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International Conference of the Interdisciplinary Council on Developmental and Learning Disorders November 24, 2008

Filed under: Conferences — ellie @ 9:47 pm

Earlier this month I attended the12th Annual International Conference of the Interdisciplinary Council on Developmental and Learning Disorders. My mother was speaking and psychology is one of my new collection areas, so I thought it would be fun to tag along. Below are my notes from a few of the programs.

Understanding Aggression from a DIR Perspective – Ira GlovinskyPh.D., Diane Selinger Ph.D., Stephanie Pass Ph.D.

Full room, confirms importance of topic. Mixed room – occupational therapists, physical therapists, metal health, teachers, parents

Stephanie

aggressive behavior is…

  • worrisome
  • scary
  • dangerous
  • exciting
  • normal
  • necessary
  • etc. etc.

also

  • challenging
  • essential

DIR model = development, individual, relationships

Diane

modulation of aggression, mastering aggression at each level

level 1 (regulation and shared attention)

  • aggression occurs as an unorganized chaotic response or discharge and is experienced in relation to displeasure
  • there is also pleasurable non-destructive aggressive impulses. aggression promotes pleasure (tension releasing )
  • parents can soothe and calm through co-regulation

level II (engagement)

  • 2-5 months
  • through co-regulation parents learn to read the infant’s cues, and the infant learns to signal to parents.
  • self-regulation
  • videos – parents are experienced floor time players
  • show how moms regulate and how kids self regulate through motor skills (rhythmic kicking of feet)

level III (intentionality and two-way communication)

  • 6-9 months
  • aggression becomes more intentional, and thus is not experienced as random or overwhelming by infant or parent
  • the capacity to assert oneself increases tactile, visual and motor exploration and development
  • aggression helps motor system develop and vice versa
  • mastering stranger anxiety
  • separation anxiety
  • peekaboo helps

level IV (9-18mo)

  • shared social problem solving, mood regulation, formation of the self
  • the toddler begins to lose sense of omnipotence and control
  • the dance and the duel
  • need aggression to assert self
  • motor skills had been container of aggression, now words become new vessel
  • importance of not losing verbal skills when get angry or upset

level V (18+mo)

  • creating symbols – using words and ideas
  • allowing them to be the bad guys (pirate)

Stephanie

individual differences

it looks aggressive but maybe…

  • a child is overwhelmed by the environment
  • a child is seeking sensory stimulation

most of the time with impulse control haven’t mastered engagement (eye contact – evil look)

  • if they miss co-regulation they have difficulty learning to regulate, no confidence he can be soothed, a feeling the world is not a safe place

sensory differences

  • fight/flight response – people living in a sympathetic overdrive
  • world feels too intense, they live on high alert

it looks aggressive but maybe

  • a child is frustrated because he cant get his body to do what he wants
  • a child is angry because he cant find the words to make himself understood

initiative and the gestural system – initiative is key – if you don’t have body that you can rely on, that supports you, you can’t gesture

  • if you can’t feel aggression in your body you can’t organize around it
  • get angry at mom when can’t rely on body

getting the circles of communication, rooted in early rhythms of reciprocity, its hard to get that good co-regulated back and forth when you didn’t have it early on

language

  • the importance of being able to attach words to feelings
  • NOT just a matter of knowing the words (not just learned phrases)
  • words. affect. action.
  • communicative speech is functional and emotional

negative of violent themes may be avoided or repeated in the service of mastery

difficulties at symbolic level

  • if you don’t become symbolic around aggression, you never learn to control it
  • aggression is held in stories
  • aggression is held in the body
  • symbol of girl making her own food to let out aggression of not getting to go out to the restaurant

working with severely aggressive children, ideas about dealing with aggression

personality qualities for parenting a child with a severe mood disorder

  1. tenacity
  2. endurance
  3. thick skin
  4. sense of humor
  5. patience of mother teresa
  6. serenity of buddist monk

one size doesn’t fit all – what is the form of the aggression? anxiety, proactive, reactive, etc.?

dealing with underlying cause – who are they acting out at?

a need for space in order to calm down, when they feel dysregulated

targeting internal and external variables

never tell how to deal with a situation – always “what do you think you should do”? – them thinking it through

internal

  • social problem-solving
  • attributions
  • impulse control

external

  • parents/family
  • neighborhoods
  • schools

these problems need to be regarded as chronic and continued intervention

working with the parent

  • defining
  • tracking child behavior
  • monitoring themselves
  • positive reinforcement
  • forms of extinction (ignoring negative)

primary principles

  • safety
  • calm
  • counter-balancing

how do we get there​​​?

  • situation selection
  • situation modification
  • attention deployment
  • cognitive change (reframing)
  • response modulation

observation informs the intervention

  • is this intentional an hostile?
  • is it fulfilling a sensory need?
  • is it a reaction to an environmental assault?

slow down and think about how it got there

co-regulation – children at all ages frequently require co-regulation rather than punishment, time-outs, or behavior plans

kids learn to get excited and come down again – like rough-housing

talking with affect in floor time – not just giving them the word, really holding the feeling – helps the child organize and get it

sometimes what looks like aggression can be excitement – example of little boy biting b/c he’s exited and in the oral stage

videos

playing assertive game lets boy feel in control and organize self and move on to words

helping children through anxiety

tempting to make children be nice when the kid wants to feed someone bad food – but its through play children learn to modulate

symbolizing aggression

  • identifying with power: doctors, teachers, and policemen
  • fascination with the bad guys

Book – Horrible Harry by kline

It’s part of integrating that they have bad feelings and what are they going to do with them

aggression has to be seen for some as a sense of achievement

when kids have reached the symbolic level we can use picture books to communicate

have to acknowledge the pleasure of aggression

more likely to be a problem later if you don’t let them act it out

strike when the iron is cold

revisit issues in a way kids can reflect upon them

aggressive language

the good news about “bad words”

“use your words” they won’t always be nice words

we need to observe our own feelings – all kinds

what are our sensory sensitivities? how do they effect the dynamic in the family? in the therapy session?

it can feel inappropriate to be angry at a very young child, but it’s still normal feelings to come up

Is PDD Resolvable – A Comparison of Selected Interventions for Pervasive Developmental Disorders

Insurance often won’t fund PDD

they didn’t pick the title

they want to start with 2 questions

  • what brought you into this room
  • what do you think of the title?

we all have quirks, sensory preferences, at what point do we say pdd?

well, it’s at the point it interferes with our 6 levels (regulate, symbolize)

audience member – saying “she’ll outgrow it” demeans it

clip

defining issues

  • ‘upstream’ issues – genetic heritability, congenital anomaly, perinatal insult
  • ‘downstream issues’ – environmental toxicity relational mismatch, postnatal trauma

regulatory and sensory issues

  • sensory issues are observable as the behavior which an individual uses to function in her world
  • regulatory issues are not observable directly: behavior change of patterns of behaviors identify regulatory issues

models

a model can be defined as something that stands for or represents something else. the most general models – sometimes called world views, world models or paradigms – offer statements and ideas about the nature of human life. these models rely on metaphors to describe human nature and such models are rooted in philosophical beliefs

these models are meta-theoretical and are rooted in pre-theoretical origins – meaning that while the models may generate more specific theories – and even testable …

metaphor uses better known to explain lesser known

core tendencies

peripheral

developmental statement

blue handout talks about 2 kinds of functional analysis of behavior

nice sneezing example – idea that a sneeze can be controlled behaviorally – but important to understand what’s going on underneath/behind that

concepts to use in a comparative analysis

models and metaphors

core tendency of human functioning – (yellow hand out)

clip – doesn’t use eye contact, doesn’t use words and has motor skill problems – cant walk at 19 mo,

medical diagnosis – clumping – says he has autism

other way is to take it apart and treat each item separately

there is talk out there that the behavioral approach is best

based on your approach will define what you measure

  • mechanisitic view (applied behavioral analysis)
  • rationalist/organismic/developmental (affect/social/relational/developmental based)

no strong evidence saying behavioral is better

model looks at back end – counts sneezing

open discussion of clip

doesn’t have eye contact

can say – we need to get this

or

why doesn’t he have this

kid lets dad touch stuff he touches – happy for interaction

I don’t have good notes from my mother’s presentation because I was helping with her videos. We had some technical set up problems.

One of her co-presenters had some nice ideas to steal from the corporate world:

need to see ourselves as leaders and align ourselves with leaders who have moral and ethical understanding

principles learned from son from corporate america

  1. crowning – not a king or queen or 1 leader, but organization is sovereign
  2. always need to up the ante – focus the resources on a few big bets
  3. top of the bottle is always the bottle neck, instead focus on process
  4. building character – this project has a reputation of doing good – parents feel they’re getting good service
  5. navigating the bermuda triangle – cant direct the wind, but an effect the sails – keep detail and big picture in mind
  6. erect scaffolding along the way – go outside your own ideas and look at ideas of others
  7. enlisting insultants – giving you unpleasant truths. always question your fundamental assumptions

“If you want to build a ship – don’t drum up men to gather wood, divide them and give orders. Teach them to yearn for the sea.”

grass root changes get new presidents

A Bioethical Approach to Overcoming Problems with Aggression and Misbehavior in Schools – Stanley Greenspan, M.D.

a paradigm shift from solving problems to having a quality of life that is acceptable

new graduate school – 1st of its kind

an ethical approach begins with not separating emotional, academic, etc growth into separate categories

academic work builds stepwise and at the cornerstone is thought

if you don’t have causal thinking that’s going to be very difficult – if you can say want drink or open door, but can’t answer why

at the first couple months of life, babies are born with individual differences with how they take in what they see, touch, etc

they use their affect to turn towards mommy’s face

gets all their parts working together

an ability to take an interest in the outside world – beginning of academics

next – taking an interest in other human beings

brain working in a more organized fashion. pattern recognition – another step of academic work

that comes from emotional interactions in early stage of life

beginning of language development – is that another part of academic life? i should hope so

so these developments are academic as well as emotional

you’re learning about causality (reciprocating facial expressions)

4th stage – taking daddy’s hand to get a toy

foundation for quantity is being laid down (learning math)

learning 2 words together can be sequenced

language only has meaning to the degree it has affect behind it

(these are the D – the levels 1-6)

if you get involved with emotional signaling you go from catastrophic all or nothing towards free standing images

images move towards symbols as you get more experiences

and get deeper and deeper meanings

symbol formation – an essential part of academic life

and we haven’t even gotten to the point you’re leaning to use ideas

level 5 – ideas

have to be connected to affect or they’re just memorized scripts

ability to regulate yourself, to pay attention

also comes from these early interactions

attention is not a static state, it’s active

learned by getting more and more circles of communication going

learning pretend play teaches creativity

creativity is important for being able to be a thinker

if we made this the core of our education

where affect moved us along at each step

this is the ethics of proper education

these steps are just quickly outlined here.

“the first idea” (book) goes through the theory of it

our education should focus on the broadest application of these core developmental steps

we see that social, emotional and academic proceed together

and that’s the key

now to apply that to aggression

tailor educational environments to each child’s nervous system

let each child’s own learning curve determine his/her potential

provide learning relationships with trained adults

have a pre-planned strategy to help each child calm down

life skills and academics are part of the same process

don’t set limits, don’t break kids into different groups

redefining potential

not breaking students into academic v. life skills

schools must be geared toward individual differences rather than standardized curricula

life long learning systems for adults. some of their nervous systems are still developing into adult hood

what if a child gets out of control

respect the child’s nervous system

switch to soothing, self-regulating

ethics of medication usage

if medication is needed it should be used to facilitate the learning process, to help the child reach his/her highest potential

if medication is just used for compliance in an an environment that is not tailored to him then it’s not ethical

dos and don’ts

don’t

  • over control
  • over load
  • remove empathy and respect
  • become irritative or angry
  • throw fuel on the fire
  • become immersed in power struggles (need to get your way)
  • over worry about spoiling the child
  • worry about the child getting his or her way
  • worry about rewarding bad behavior

with work of skinner et al – they were trying to teach a specific behavior in an animal – not trying to teach emotional understanding

dos

  • counter balance the child’s emotions e.g. calm and soothing when the child is storming
  • inact the five-step plan:
  • help the child calm down
  • engage with the child in a warm and soothing manner
  • engage in a step-wises progression “up the developmental ladder” to the child’s highest level of functional emotional development
  • after the child has been calm for a while, respectfully inquire abut what was going on in the child’s mind and feelings, to the degree the child is capable of elaborating
  • then, or later, play the thinking about tomorrow game, or with a non-verbal child, play the anticipatory rehearsal game

remove the situation from the child (the Agnes Principle) rather than the child from the situation (aside – my mom let me know that schools do this – will clear the class and leave the child there to storm)

if sanctions are necessary, tailor them to the child and try, as best as possible, to make it a constructive learning experience

learn what pushes the child’s buttons

refrain from pushing those button or having other push those buttons (and again, don’t feel the child is getting away with something)

create relationships and environments that enhance flexibility and coping

respect each child’s individual differences

respect the unity of social, emotional,developmental, academic,intellectual

recognize each child has their own way of calming down

recognize learning is a lifelong process

I believe this is the point at which it switched to Serena Wieder

aggression

  • a failure in relating and empathy
  • a failure in communication
  • a failure in problem solving
  • a failure in reality testing
  • A FAILURE IN SYMBOLIZATION

not enough to just say he/she is aggressive or acting out

the young child might hit, fight, bite push, throw, break things, when feeling:

  • angry
  • afraid
  • confused
  • defensive
  • frustrated
  • retaliatory

easy to criticize the child rather than thinking what are we doing to help the child

  • does he/she understand
  • did she mean it?
  • did she want to do that?
  • did she get out of control?

answer could be yes or no

so how to children develop the abilities to experience these feelings safely, express these feelings appropriately

how do children know what’s real and not real

a child who is acting aggressively and cannot self regulate and find ways to express symbolically has developmental challenges

parents go through parallel process

when we look at symbolic development we’re looking at emotional development

early symbols help understanding emotions

don’t overwhelm children with symbols they’re not ready for

when does a child know what is real or not?

develop reality testing between 3-8

emotional thinking must develop and cannot be taught

Glen Mcgee couldn’t come – Summer Johnson was his replacement

move towards early detection is an important ethical item – that will shape their entire life

that “label” process of being identified changes their whole world and that of their family

problem of emphasizing research over services

parents on both sides – ones that call their child cured when they become highly functioning, others that embrace the communities

with other disabilities we try to make the world change for them

so looking at the spectrum from a disability standpoint moves towards that

ADA definition

not that there’s some pill cocktail that makes it so we don’t have to deal with them

disability v. disease

there’s also been a move to understand autism as a medical problem

this isn’t something healthcare can absorb, the whole community needs to be involved

there’s a moral imperative here.

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