions or ideas. Once the child becomes comfortable with these minor changes it may be increasingly possible to collaboratively shift between or elaborate on ideas in the play.  
 
Recognize and encourage emotional expression in play
 
For children to be able to effectively cope with and manage their feelings, especially children with autism and other developmental or behavioral challenges, they must be offered many opportunities to label, identify, and discuss emotions. Engaging in pretend play with children in which they play out emotional themes is critical to helping them feel comfortable with a full range of emotions. When an emotion, particularly an intense emotion such as anger or aggression, is expressed through words or play rather than the child directly acting it out or simply attempting to inhibit it, it is an enormous advance. Although at first it may not be apparent, allsymbolic play represents the child’s experience and emotion in the present moment whether he or she is feeding a baby doll (feelings of nurturance and dependence on others), making her zoo animals jump excitedly (pleasure and excitement), searching for hidden treasure (curiosity), has dressed up as a super hero with super-human powers (sense of power), or is having dinosaurs attack each other (aggression).
 
A full range of emotions includes anger and aggression, fears and anxieties, sadness, shame or embarrassment, rejection or loneliness, etc., positive emotional expression such as love, joy and happiness, or a sense of pride and competence, and themes such as nurturance and dependence, curiosity, and desire. When adult partners join in the child’s play and accept and encourage the emotions expressed, including anger and aggression, they help a child become more comfortable with expressing a full spectrum of emotions. In addition to accepting and encouraging the predominant emotions, partners may also gently suggest a theme that counters the child’s predominant emotions. For example for a child who engages in frequent repetitive angry/aggressive play with animals, dolls, or action figures we might have our character offer something helpful or nurturing such as a band aid or to “kiss the booboo”.  For the child who is uncomfortable expressing control or assertiveness we can use a big voice and have our character demand, “More pancakes now!” and encourage the child to have their character do likewise.
 
Tailor play to children’s individual differences
 
Children on the autism spectrum or with other developmental challenges have a range of individual differences that can significantly impact their social interactions and play.  These include motor planning difficulties, high or low muscle tone, auditory processing, visual-spatial processing, sensory processing difficulties (including under-reactivity and over-reactivity/sensitivity), distractibility, hyperactivity, etc. We can support interactions and play by playing to the child’s strengths and modifying and tailoring the way we interact with the child. I will provide a few examples. (For more extensive discussion see the recommended publications and Internet resources listed below).


  • For the child who is under-reactive to sensory input and tends to be withdrawn we want to really ham it up in our play while for the child who is under-reactive and craves sensory-motor input combine pretend play with gross motor activities (for example, pretend to be on a pirate ship while bouncing on a trampoline or pretend an outdoor play structure with a climber and slide cis a space ship).
  • For the child with auditory processing issues words need to be clear and lengthy monologues should be avoided. Use lots of animation as you act out pretend characters.
  • The play of children with visual-spatial processing issues can be very fragmented as they move randomly from one idea or theme to another. They may have difficulty keeping track of and integrating objects and props into their play and can be helped by reintroducing the objects into their play. Children with these issues will also have difficulty sorting through and selecting objects from cluttered toy boxes or shelves. It can be helpful to sort out toys and props and assemble pretend play sets based on themes of interest to the child such as “fire station”, “cooking”, “baby care”, “the zoo”, “restaurant”, “farm”, etc. in plastic bins, cardboard boxes, or on shelves.
 
Recommended books for supporting the pretend play of children with autism spectrum disorder and other developmental challenges:
 
The Child with Special Needs: Encouraging Intellectual and Emotional Growth by Stanley Greenspan and Serena Wieder.
 
Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think by Stanley Greenspan and Serena Wieder.
 
Floortime Strategies to Promote Development in Children and Teens: A User’s Guide to the DIR®Model by Andrea Davis, Lahela Isaacson, and Michelle Harwell.
 


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Learning to Pretend: Part 1: Getting Started

4/1/2019

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A question that comes up in my work with children is when and how to help a child engage in pretend play. Pretend play is an essential step in child development. Pretend play (and symbolic thinking more generally) underlies the ability to reflect on reality, imagine “what if”, and to think flexibly and is an essential step in child development. Understanding and using symbols including verbal language, reading decoding and comprehension, written expression, mathematics, the sciences, and the arts are built on this foundation. Participation in pretend play enables children to connect words and symbols to emotions and act less impulsively. A critical aspect of social development, perspective taking (also referred to as “theory of the mind”) which enables children to understand the world from another’s point of view, is supported when the child takes on the actions and roles of others in pretend play. 
 
Given the importance of pretend play for developmental growth there may be a question as to when to begin focusing on this type of play, particularly for a child with autism or other developmental disorder. If you’re regularly engaging your child in back and forth interactions and she’s warmly engaged with you, closing many circles of communication (i.e., responsive to your initiations), and initiates to you with gestures, vocalization, etc. she’s ready for pretend play. In this post (Part 1) I offer pointers to “get the ball rolling”. Part 2 will suggest ideas to further enrich and elaborate on play and address individual differences and concerns. 


  1. Engage around what interests your child 

Engaging with children based on what interests them facilitates rich interaction and sustained engagement and these interactions offer the foundation for developmental growth. To learn what interests your child observe what he or she does in their spare moments, what fascinates them, what they love to do, and what they’re interested in in the moment and then look for opportunities to engage them around these interests. Do they love it when you play music at home or in the car, do they love nothing more than looking out the window to see all the cars and trucks that pass by, are they fascinated by airports, are they always in motion, or do they have a strong interest in sports stars and statistics? Acting out imaginary games of baseball or basketball may be the entrée to symbolic play for a boy or girl with a strong interest in sports and sports stars.  If a child loves dump trucks, play can focus on pretending to drive, back up, load and unload a toy dump truck.  A child who enjoys going with Dad to pick up food at the drive thru of a fast food restaurant is likely to enjoy enacting this activity.  Offer a pretend “mike” to a child who enjoys listening to music on YouTube, CDs, or the car radio.

 2.    Treat actions and objects symbolically

As we engage with children during their daily activities there are often opportunities to offer symbolic ideas by treating objects and actions symbolically. Here are examples: 
  • Your child has finished drinking his milk or juice from a cup. You pick up the empty cup and pretend to drink from it (including sound effects of slurping). You say “Mm! That was delicious juice!”
  • You’ve lifted up your child in your arms. You say “OK pilot, let’s take off” and move her around as she “flies to Florida to see Grandma”.
  • Hand your child a “key” to open the front door of a dollhouse or to start the engine of a toy car he’s shown interest in.
  • As your child is pushing a toy dump truck around on the floor have a toy figure ask if he can get a ride home.
  • As your child crawls in and out of a play tunnel suggest that she’s exploring a cave and ask if she sees a bear in there.
  • As a child is sliding down a sliding board talk about sliding down into the ocean and mention the sea creatures he may encounter (whale, shark, schools of fish, etc.) after he steps down. Ask what he sees once he’s gotten off the slide.
  • As a child is banging pots together say, “I’m in the band too” and join in or you can start marching and say, “Let’s start a parade!”
 
3.  Offer toys and materials that support pretend play


  • Pretend play toys include dolls, puppets, stuffed animals, action figures and toy figurines, play vehicles (cars, trucks, trains, airplane, bus, etc.), materials for pretend cooking and housekeeping, empty food containers, play sets for different themes (farm, zoo, fire station, etc.), etc. 
  • Open-ended toys and materials including art materials such as crayons, markers, paints, modeling materials (play dough, clay), and blocks and construction toys can also be offered to encourage symbolic play and representational thinking. These open-ended materials are age-appropriate for supporting symbolic thinking in older children and teens. Older children and teens may also enjoy discussing the plots of books, movies, fictional TV series, etc. including possibilities for alternate endings. 
  • Closed ended toys and materials. Closed ended toys are more helpful for promoting fine motor and perceptual skills and building attention than pretend play. These types of toys have a specific purpose and are generally used in a set way. These include puzzles, shape sorters, matching and memory games, mazes, manipulative/fine motor toys such as stringing beads, pegboards, etc.
  • While pretend play toys and materials are helpful, don’t overlook the opportunities for pretend play/symbolic thinking using everyday materials  throughout the day including large motor play, outdoor play, and daily routines such as snack time, bath time, etc. as discussed in pointer #2 above.

 4.  Broaden the child’s range of emotionally meaningful experiences 

​Inspiration for pretend play is all around us and can emerge from a broad range of emotionally meaningful experiences such as visits to a zoo or aquarium, a fire station, an airport to see the planes take off and land, the beach, an animal shelter, etc., etc. Even routine trips to the supermarket or accompanying a parent to pick up pizza at a pizzeria can offer possibilities for imaginative play and enrichment of play. During the visit help your child notice various facets of the setting or experience and the roles of people. If possible take photos or make a video to talk about afterward. Also keep your eyes open to what is of interest to your child right in their own neighborhood such as the mail delivery person doing their rounds or workers repairing the road. For each child, among their experiences in the world around them, there will be ones that particularly “click” and inspire play.  
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Play: Lining Up Toys or Objects

9/13/2018

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Introduction
 
While most of the articles found on the Internet on the topic of lining up toys focus on it as a sign of a possible autism diagnosis this article is primarily about ways to join with and play with children who enjoy lining up objects whether the children are on the autism spectrum, have sensory processing differences, have other developmental differences, or are typically developing. The ideas discussed incorporate principles and strategies of the DIRFloortime model. Some of the ideas will be applicable to children who engage in other types of play that tend to be rigid.  
 
Why children line up toys
 
Lining up toys represents a very normal type of play in young children as they take in the complexities of their world and seek to process, sort, and organize objects and materials in their environments. Sorting, classification, and understanding patterns are important mathematical skills and this type of early play can provide an important developmental foundation for all young children.
 
Related to the visual system, lining up toys can also be regulating and organizing for children with autism and sensory processing difficulties by offering a type of sensory anchor. This type of play helps the child gain a sense of control and organization when confronted with more sensory input than they are able to take in. The predictability can be very soothing and calming thus the play serves a purpose for the child.
 
For the perspective of an autistic adult on why he enjoyed lining up his toys as a child: https://themighty.com/2016/11/autism-letter-to-parents-whose-children-line-up-their-toys/
 
Some children are resistant to a partner joining this type of play. If this is the case I suggest starting with something very simple like simply handing the child an object. If the child accepts this type of interaction, try varying what you’re doing a bit. If what you try is not initially accepted, as long as the child is not agitated or upset, give it a try a few more times. Sometimes after a few tries you may begin to see a bit of smile forming at the corners of the child's mouth. Whatever you do, remember to do it playfully! The list below offers suggestions for joining with your child in this type of play. 
 
Suggestions for joining the play
 
  • Assist the child by handing them objects to add to the line-up.
  • After you’ve handed the child objects several times, playfully hand her an object that’s different from the other objects in the line-up and if they notice and show consternation, playfully and emphatically apologize (“Oh no! I thought that was a block!).
  • Ask the child to show you where to place an object to add to the line-up.
  • Make your own line-up that is parallel to the child’s line-up.
  • Count the objects in the child’s line-up (pointing to each object as you count).
  • Change the spatial configuration as you add to the line-up (e.g., add a vertical line, stack objects, etc.).
  • If the child’s lining up toy cars, pretend the lineup is a parking lot and add a car by driving it to the lot and parking it (make car sounds as you drive) or ask where you should park it. For some children lining up play can be a launching pad to pretend play.
  • If the child is lining up play food items or eating utensils, pretend to eat a food item the child is lining up or eat from an eating utensil in the line-up (“yum yum that looks delicious!”).
  • Place items that can be added to the line-up in a toy truck, shopping cart, or wagon and deliver them to the child (this may change or expand play into gathering objects to place in the truck or cart or pretending to load, drive the truck and make deliveries).
  • Join the child in looking around the room for additional objects within a category to gather to add to the line-up.
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Connection vs. Compliance

4/2/2014

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When I think about differences in ways of interacting with children, one defining factor that stands out to me is whether adults attempt to engage the child by insisting on compliance or by genuinely connecting with the child. This I believe is one of the key defining differences between different approaches to parenting and educational and treatment philosophies. What exactly do I mean by this? I offer examples below.

In my work I often focus on engaging children who are initially difficult to engage (often as a result of biologically based challenges such as motor, sensory, visual, and/or auditory processing difficulties). The child may be self-absorbed or withdrawn or focused on a particular activity or object (watching a Barney video, running around the kitchen island, lining up objects, opening and closing doors, picking pieces of yarn in the carpet, etc.) to the exclusion of engagement with the people in his or her life. As a DIR®/Floortime™ practitioner, I (and others with a developmental philosophy) approach this by seeking ways to connect with the child that follow his lead and are in sync with his unique ways of hearing, seeing, touching, smelling, and/or moving and that will not cause him to underreact or overreact and be overwhelmed and pull away. A practitioner with a behavioral philosophy approaches this from a different perspective, gaining compliance, often referred to as “gaining instructional control”. The focus is on having the child associate the parent or practitioner as a provider of reinforcers in order to gain compliance with directions or requests. As I explain below I see a focus on compliance as limiting and often counter-productive in interactions with children.

Opposing philosophies or approaches are also played out in everyday interactions with children in families and in school settings. In schools teachers adopt different methods of engaging children in learning and in guiding their behavior that are influenced by educational philosophies (which may be their own or that of the educational program or school) and/or personal and professional history and experiences. Some teachers, schools, and programs focus on things like “running a tight ship”, children following the directions and completing the assigned work, checking off goals and objectives, or higher scores on standardized tests rather than deeply engaging learners in content, considering different points of view, posing questions, making sense of the ideas or concepts, problem-solving, divergent thinking and creativity, and a love of learning. The latter is often referred to as "engaged learning". The teacher whose focus is on engaging learners is also a teacher who values connection and forges genuine and joyful learning relationships with children. A narrow focus on compliance limits opportunities to genuinely connect with children and also limits children’s learning horizons.

When it comes to guiding children’s behavior in everyday situations like needing a child to brush their teeth; put on their coat, hat, and mittens to go outside; or follow the rules in the school lunchroom parents and teachers can choose between demanding compliance or supporting their child’s cooperation through connection. For example, a parent who connects with their child might engage with their child over choosing toys or different types of bubble bath for the bathtub instead of demanding compliance with the routine, using threats when the child refuses or fails to comply, or resorting to rewards or bribery. Not only is the connection approach likely to be more successful in facilitating the child’s cooperation, the very interactions between the parent and child to get ready for the bath, choose tub toys or bubble bath, run the bath, get dried and dressed for bed offer countless opportunities for learning. As parent and child connect and engage in this bath time routine the parent is supporting the child’s abilities to read and respond to the emotional cues of others, engage in long chains of back and forth interaction, modulate emotions, problem solve, engage in imaginative play, etc.! Likewise in a classroom the teacher whose focus is on connection rather than compliance, directly involves the children in discussions and formulation of classroom rules and uses problems that arise between children or between a child and adult as opportunities for supporting social problem-solving as well as social skills and higher levels of reasoning and thinking. These connection-focused interactions also build the foundations for self-regulation (involving the ability to plan, set goals, regulate emotions, inhibit impulses, delay gratification, independently problem-solve) a critical underlying foundation for development and learning.

Over-reliance on demanding compliance can be counter-productive in multiple ways. Over time, excessive, and especially, coercive demands for compliance are detrimental to the parent-child relationship. Often the result is exacerbation of a difficult temperament and problematic child behavior as well as negative interactions between parent and child. Demanding compliance can also undermine children’s formation of self-concept and self-identity, self-esteem, development of autonomy, and initiative taking. This is problematic for all children but even more so for children with developmental disabilities who are at much higher risk for developing learned helplessness and passivity. In the broader picture, as discussed above, emphasis on compliance instead of connection undermines the development of self-regulation and healthy foundations for relating, communicating, and thinking.

While I recognize the use of reinforcers, a schedule of reinforcement, or a reward system is an improvement over simply demanding compliance, making threats, using punishment, and coercive or negative interactions between children and adults and can see a limited place for this in some situations, support for a philosophy that embraces connection is a far better long-term alternative. A focus on reinforcers and simply changing a behavior in order to address problem behaviors such as aggression, non-compliance, tantrums, moodiness, impulsivity, etc. does not in and of itself build the foundations for self-regulation. Self-regulation enables children to manage their emotions, understand what’s appropriate and inappropriate, and respect the needs of others. Compliance-based philosophies when used in classroom settings can also undermine academic and pre-academic learning by limiting children’s potential for higher level, creative thinking and in-depth learning within a subject or topic. Parents, teachers, and therapists, who embrace connection over compliance, are best able to provide the vital opportunities for building healthy foundations for development, learning, and relationships.


 
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Family-Centered Practice, Autism, and Informed Choice

11/7/2013

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Family-centered practice is considered the “gold standard” of practice for children with developmental disabilities and their families in health care, education, mental health, and social service systems and the relevant disciplines that provide services within these systems. It involves not simply collaborating with families but collaborating with families in ways that empower them in their role as decision maker. Allen & Petr (1998) identify among the core elements of family-centered practice “informed choice”. The element of choice is a core concept that is widely accepted in conceptualizations of family-centered practice.

Barry Prizant (2008) summarizes the key elements of authentic family-centered practice:

"Family-centered practice has as its primary goal, empowering families with the knowledge and skills to make the best choices for their child and for the family. In family-centered practice, professionals collaborate with families in decision-making about specific goals and objectives, as well as educational/treatment approaches. Parents are respected as experts regarding their child, and professionals consider each family's unique strengths and needs, as well as its cultural and religious values."

There are a number of factors families of children with autism spectrum disorders (ASD) should consider when selecting treatment options for their child. Among those I believe are particularly important for families to weigh are the following: (a) the goals or intents of the approach and whether those goals match the long-term and short-term needs of the child and family; (b) whether the philosophy of the approach respects and honors children’s individual differences, interests, and passions and families' culture and beliefs; (c) if the focus is on supporting and enhancing the child’s current capabilities and facilitating growth rather than changing the child in a fundamental way; (d) whether the approach is likely to support and strengthen the family's relationship with the child or if it could be counterproductive to this; (e) whether any methods that might be used with the child could potentially be aversive; and (f) if the approach is fully attuned with presuming competence and respecting the child's neurodiversity. Treatment approaches, or for that matter, providers, vary considerably in meeting these criteria. Thus, it’s critical that parents are able to access complete information on treatment approaches and it’s equally important that multiple treatment/intervention options are available to children and families. It's  also important to note that children with ASD often have needs that may require multiple therapies and treatment modalities and that needs change over time as the child develops. Even if a treatment approach has been helpful at one stage of development new or additional areas of need may emerge for which supplementary or alternative approaches are necessary. When information about potential options is withheld, incomplete information is provided, or information is provided in a biased manner, or agencies, organizations, or systems seek to limit the treatment options available this represents neither individualized intervention nor family-centered practice.

Practices of professionals, organizations, and service systems are relatively easy to categorize as to their family-centeredness. When it comes to the provision of services for children with ASD we see the following practices all too frequently and in many states and locales in the US these are the prevalent practices:

  • One size fits all service system that offers no funding or access to real intervention choices (e.g., developmental approaches as well as behavioral, range of therapies including music, art, dance, etc. as well as OT, speech, PT).

  • Professionals or agency administrators who cannot see beyond their own paradigm of practice and therefore limit the information or options discussed with parents. Whether motivated by sincere belief in a particular philosophy, the convenience of referring to a limited group of service providers, or financial factors this cannot be regarded as informed choice.

  • Professionals who make a standard recommendation for treatment (e.g., “40 hours of ABA”) without ever questioning the “standard”, informing themselves about the research that supports their recommendation, seeking the actual lived experiences of individuals who have received the prescribed treatment, or fully understanding the implications of children’s individual differences and needs and families’ preferences and choices for selecting among treatment options.

  • State service systems that build services around the treatment approaches favored or practiced by some practitioners while excluding or creating a firewall around other methods or models. This situation continues to be perpetuated even when newer or emerging research indicates potential benefit to children from the “out” methods thus depriving children and their families of the opportunity to benefit from these treatment approaches. In some instances the barriers created to prevent families from being informed of and accessing other methods not only exclude the “out” practitioners but financially benefit the “in” practitioners. Often this situation is further maintained by overly restrictive definitions of evidence-based practice which have been criticized in multiple disciplines (e.g., Biesta, 2007; Prizant, 2011; Rycroft-Malone et al., 2004).

The practices described above clearly do not represent family-centered practice. I have also observed initiatives and efforts around the US that do provide real options to families and children with ASD and other developmental disabilities. Examples include providing a pool of flexible funding which parents can directly access to pay for services of their choice such as consultations, evaluations, treatment, or supports; incorporating treatment options (e.g., DIR/Floortime, SCERTS, TEACCH) into children’s IEPs or IFSPs, and ASD insurance legislation that allows insurance payment for a range of treatment options beyond ABA services. Policymakers embracing family-centered practice and informed choice should also adopt policies that support training for practitioners in evidence-based intervention approaches and capacity building to enable schools and programs to provide multiple intervention approaches. This is particularly crucial for ensuring equal access of underserved and rural communities. I call upon all professionals, policymakers, agencies, and service systems to fully embrace family-centered practice and create greater flexibility and access to a range of treatment and support options for all families of children with ASD and other developmental disabilities.

Allen, R. I., & Petr, C. G. (1998). Rethinking family-centered practice. American Journal of Orthopsychiatry, 68(1), 4-15.

Biesta, G. (2007). Why “what works” won’t work: Evidence-based practice and the democratic deficit in educational research. Educational Theory, 57(1), 1-22.

Prizant, B. (2008). Treatment options and parent choice: An individualized approach to intervention. Autism Spectrum Quarterly, 4, 34-37.

Prizant, B. (2011). The use and misuse of evidence-based practice: Implications for persons with ASD. Autism Spectrum Quarterly, 15, 43-49.

Rycroft-Malone, J., Seers, K., Titchen, A., Harvey, G., Kitson, A., & McCormack, B. (2004). What counts as evidence in evidence-based practice. Journal of Advanced Nursing, 47(1), 81-90.


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Why DIR®/Floortime™?

10/11/2013

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The goal of this post is to clarify the reasons I believe DIR®/Floortime™ should be at the core of an individualized program for all children with autism spectrum disorders and other developmental challenges.  This is not meant to rule out other intervention methods and techniques that can and should be incorporated when they are needed to address individual challenges and needs, but rather the focus here is on what should be at the heart of an individualized program for each child.  For me that should be Floortime and Floortime-like interactions throughout the child’s day as the essential component of a comprehensive program tailored to that child’s individual differences and challenges, gifts, interests, and passions. Through this blog posting I want to convey why I feel so strongly about this model and why I’m working to get it out there to parents and professionals.

To make a real difference for children and their development we must deeply and intensely engage their emotions.  Stanley Greenspan and John Dewey told us, and now an increasing chorus of brain researchers, psychologists, and educators are telling us that it is indeed emotions and affect that drive learning and development.  I contrast this deep engagement that’s the focus of Floortime with my observations of other strategies being used with children (including discrete trial training, although not exclusively) in which the child’s engagement is often superficial and fleeting (except in instances in which the child is in distress because the adult’s expectations are not at all in sync with the child’s current regulatory, processing, or communicative needs, a very counterproductive situation).

DIR®/Floortime™ focuses on fostering essential social, emotional, and intellectual capacities. These fundamental capacities are the key to meaningful and rewarding human relationships and are the building blocks of development.  They include sustaining attention and self-regulation, engaging in a continuous flow of back and forth interactions (called circles of communication), social problem solving, imaginative play, and logical and abstract thinking.  DIR® practitioners seek to support and enhance the child’s current capacities and abilities and facilitate growth, not through changing the child in a fundamental way, but through tapping into, respecting, and honoring their individual differences, interests, and passions.  This is an approach that is fully attuned with the concept of presuming competence and respecting neurodiversity.

Through this model parents and professionals are supported to deploy affect and challenge the child in ways that are attuned with the child’s interests and engagement but that also encourage growth and climbing the developmental ladder.  Coaching by a professional such as myself can significantly aid parents, teachers, and therapists to incorporate these strategies into their everyday interactions with children.  Over time as adults learn to incorporate these methods they become a very natural part of their interactions.  The very naturalness of these techniques adds to the powerfulness of the model.    
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Supporting Social Play and Friendship: Part 2: Strategies for Helping Children Connect and Play

9/20/2013

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During play adults should foster a playful, fun environment that is responsive to children’s interests and supportive of individual challenges while also assisting children to connect and play with each other. In addition to the suggestions posted in Part 1 for setting the stage for the group or activity period here are strategies that can be used to help child connect and play together during playtime.

Model high affect

A key strategy for adults supporting play and interaction is to model high affect (e.g., feelings, emotion, as shown in facial expression) and playfulness. This helps entice children toward a common activity and/or each other. Given high interest activities and a supportive environment that is in tune with each child’s individual differences, the adult’s affect/playfulness can help create a climate to encourage communication and back and forth interaction. In addition the adult should use heightened affect/emotional expression to reflect differing emotional contexts in the ongoing play such as a look of surprise when a child uncovers a bright red caboose in a treasure hunt game, a look of sadness when a character in a story has lost his beloved pet, or a look of concern when two children .

Observe for interests to help link children together

Observe for children’s common interests in play and activities and follow their leads to link them together in ways that have the potential to support back and forth interaction. Examples:
  • Two children are moving/dancing independently to recorded music—the adult suggests they dance in unison (“Look how gracefully you and Marie are dancing! Shall we dance together?”). 
  • An adult suggests to two children who are engaged in parallel play with pieces from a miniature playground that they take turns having their toy figures go down the toy sliding board. Further suggestions might include one toy figure pushing the other on the toy swing.
  • A child observing and appearing interested in the play of another child can be assisted to “break the ice” by suggesting a complementary activity such as sitting at the table and “eating” the pretend “eggs” being prepared by his peer. 
  • As suggested in Part 1 observe carefully for children’s interests (ask parents too) and offer opportunities to pursue these interests whether it’s spinning objects, space travel, Thomas the Train, or taking apart small appliances. Look for signs of interest by other children and opportunities for social exchange.

Focus on nonverbal signaling

In addition to observing for mutual interests, supporting children’s use and understanding nonverbal communication signals (e.g., sounds, gestures, facial expression) is critical for the development of functional communication skills and social and emotional capacities. These signals may indicate interest in another child or the child’s activity, a need for help, a desire to participate, wanting to take a turn, continue a shared activity, or get the attention of another child. 

Examples:
  • A child standing across from another child playing with a water pump at a water table shows interest in the other child’s activity. The adult alerts the child playing with the pump to the peer’s interest (“Look Janny, Sammy really likes what you’re doing!”) and makes a suggestion to either child to support interaction between the two (“Janny, Can you pump water into Sammy’s pail? Here Sammy, put your pail under the pump. Janny will pump water in it.”). 
  • Children have been building and knocking down tall towers of cardboard blocks. Jay, who has observed this play, starts to build his own tower and keeps looking over with apparent interest at the spectacle of the blocks falling over but hasn’t joined in. The adult might say in a silly, exaggerated, slightly provocative tone to another child “Oh no! Don’t knock Jay’s tower down! Don’t you dare knock it down!” The adult thus interprets Jay’s nonverbal cues of interest and alerts other children in a playful way of his desire to join in. 
  • Similarly alerting children to each other’s cues of needing help with something like a challenging puzzle or using a new app on an I-Pad is a great opportunity for supporting back and forth communication and emotional signaling.

Use “problems” as opportunities

Problems or disputes that occur among children should be viewed as golden opportunities for children to use negotiation or problem solving to resolve issues. Adults can guide children through steps for solving problems (e.g., cool down, ID the problem, brainstorm solutions, try out the solution, follow-up). Adults can also experiment with purposely creating “problems” for children to solve that require them to problem solve and work together to overcome the problem. The “problems” that are set up generally involve high interest activities or materials. For example, the adult tells children that painting (a very popular activity) will be available and as he goes to set up the painting activity “discovers” that there is no more red or blue paint in the room. There is paint (which is in gallon containers) in another room. This problem is posed to three of the children who are most interested in painting. They brainstorm various solutions eventually settling on using a small wagon to transport the paint. The heaviness of the containers means they also have to work together to lift it onto the wagon and lift it out when they return. “Problems” can include desirable materials or equipment placed on high shelves or the door to an outside play area blocked by large and heavy blocks such as hollow wooden blocks.

Focus on natural spontaneous interactions not mechanical or prompted behaviors

Examples of mechanical or prompted behaviors include prompting children to greet others or make eye contact. Interactive behavior taught in a rote or mechanical way tends to be disconnected from the emotions and affective experience so critical to genuine and enriching reciprocal interactions and relationships with peers and others.

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Supporting Social Play and Friendship: Part 1: Setting the Stage

8/28/2013

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For most of us, being liked and accepted, having friends, and engaging in enjoyable and reciprocal interactions contributes to a full and happy life. Children with autism and other developmental disabilities often experience significant difficulty connecting with and sustaining interactions with their peers. Participation in inclusive education programs, social groups, play dates, and recreational programs can offer potential opportunities for interaction but unless environments, activities, and adult support are carefully and thoughtfully planned and implemented goals for building social competence and nurturing friendships will not be fully realized. In a two-part posting I offer parents and professionals ideas to support social play and budding friendships among young children. The first posting (see below) deals with setting the stage and Part 2 will focus on the use of affect and scaffolding/guidance to support play and social interaction. The tips and ideas can be applied to many different contexts and settings including classrooms, social groups, play dates, etc. with modifications to fit the particular context. These can be used with groups that include children with disabilities exclusively as well as inclusive groups. This was written with children 3 to 8 years old in mind but many of the ideas may be applied to groups of younger (toddlers) or older children with modifications.

Parents and professionals implementing classroom programs, play groups, therapeutic social groups, and play dates should give careful attention to the selection of activities, play themes, and/or materials. Selection of activities and play materials should take into account the interests and passions of children and address individual challenges such as sensory reactivity/sensitivity, sensory preferences, motor planning, visual-spatial and other individual issues and needs. The following are tips and ideas for setting the stage

Individual interests and passions

An example of incorporating an interest/passion is matching a child who loves finding bugs in the backyard or on the school playground with a partner who also has this interest with whom she could share a magnifying glass and delight each time a new insect is sighted. Other activities the child might enjoy with a partner could include looking through nature guides or books with pictures of insect species and/or finding and cutting photos of insects from old nature magazines or on the Internet and pasting these into a “book” the children co-author.

Incorporation of interests into play activities should include the very specific interests of many children on the autism spectrum whether Disney characters, Thomas the Train, a particular video, letters of the alphabet, colors, etc. For example, the Disney character molds that are of special interest to one child could be provided along with the play dough and small rolling pins that are enjoyed by multiple children in a group. The molds could be exchanged among the children and for further fun children could animate and pretend together with the characters they cut out with the molds.

Individual differences and challenges

Children’s individual challenges should be considered in the selection of play materials and activities. For example, play sets that have many small figures and props that require a complex sequence of actions to enact pretend play could hamper the imaginary play of a child with motor planning issues. Instead allow the child’s imagination to unfold by offering him and his peers a couple of larger props that set the scene for a pretend theme such as piloting a spaceship, a visit to the zoo, operating a hair salon, or acting out a story or fairy tale of high interest to children in the group. Also be aware that some children with visual-spatial or fine motor challenges may become frustrated with traditional blocks or sets of construction toys. Some children with these challenges might do well working cooperatively with other children to build large structures (e.g., a “space station”, a “fort”) using large sturdy cardboard bricks or large hollow wood blocks.

Communication devices such as PECS, I-Pads, or other technologies used to support communication of individual children should be incorporated into ongoing activities and used to communicate with peers as well as adults. Other individual differences such as auditory processing, vision, hearing, and motor challenges should also be taken into consideration in selecting play materials and in arranging the play environment. Although beyond the scope of this posting, universal design principles and assistive technology and modifications of materials and equipment should be applied to increase accessibility of the environment and materials, active participation, and independence of all participants.

Sensory sensitivity/reactivity issues are critical to consider in arranging space and materials and deciding the number of children that will constitute a group. Children who are highly reactive to visual, auditory, and tactile stimulation and those with significant regulatory challenges will be better able to maintain a calm, regulated state in smaller groups and initially will benefit from participation with just one other child in simple activities with the adult monitoring for signs of dysregulation. Additional play partners should be added very gradually over a number of sessions with consideration given to the child’s improving capacity to co-regulate with playmates. Activities that offer proprioceptive input (what is often called “heavy work”) such as pulling a friend on a blanket or pulling them in a wagon can be helpful.

Children who tend toward under-reactivity and under-arousal may benefit from activities that help to energize them although this should be accomplished gradually, first matching the child’s rhythm and then building in intensity. Music, dancing, and rhythmical clapping games that build up gradually in intensity, for example, could be offered to children.

Environment, schedule, and/or rotation of activities

A well-organized, uncluttered play environment will help children focus and sustain attention and regulate emotions and arousal. In home settings avoid having all of the child’s toys available at once. Develop in advance a plan for the activities and materials to be offered and have only those play materials available. The plan should include a mix of different types of play activities and experiences including sensory, movement, and musical activities. Play and games that are more demanding on the child’s social, communication, and higher level thinking and problem solving capacities or that make demands on easily overstressed sensory or motor systems should be interspersed with less demanding and more relaxing activities. Although it’s important to be prepared with varied activities and materials, these should be offered flexibly and a shift to a different activity should be based on children’s interest and engagement, how much children are connecting with each other, and needs of individual children for up- or down-regulation.

In a classroom setting a mix of several different activities each with potential for social interaction can be offered simultaneously during a free choice period or during another block of time. Each activity should be led/facilitated by a staff member and children assisted to select and transition among the various activities as necessary. As discussed above a balance of activities should be offered based on children’s interests/passions, individual differences and challenges, and play/developmental needs.

Types of activities and examples

Listed below are several different activity categories with the potential to support social play and interaction and examples of each:

1.    Single focus and proximity activities—these are high-interest activities that bring children into proximity with each other or promote a common focus on particular materials or an activity and increase the likelihood of joint attention. Examples include children facing each other in a rocking boat singing Row, Row the Boat; swinging together in a hammock; painting together on a very large sheet of craft paper; completing a large jigsaw puzzle together; playing together in a water table or bin with a few special, novel materials (e.g., water pumps, tubing and funnels, spray bottles, a siphon, etc.); playing together in a large appliance box; decorating a large appliance box; toy vehicles and roads and bridges; a simple train set with trains and tracks; looking at/reading a selection of high-interest books. 

2.    Sensory, movement, and musical activities—sand (or other interesting tactile materials) and water play; running under a water sprinkler; swinging together on a hammock; chasing games; dancing together with streamers or ribbons; rocking together in a rocking boat; playing with a small parachute; taking turns pulling each other in a wagon or wheelbarrow; following each other on trikes/riding toys; working together to keep a large beach ball in the air; clapping games; making music together with rhythm instruments.

3.    Pretend play themes with reciprocal roles—many pretend play themes naturally incorporate reciprocal roles and thus can provide a rich context for social play and interaction including opportunities for simple pretend play for children at beginning levels of pretending. These include doctor/nurse-patient, waiter/waitress and customer, barber/beautician and customer, airplane pilot-passenger, store clerk-customer, birthday party, car wash, mechanic/customer, etc., etc. At a more sophisticated level, the possibilities for complex play scenarios are endless. Examples include veterinary office, museum (could be an extension of art or nature study activities), car wash, bakery, magic show, circus, camping, acting out favorite stories or videos, etc., etc.
   
4.    Simple games and games with rules—games can be as simple as peek-a-boo, playing chase, keeping a large inflated ball in the air, hide and seek, fishing with a toy magnetic fishing pole and cut out fish with attached paper clips, follow the leader, treasure hunt, pillow fight, bean bag toss etc. More advanced games with rules require that children have some understanding of rules and can voluntarily submit to and maintain the rules although blind obedience to rules is not the goal and, in fact, this type of play can offer lots of opportunities to facilitate social problem solving and negotiation. Games with rules include all of the beginner (e.g., Candy Land, Chutes and Ladders) and classic board games, hopscotch, Mother may I, Four Square, kick the can, jump rope, marbles, jacks, and variations on tag, among others.

5.    What interests children—as was discussed above, there are infinite possibilities for activities that can be shared by children that are based on particular interests of children whether those be numbers or letters of the alphabet, things that spin, components of toys or devices, videos or stories, Thomas the Train, Toy Story, a fairy tale, space travel, nature study, mathematics, magnets, etc., etc. The key to incorporating these interests into social groups or activities is to find ways that children can share the activity or interest and interact with each other. In the case of a child whose interest is in spinning objects, children could be provided with a box of objects some of which can be spun easily and others that can’t. Children could take turns showing each other the objects they found that could be spun. The child who is the “spinning” expert could be called on to help other children make their object spin. The focus on spinning might also be extended into other types of movement such as rolling with experiments involving rolling objects down different types of inclines including ramps that vary by steepness. The common interest of many young children in Thomas the Train can be parlayed into many activities including story books to look at together; train songs, games, and finger plays; pretend play involving trains and train travel; and construction play in which ramps to load cargo onto trains and train stations are constructed; as well as lots of novel ways to construct train tracks and move the trains on the tracks, including knocking over obstacles placed in the way.  

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    Sandy Doctoroff

    With 40 years in the field I bring a developmental and relationship-based perspective to my work with children, families, and providers.

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