Archive for the ‘DIR/Floortime’ Category

Guest post by Tamara Kaldor, Developmental Therapist, Director of Chicago PLAY Project 

A child’s “communication toolbox” is best strengthened through a multi-disciplinary approach. It is exciting for me to be able to collaborate with my colleagues at Communication Therapy + Friends who truly understand that communication skills go beyond spoken words and vocabulary building.

It takes all of a child’s mental and physical abilities to communicate effectively so they can play with peers and participate in the school environment successfully. As a Developmental Therapist, I focus primarily on helping children’s social-emotional development through play and I also provide inclusion support for children in school and community programs. My goal as a therapist is to help every child develop the skills they need to form joyful and meaningful relationships and to be successfully included.  This is done primarily through play.  Play is important developmental work for all children. Through play, children learn to use non-verbal communication skills, negotiate with peers, communicate their ideas effectively, and play out their fears and fantasies safely.

Communication Toolbox: Non-verbal communication

I want to focus on why non-verbal communication skills are one of the most important tools a child must develop and learn how to use effectively.

Much of how we communicate (about 85-90% of our day) is through non-verbal communication and it is also the first level of language that ALL children develop– before spoken words.  Non-verbal communication is extremely important for young children to master because the ability to read facial expressions, gesture (e.g., pointing), communicate with a peer while being active on the playground, or express their emotions appropriately is what helps children to develop their earliest friendships during playtime. To learn more about why non-verbal communication skills enhance a child’s communication skills and school performance read this excerpt from Dr. Stanley Greenspan on the importance of non-verbal communication from Playground Politics: understanding the emotional life of your school-age child

When will my child talk?

ALL children must develop some non-verbal communication skills before they will utter their first words, whether they do so verbally or through augmentative and alternative communication (AAC). For many children we work with, we must first start by strengthening their non-verbal communication skills before we can work on speech goals. We realize this is disappointing for many families to hear, but non-verbal communication is an important developmental milestone.  It cannot be skipped over. Sometimes we have to climb down the developmental ladder before we can go up at full strength. The stronger a child’s non-verbal skills are, the better communicator they will become. Without a strong foundation, the developmental ladder that all children must climb will be very rickety.

The body also plays an important role in language development. Beyond having strong mouth muscles, there is a close correlation between the brain learning how to read the signals that the muscles are firing throughout the body and language production. Getting in some good body work with Cara Lindell at Kinetic Konnections (also a colleague at Communication Therapy + Friends) or a qualified Occupational Therapist (OTR/L), can sometimes be the key to getting the body in sync so children can develop their full language capacities.

Get Moving!

I can’t urge families enough to not only get down on the floor and play, but to also get climbing on the jungle gym at the park. I often hear parents report back to me that their child is the most verbal when they are swinging, climbing, or going down the slide. When possible try to include some non-verbal gestures with your child at the playground.

Play Dumb

The strategy of “playing dumb” can often help a child use their toolbox of communication skills to get their needs met. The goal of “playing dumb” is to encourage your child to expand their communication tools and the length of the time they interact with you. Here are some tips on how to “play dumb”:

* Therapists don’t just keep things in boxes, locked cabinets, or up high to keep our offices tidy. We try to get as much communication and problem-solving into our interactions with children as possible. We want to make them work for it! You can do this too! If your child needs help with an activity and is stuck using the same communication strategy they depend on to get your assistance or attention, try to expand the interaction and support their use of non-verbal communication and reading cues by:

1. Slowing down and being patient so that your child can read your cues, process the information, and respond;

2. Exaggerating all of your facial expressions and gestures, e.g., making a puzzled face and shrugging your shoulders;

3. Not responding right away until he/she is pointing, pulling you over to the activity, or uttering some words (using at least one means of communication that is different from his/her fallback methods);

4. Going up the slide or getting into the swing yourself and seeing if your child will communicate that you are doing the wrong thing. This will often elicit a lot of laughter!

5. Saying “Hmmm . . .I don’t know what you want right now…”

If your child seems close to a “meltdown” due to frustration, try saying softly, “I know you are trying to tell me what you want. You are working so hard. Let me try to help you,” and try giving two choices to see if your child will point to one of them.

Mealtime Ideas

A fun snack/dinner time non-verbal activity: At your next meal or snack time try practicing your family’s non-verbal communication skills by asking for a glass of water, requesting others to pass a favorite food around, or playing a simple game of “Go Fish”.  Try expressing your disappointment or excitement without words (think: miming) and see how far you get.  Remember to have fun and laugh as you go along. Your child will also see that she/he is not the only one who is frustrated when they are not being understood. It is challenging, but it will help your child learn how to read non-verbal cues that she/he will need on the playground and in the classroom.

More about Chicago PLAY Project:

Tamara Kaldor has extensive experience working with the DIR®/Floortime™ therapy model and supporting families and educators as they use the model successfully at home and in inclusive school programs. In addition, Tamara advocates with families for children in school and community programs. She is the only licensed provider in Chicago of The P.L.A.Y. Project, an effective, affordable, and evidence-based intervention for children with autism and other developmental delays, based on the wonderful DIR®/Floortime™ model developed Dr. Stanley Greenspan.

Parents play an important role in the DIR/Floortime model. For any therapy model to be truly effective, it must be intensive. The National Academy of Sciences recommends at least of 25 hours of intensive intervention per week for children diagnosed with autism and other significant developmental delays.  However, for many families this is just too expensive and can seem overwhelming to do themselves. The P.L.A.Y. Project specializes in coaching parents, sitters, and other team members to be a child’s play partner in their most natural environment, home, and move a child up the developmental ladder.

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My own 5-year old son Lyle recently expressed an interest in playing the violin.  Having played violin and viola myself growing up, I was absolutely thrilled.  I signed him up for some private lessons and rented violins for both of us.  For a few weeks, I’ve been relearning to play some simple pieces of music and he has loved listening and learning the little things I can teach him while we waited for our class to begin.

His first lesson was last Monday, at a reputable music school here in Chicago.  I sat in and observed.  His teacher moved fast.  She was intense. She wasn’t “mean”, but there was no small talk, no friendly chatter.  She moved right into work on posture  – holding the instrument properly – and told me that he wouldn’t pick up the bow for at least 2-3 weeks.  She spent the full thirty minutes on a sequence of movements required to move from “concert rest position” to “playing position”.  Each time Lyle moved his arm into a correct position he also accidentally moved one of his feet a step and had to start over from the beginning.  It was a bit like boot camp and hard to watch, but I was impressed that he stuck with it and cooperated so beautifully.

However, the instant she told him he was finished, he rushed across the room, fell into my arms, and sobbed.  She didn’t address this, simply let the next student into the room and pushed us quickly out the door, Lyle still crying.  He cried all the way to the car, raging at me, saying he never wanted to take another lesson, never wanted to go back.  He asked if he could keep his violin, but I told him we couldn’t keep the rental instrument if he didn’t take lessons.  I assured him that we could find another teacher, however.  Much to my shock, by the time we got home he told me determinedly that he would go back.  I was simultaneously impressed and appalled.

All week I grappled with this.  Was the teacher too harsh? – or is this the way you teach a young child a challenging instrument like the violin? I don’t remember starting out that way, but perhaps I’ve forgotten.  A friend told me it reminded her of early ballet lessons, in which you must master the positions before you can dance.  But shouldn’t she have established some sort of rapport with him first, made a connection with the child? – or was I applying what a good therapist does to a different situation, one that doesn’t necessarily require it?  She was teaching him skills and he was capable of learning them with repetition, I saw that.  But was it meaningful to him? No.  Was he motivated to learn from her? No.  So how could it be different from a negative therapeutic situation, then?

In fact, although he was determined to continue so that he could keep his beloved tiny violin, I watched my son struggle more and more as the week went on.  His anxiety grew more with each day, and his behavior became extremely controlling and defiant.  He wanted to be in charge of every conversation and everything anyone asked him to do.  The closer we got to the second lesson, the less tolerable his behavior.  On Saturday morning, we had to leave a Halloween festival we’d invited friends to because he was acting downright belligerent.

I could see it quite clearly.  He was turning the tables on us, acting out exactly what he felt the teacher had done to him.  She had controlled every move he made for thirty minutes straight.  He’d never seen an adult act like that with a child.  Each time I tried to discuss it with him, he waffled painfully; on one hand, he never wanted to go back to that teacher again. “I HATE violin,” he shouted at me angrily, at least once a day.  On the other hand, he was asking to go back to her rather than another, unknown, teacher.  He didn’t want to give up that violin.

And I still wondered: Can he do it?  Should he do it?  Is this how he needs to learn?  Will he simply get used to her style?  Should he?  After all, we need to be able to learn from different kinds of teachers, don’t we? Do we pull the plug this fast, or give him one more week, especially since he says he’s actually willing to go back?

But I watched my son and saw how incredibly dysregulated he was becoming, and noted that it was worsening every day, and decided to cancel the lessons.   I realized suddenly that this is exactly the kind of thing I talk about at work all the time with families.  The violin teacher did all of the things I warn against in therapy:  she was introduced to a brand new child and immediately started drilling discrete skills (e.g., posture and movement sequences) without establishing any rapport whatsoever, without placing those skills into a meaningful context (e.g., music), moving too fast, and talking too loudly (not adjusting pace and volume to a child’s developmental level and temperament).  There wasn’t a word of praise. When he had a negative reaction to the session, she did not address or acknowledge it even for a moment.  And, thanks to these missteps, my child’s behavior took a huge turn for the worse in a matter of only 5 days, even with me processing it with him every day.  (Imagine a child with a classroom teacher, therapist, or aide who behaves this way towards him at school?  Think about the “naughty” behavior we’d be seeing!  What if a parent didn’t see it, and so didn’t know what accounted for his sudden change in behavior at home? All that I have described was observed after only a single 30-minute session with the wrong teacher.)

Maybe what my son’s violin teacher was doing is considered to be an optimal way to begin this particular instrument and some kids can learn that way, but my kid clearly isn’t one of them – and I simply cannot feel bad about that.  A good teacher or therapist of any kind doing individual work is going to assess a student long enough to figure out who this child is and meet him right where he is developmentally in order to move forward.  I don’t think that would’ve taken more than five minutes in this case.  This is exactly why I always do a free initial session with a new client: to make certain that both the child and the adult are comfortable with each other.  No therapist or teacher is going to be a good fit for every child.

Once Lyle knew he’d never see that teacher again, he was able to relax.  His behavior was back to normal within 24 hours.  I have a couple other violin teachers for us to meet with this week and he’s happy about that.  Maybe one of them will be a better match and we’ll continue on this road, and maybe not.  In the end, it doesn’t matter.  But one thing is for certain: we are not going to suffer through 8 weeks of lessons with the wrong teacher.  Lyle showed us very clearly how he felt about that.

Kids will tell us when they’re comfortable with an adult; it’s our job to listen to them.  Their learning depends on it.

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Charlotte hiking with her dress

I am somewhat horrified to realize that two months have passed since I promised you Part 3 of the “Transitions and Emotional Processing” series I began last summer, but I see that Part 2 was posted the week before school started.  I can now safely say that it takes me two full months to get myself and my family into the school routine before I can get back on track!

If you didn’t read Part 1 and Part 2 (or need a refresher on them), I recommend going back to read those posts before reading this conclusion.  As promised I can give you some follow-up information about how the suggestions I gave goodfountain in those first two posts worked out for her daughter Charlotte.

The day after I gave her my recommendations, I received a copy of the heart-warming photo above, attached to the following email:

We went to a nature preserve today to walk one of the trails.

When it was time to get dressed, I started talking to Charlotte about how this was a place that was for shorts and tennies, not dresses and slippers.

She said, “Can I take it with me?”

And with the memory of your email in my head, I said, “Sure! You can take it!”

She went and found her backpack and packed her dress, her shoes and her necklace in it and carried it the whole time.

Not even a single whine about getting dressed.

The following week, I checked in with goodfountain again about how things were going and received more information:

What I am seeing is that I have to basically use ALL of these strategies and rotate among them. Carrying the dress in the backpack worked a couple of times. Referencing the little card with things to do when she feels angry has worked a few times. I haven’t had a chance to do any big feelings discussion, but I did make a list of where we can and can’t wear the dress. That helped some, for a couple of days, along with not ignoring the dress issue. I just bring it up right away and we tackle it head-on.

Another thing that has helped is giving her some good motivation. The other day I got no complaints from her when we went to return the guinea pig to school because I let her ride in the back next to the cage (I folded half the third row down and put cage there). She changed out of her dress right away.

It seems that the best thing is having an arsenal of things to try while we weather out the “storm” of these passing phases. She’s not going to be obsessed with a Belle dress forever, but she’ll move on to something else. And I’ll adapt the strategies. And eventually it will all sink in.  Having a variety of different things to try with her has made getting through the difficulties a lot easier.

This is an excellent point.  It is so helpful for caregivers, teachers, and therapists to have that “arsenal” of strategies to try when things get challenging.  No one strategy will work every time – we need to be on our toes and think flexibly in the moment.

I’m curious: what other strategies have you tried in a situation like this?

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Some of you may already know about the wonderful blog Autism Games by Tahirih Bushey, SLP, but in case you don’t, we’d like to send you on over to check it out!  There are some posts that are particularly relevant to many of our clients just this week – for example, “Being a Translater for a Child with ASD“, “The Ducks Go Marching Two By Two“, and “Eric and I Look for Mommy“.  There is also a fabulous piece that was posted on March 9 that is untitled and I was unable to link to it, but it’s a true example of what following a child’s lead in order to get engagement started.

I hope you’ll check out these and some of the other excellent posts!

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Some of you have requested more information about the new SCERTS-based preschool class that my colleague and I just launched this week.  I will be happy to provide that, with ongoing updates.  Tonight I’ll give you the basic overview.

We have developed a small, highly individualized class called L.E.E.P. into Communication, and it is designed for a group of children ages 4-6 with social communication and emotional regulation challenges.  We meet five mornings a week for three hours a day.  My colleague is there all five mornings, I am there three days a week, and we have three Assistant Teachers who are there all five days.  In addition, we currently have a psychology intern from Loyola University and may get an intern from Erikson Institute and a speech/language intern from Northwestern University.  Our ratio rarely drops below 1:1.

In addition to having a Developmental Therapist and an SLP (myself) running the program, we have hired an excellent Occupational Therapist and a Clinical Psychologist to consult to the program once a month.  This means that they will visit, observe, and provide us with any additional suggestions and observations that would benefit the kids.  The OT and psychologist are both DIR/Floortime experts, with one of them being an ICDL Faculty member.  Beginning next month, we will also have a specialist coming to do music/art therapy with the kids once a week.

This being what I refer to as our SCERTS-based, DIR/Floortime-informed program, it is highly focused on both communication and each child’s social-emotional development.  It is also very family-centered.  Our goals incorporate the parents’ priorities and areas of greatest concern.  We present proposed initial goals to the parents and adjust them if necessary.  We spent 6-8 hours completing a full SCERTS Assessment Plan on each of the children, which included a great deal of video review from the clinic and the home (we went to all homes and videotaped the child for an hour in natural routines).  The parents are asked to meet with us for an hour every 6-7 weeks to review progress and discuss how things are going at school and at home, so we have a rotating schedule which allows us to meet with one family each week throughout the year.

The program is truly cutting edge in terms of its philosophy and guiding principles.  It is aligned with the most current and appropriate best practices guidelines out there for kids with Autism Spectrum and Related Disorders, and it shows.

From the minute the kids arrived on Monday morning, they were happy and relaxed.  We had the environment set up in a way that enticed each of the children into a regulating activity, whether it was a favorite swing, play doh, or animal puzzles.  We have visual aides everywhere you look, and use music and singing to help with transitions throughout the school day.  Kids take movement breaks in a ball pit, a resistance tunnel, on their choice of swings (e.g., boat swing, bungee swing, huge lycra) when they need to, and then re-engage with the group.  We also spent four days providing intensive training to our staff, which meant that everyone knew the kids’ needs, favorite activities, motivators, and how they expressed dysregulation as individuals (e.g., one child’s toe-walking is another child’s recitation of the alphabet) before they arrived.

Although we worked incredibly hard to prepare an envirnonment and staff perfectly suited to this group of children, we were still shocked at the ease with which the kids moved through these first five days.  From Floortime play to Morning Circle to TEACCH stations to lunch or art or cooking projects, the kids transitioned well and without any meltdowns.  Seriously.  No meltdowns.  I didn’t see or hear of one all week.  We took a lot of videos and photos!

Speaking of videos and photos, I’ve created an online group for the parents and staff of the program as one of our lines of communication (in addition to the daily notes we type up and hand them on their way out).  It’s been a great way to make announcements and share information with everyone this week, and tonight I put up a lot of photos for the parents.

I could go on and on (some would argue that I already have!), but these are the basics of what we are offering.  I’ll update you through the year about how it’s all going, but I will say that – judging by the progress we’ve observed just from Monday to Friday this week – we are going to see some kids whose development looks very different in June than it does today.

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