DIR floortime and development

 Excellent interview with Dr. Serena Weider, founder of DIR-floortime therapy.

Her book was recommended to us when our son was 4-5.  It became the foundation we used to measure all other “therapies”.  It felt right because it was all about engaging with him on his level and was based on relationships and secure attachment.  (We found Dr. Sears attachment parenting books a very useful resource as we were starting our family....so this set the foundation years before). So DIR floortime was like an extension of this idea of prioritizing the relationship, following our child’s lead to meet their needs and connecting on our child’s level. 

This interview with Dr. Weider is amazing. I was reminded of what to do when ABA was a complete failure and left my son (and me) traumatized.  I remembered to see my son where he is developmentally.  We needed to meet him where he was at.  He was 11, but that was not where he was developmentally.  The next few years, I sat on the floor with him, watched him play his legos, creating worlds and expressing ideas and thoughts through his play.  I treasured the moments he invited me to participate. I followed his lead.  I responded to his needs.  I placed no demands or expectations on him.  He didn’t yet have the skills to move to the next level.  I had to respect this.  We shared playtime.  We engaged in play together.  I learned so much about him.  How he sees his world.  His experiences were expressed in a healing way through his play.  

The next few years were all about meeting his needs.  Following his lead.  Engaging together.  Experiencing shared moments of joy.  Healing through connecting.      

So when I watched this video, I wanted to share.  There are ways to help support our children who struggle.  We just need to be prepared to allow our children to guide us.  This is what they need from us.  

Development is a lifelong process

Play is children’s language

Play is the vehicle for learning

Development has its own trajectory

Relationships are the most critical form of supporting development 

https://youtu.be/PEcM-8_wpOY

https://youtu.be/PEcM-8_wp

Understanding the WHY!

 Institute of Child Psychology -

All behavior is communication. Slow down and ask yourself what your child’s behavior is telling you. When we work with the underlying need, we create long-term solutions instead of quick, temporary fixes.

This is it, right here!  Why!!  This is the only question we need to seek information about.  When behaviorism says “who cares about the why, we need to stop the child from doing x, y or a; or when teachers say “I don’t care about why, just make it stop it is disrupting the class” we only create more issues for the child because the why is what drives what we see.

If we look at it through a compassion based lens, of what does this child need, rather than through a compliance or manipulation lens, this is when we see the child.  Not the child who isn’t following directions or is “acting out” but the child who has no other way to communicate distress he is experiencing.  It is a stress response that drives the child.  When we see that they are having a hard time, not giving us a hard time, we see them as needing us.   Needing our comfort, our safety our connection.  Yes it can be inconvenient.  Yea it can be disruptive.  Yes it can be exhausting.  Yes it can be so hard.   Imagine how hard and exhausting no scary it is for the child?   Our children do well if they can.  If they can’t, we need to figure out the why not!   

My son at age 16 still cannot tell me the why beneath his “behaviors”.  By the time we see the behaviors, he is already dysregulated and in his downstairs brain experiencing great distress.  The only thing I can do in this moment is be present.  Be calm be still be with him.  Nothing I could say would ever help in this moment.  But what we try to do, is meet his needs, support him and continually co regulate and importantly notice the signs of distress before they go all the way.  Sometimes, it is a simple request I have, and if he screams immediately back at me, ok that was 0-60 and means drop the demand and co regulate.  Our kids especially right now are experiencing overall so much stress.  The starting point is so much higher than it was pre pandemic and pre distance learning.  Which is exactly why we need to be really patient with our kids.  Our expectations cannot be what they were.  I know for myself, I have had to drop my own expectations for myself.  If the laundry doesn’t get folded, who cares.  The clothes are at least clean.  

Our kids need this same kind of empathy and compassion from us.  We need this kind of empathy and compassion for ourselves.  

We are our kids rock.  They need us now more than ever.  Even our older kids.  The best thing we can do, is understand the why when we see a behavior and be present and connect with our kids.  It really is that simple.  

I love the saying “when our kids are at their worst is when they need us the most”- Dr. Tina Payne Bryson.

This is so true which is why self care is so crucial.  Because I know first hand, if we are too dysregulated, and our child becomes dysregulated, it is a whole hot mess of elevated toxic stress and emotions.   Which is not good or helpful for anyone.  But remember, our kids are still developing.  They need us, the adults to be the solid reliable calm present safe space.  If we can’t provide them this, the world becomes even more frightening for them.  

So do what you need to to take care of you.  Go for a walk, take 5 deep breaths and exhale slowly, drink a glass of water, listen to music, splash water on your face.   Do whatever you need to in order to be the regulated, calm  and loving caregiver i kids need us to be so that they can be their best selves.

Aggression.....what is it really?

 This is a great blog post (below) from Profectum Foundation.

 I would add what Dr. Ross Greene says, “kids do well if they can.  If they can’t, why not.”   We must identify and understand the WHY that lies beneath our kids behaviors.  What we see is the observable behavior, but under that tip of the iceberg are the numerous reasons that led up to what we actually see.  And the most important thing is only a calm regulated caregiver can calm a dysregulated child.  

In the moment, nothing but sharing calm matters (wish I knew this years ago).  We were told to ignore him, to restrain him, to punish.  This is exactly what NOT to do.  Our kids need us.  They need our connection and our sense of felt safety.  Their nervous systems have taken over and the only thing is to co regulate through loving connections and compassion.

Demystifying Aggression

January 13, 2020 Beth Arena Behavioral Challenges, Behavioral Health Specialists, Emotional Regulation and Development, 

Let’s Change the Dialogue Around Children and Revisit Development

Profectum Foundation

 

“Aggressive behavior at any age is challenging and distressing for parents, teachers, clinicians, and others, as well as for children themselves.

Sometimes we see it coming, sometimes not. Sometimes it is physical, and sometimes it is a threat or disparaging remarks. But we all know it is dangerous and damaging. Of course, our first step is to stop aggressive behavior and secure safety. But what we do next will depend on how we understand its meaning?

All behavior has meaning, and aggressive behavior is complex.

Thinking about it requires a multifaceted approach. All children experience anger, fear, anxiety and frustration, and vary in their capacities to regulate these big emotions, impulses and negative feelings. But not all children resort to aggressive behavior. Start by examining the development of self-regulation. Each child is born with individual differences in sensory motor processing, and have different physiological patterns of under, over or mixed reactivity to sensation, emotions, and stress in the environment.  The availability of caring relationships to support both emotional and physiological regulation in the face of environmental stress or trauma is essential.

Many external and internal emotional and physiological processes contribute to a child’s dysregulation.

Some are more evident than others and can be ascertained by examining the world the child lives in. Others require us we take a deeper look at the underlying causes or hidden triggers. High levels of arousal and perceptions of threat related to changes or transitions may be triggers. Here the meaning of threat to the child must be understood if we are to lower the anxiety and fear that propel the child into the behavior. The behavior may just be the tip of the iceberg.

Given the complexity, it is important to find one lens or perspective that is universal to anchor our understanding of aggressive behavior and ability to help.

And that is development. Not the silos of cognition, language, motor, social, etc., but the integration of all these aspects as they function simultaneously and are synthesized in the DIR ® Model (Developmental, Individual Difference, Relationship Model) created by Stanley Greenspan, MD and Serena Wieder, PhD.  Evaluating the child’s functional emotional developmental capacities, the “D” of the DIR® Model, allows us to identify the gaps that get in the way of regulation and shared attention. From the start of life regulation is embedded in the infant’s relations with parents as they connect around the need for regulation of feeding, sleeping, crying, temperature and self-soothing.  As the child develops, regulation of self-control, impulses, anxiety and the expanding range of emotions continue to be embedded in relational and physiological, as well as environmental and trauma factors.

To develop therapeutic strategies, look for the gaps in all functional emotional developmental capacities.

 Has he not learned to relate or engage warmly to other people or others have not related to him to build trust and security?  Perhaps he has not developed the continuous flow of interaction with others that support communication of feelings and problem solving. Or, he has not entered the world of symbolic function for the safe expression of big emotions and has not developed adequate understanding of what is real or not. If he has not learned to regulate or control aggressive impulses, he may lack the capacity to see his behavior has consequences for others and has not learned to empathize with someone else’s perspective. Targeting these gaps can guide therapeutic interventions to support the foundation necessary for mental health and behavioral regulation.”      

F

Covid 19, what has it revealed about education? Time to rethink education

 What Covid 19 revealed about schools and 4 ways to re think education 

“The pandemic created many challenges for students, teachers and parents — and it's also showed us what they truly need from their schools:.....”

“Chances are the kids mostly miss the playground more than the classroom.....that social emotional piece that forms the core of human learning.

We will need social workers, nurses and counselors in every school ......to help kids feel safe....and find their way back to school.  

We will need art class, physical education.....music more than ever

We need to rethink assessments

We need to stop making school about scoring better than the kid next to you....” 

https://www.ted.com/talks/nora_flanagan_what_covid_19_revealed_about_us_schools_and_4_ways_to_rethink_education?utm_content=2021-1-27&utm_source=facebook.com&utm_campaign=social&utm_medium=social

The Model of Engagement

 I love this post today from OT Greg Santucci.  So much of what I have learned is how OT and consideration for our kids nervous system and how they process the world around them is the KEY to supporting them.  

When the world is overwhelming, they lose the ability to maintain a sense of calm, or of themselves ( which is why you may see a child who normally doesn’t lash out when frustrated, but then starts to lose it over something). Their nervous system is beyond capacity and it is true, when a parent says, that’s not like them.  Bingo....it is not because they are not in any control over their body and being.  

It is pure survival.  

Imagine how you would respond if you were being chased down a dark ally by a bear!!   I’m pretty certain I would not be in any mindset to make a decision let alone follow a direction or a demand.   You lose your ability to hear or to think in any rational way when in fight or flight.   

So I am a huge fan of maintaining regulation through appropriately supporting ones nervous system, throughout the day, so that everything we do, is a support for his nervous system, to help it maintain a balance and when it gets out of balance, utilizing what I’ve learned through years of his OT to help bring calm regulation back.  Nothing functions well without being in a calm regulated brain state.  

Some of our kids have a very difficult time either staying regulated or being able to self regulate when becoming escalated.  And it is important to rememebr, self regulation is a developmental process.  So for kids who have developmental delay, yeah they will not necessarily be able to self regulate their emotions, self calm, self soothe.  But I recognize the frustration parents have that their 10 yo or 15 yo still struggles to be able to self regulate their body and emotions and the consequences of this.  The explosive behaviors are real.    Again, remember it is developmental, so by supporting them during these difficult moments, you are modeling and sharing your calm that over time will help them learn to on their own.  

This is where the safe trusted caregiver can improve the situation and share their own calmness.   (Which is natural for some or some of us have had to learn it ourselves).    

Here was my response to the post that is shared below.

Love this.   It is 100% .  Trust, safety and co regulation have to be the focus for everything .  It is like magic when a therapist a family works with, “gets this” and you see your child form this relationship.  It is ll about relationships!!!!  I wish teachers, educators, therapists, parents understood how important this is to supporting kids.   And seeing when a relationship has a fracture, that the only thing that should happen next, is repeating that fracture.   The child will not feel safe or connected without this occurring.  And exactly like you said, slide back until it does.   

Keep education others.....people are starting to pay attention.   The old, antiquated methods have not worked and many relationships need repair because of them (I know this personally with my son).   

It is ok to step back, and focus on this repair.  Progress cannot happen without it!!!   Love the graphic.   Thank you for all your continued advocacy!

Original post…

Trust and Safety.

I checked in with a family about how the week went.

The child comes running up to me and says "I STAYED DRY IN MY BED ONE NIGHT!" They were so proud.

I said: That's amazing! 

Our "OT goals" were for attention, sensory processing and behavior.

I love that they shared their news with me.

Typically and embarrrassing topic, this child didn't hesitate to share their success!

This child will meet every OT goal and probably a few extra, because they trust me and I'm meeting their safety needs. Because of that, we can work on their sensory processing and regulation skills so they can participate at their highest level of ability.

At any given moment during our time together, I may need to "slide" back down to either help them get regulated, or earn their trust again....and that's OK. In fact, it's necessary.

Trust and Safety

Regulation

Participation

I will shout it from the highest mountain. If you don't have their trust or their safety needs aren't met, then you can't move forward with your goals and expectations.

If you're yelling- the child doesn't feel safe.

If you are constantly changing the rules- they don't trust you.

If you say things like "you're fine" or "its no big deal"- they don't feel safe.

If you lose your patience and take things away as a "consequence"- they don't trust you.

Trust and Safety

Regulation 

Participation

#TheModelofChildEngagement

"Safety is treatment and treatment is safety" -Stephen Porges

#occupationaltherapy

Throw away behavior charts

Throw away behavior charts.    They do not support kids and can actually cause further issues for many due to anxiety of not being able to meet the expectation.  

Kids meet the expectation when they CAN.  Kids do well if they CAN.  If they can’t, it is up to us to find out WHY and support the child.  It isn’t about motivation.  It is about lagging skills and the child’s physiological brain state at that moment.

This is a perfect example of how behavior charts will do nothing to solve the child’s problem ; which it is the unsolved problem that is the underlying cause of why the child isn’t meeting an expectation.  If we change our lenses to see the child as struggling and needing support, rather than being difficult and purposely not following directions (or any other demand), it changes our tone to a more compassionate and supportive, how I can help this child?  Rather than , what’s wrong with this child?  It matters.

From Greg Santucci, Occupational Therapist:

Charlie was in red.

I asked another student...why is Charlie in red?

The response: "He wasn't sitting right".

I'll bump up my previous post on "sitting right".

Red? For not sitting right? He went above yellow for that? Even the chart loyalists should admit that "red" is harsh! Geez!

So now what? A call home so he can get grounded later that night for "not sitting right" during the day? 

Did the teacher take away recess? Because recess would give Charlie the input he needs so he can....wait for it......"sit right". No behavior chart needed.

Charlie was having a hard time sitting in his chair.

Charlie may not need to sit like the teacher expects their students to sit in order to pay attention.

Charlie may need a movement break.

Charlie may benefit from some flexible seating options.

Charlie may have difficulty sitting up (poor trunk control, seat too high so his feet can't support him, etc). I'm quite certain Charlie is not willfully sitting "wrong" to get attention or aggravate his teacher.

 Kids "sit right" if they can. 😉

Charlie had to stare at his name in red. All his friends knew that Charlie got in trouble. Charlie was "bad" today. Charlie may feel embarrassed for getting in trouble, but feeling embarassed doesn't help him sit up. Or, Charlie may feel defeated, or not even care anymore about the punishment, because he's unable to meet the teacher's unrealistic expectation.

This chart is SO CLOSE to the garbage can...which is where is belongs.

Charlie needs support. This chart solves no problems.

Tear Down Your Behavior Chart!

 http://www.ascd.org/publications/educational-leadership/sept18/vol76/num01/Tear-Down-Your-Behavior-Chart!.aspx

#occupationaltherapy

#sensoryprocessing

#sensoryprocessingdisorder

#betterwaysthanaba

#justsaynotoaba

#knowbetterdobetterbebetter

#teacher

#teacherlife

#teacherproblems

“Our response can change the dynamic of distress”

 This is a great tweet thread.    

It makes an excellent point about our adult responsibilities to not escalate a child.  Our response absolutely can make things so much worse or can help support and co regulate the child.  Reframe and problem solving can only occur once everyone is calm, regulated and back to feeling safe.  Not one professional ever said this to us.  They said to hold child accountable in the moment.  There was no understanding about brain state stress response, regulation and co regulation and nothing matters until the child and adult are both calm, regulated and feeling safe.  Behaviors are communication.  Figuring out the WHY that lies beneath the behaviors is how we support our kids who struggle.  Not through punishment, consequences, seclusion or restraint.  If our kids can , they do.  If they can’t, figure out why!   Lack of skill to do better is always part of the “ why “ when we see our kids struggling, misbehaving, having a meltdown.  A dysregulated child cannot problem solve or learn the skill that would help them meet the demand that is being placed on them.  Adults must understand their role in helping co regulate the child through their own calmness, feelings of safety and connection.  

When we escalate the child, that is when things can really progress to even dangerous states, which can look like the autistic meltdown.  Literally it is the inability for the child to cope with the overwhelming stress response their brain and body is experiencing and their survival brain takes over and everything becomes about surviving.  This is why we say, there is no rationalizing with them, no talking with them, no problem solving or any other “solution” an adult thinks they have or presents to the child.  Only a calm, connected, present adult/caregiver that can help bring feelings of safety to the child and share their own calm can support a child to move out of the brain survival mode.  Dropping all demands and expectations that may have elevated the child to this point must be priority.  Adults have a hard time with this.  But when we understand that behavior is communication, then we see a child as needing our support and compassion.  

Kids do well if they can.  If they can’t, why not and why now!!!  

Tweet from Anne Martin

“Why escalate a student by reactivating their stress response systems when, as teachers, we have this powerful opportunity to co-regulate a child’s growing agitation and anxiety?” @desautels_phd , Connections Over Compliance

“Our response can change the dynamic of distress. It’s an opportunity - and I believe it’s an obligation. The first task is to help the child re-regulate. We will get to solving the problem once the S is physically, emotionally and cognitively settled.

At that point we can focus on the issue, reframe, validate, and problem-solve, all within the encompassing circle of relationships. - Anne Martin