Making the most of your time with

MAKING THE MOST OF YOUR TIME WITH CHILDREN WITH SPECIAL NEEDS Solana Beach School District August 17, 2007 Joshua D. Feder MD, Child and Adolescent Psychiatrist Faculty, Interdisciplinary Council on Developmental and Learning Disorders Volunteer Faculty, Department of Psychiatry, UCSD School of Medicine Abstract: Getting the most with kids who have developmental and learning disorders: How to engage in productive and rewarding interactions using a clear and easy to use approach that is individualized, developmental, and relationship based. We will cover the basics of helping kids be better regulated so that they are able to truly engage with us and then interact with mutual communication where they learn by building on ideas together with us. We will emphasize the importance of initiation and how to bring that out and build on it, folding in goals for language, learning, and social growth.

First Hour: DIR/Floortime®: The basics.

Calm enough - regulated On the same page – engagement True back and forth – social reciprocity

The Social-Emotional Growth Curve: Why is this so important?

It’s the basis for all true relating and learning.

Dual coding of emotion and learning Emotional regulation and delayed gratification: learning, loving, and limits

Second Hour: Step One: Taking your own pulse How do you self regulate?

How do you engage with others?

What are your relationships like? Reciprocal?

Step Two: Learning your student How does your student regulate? What works? What gets her off balance?

How does she engage? Can she be warm? And what are the boundaries?

What are her relationships like? Is there any reciprocity? When and how?

Step Three: Having fun How can we help the child self regulate (without ever touching her).

How can we help anyone engage better and better over time.

What do we mean by making the relationship better? Is it more reciprocal?

Third Hour: What about the IEP goals?

Project based learning – folding in all the goals.

Increasing symbolic complexity Adults vs. peers Reorganizing the goals Will it work?

Persistance Fun Data tracking Am I qualified?

Reading a book, or a pdf.

ICDL and related Certifications (DIRB, DIRC, FTP, PhD, Play Project)

Support and reflective tutoring is essential. – you need to be actively thinking about what you are doing, paying attention to your feelings, and getting help in sorting through it. There are free resources in town, and there need to be mechanisms in school to help out.

Conclusion: NOT ‘IF’, BUT ‘HOW’ The buck stops here: no choice – for parents, schools, and healthcare professionals We cannot do it alone, but we can do it with support.

Resources: Books: Engaging Autism – Greenspan and Wieder Playground Politics – Greenspan Internet: ICDL.com: lots of free information, including hours and hours of free podcasts – learn as you drive to work!

ICDL Guidelines: 800 pages in 8 pdfs of free comprehensive information: http://www.icdl.com/staging/bookstore/catalog/clinical.shtml The Floortime Foundation: books, dvds, other resources

http://floortime.org/

Celebrate the Children: very practical information specific to schools

http://www.celebratethechildren.org/ Support Group: Dr. Feder’s Free support group: Next meeting is September 5, 2007, at 415 North Highway 101, Suite A, Solana Beach, CA, 92075.

Attachments: 1. Social Emotional Growth Chart 2. DIR® IEP Template 3. Sample DIR® tracking sheet

DIR® IEP TEMPLATE XXXXX’s symptoms of his Autism Spectrum Disorder include problems with self regulation, joint attention and social reciprocity which interfere with learning and with everyday social emotional function. Fortunately XXXXX is quite able, with facilitation and support, to be calm and regulated, and to work together in sharing and building ideas.

To accomplish this, I recommend that the I.E.P. team adopt the following socialemotional goals that reflect in a straightforward manner XXXXX’s basic difficulties so that these may be addressed: 1. Self-Regulation: • Baseline: XXXXX is calm and focused __% of the time during any given 15 minute observation in class (“C”), __% during unstructured activities such as recess and lunch (“US”).

• October 2005 Goal: __% C/ __% US. • March 2006 Goal: __% C/ __% US • June 2006 Goal: __% C/ __% US • Responsible persons: teacher, staff, OT • Suggested interventions and accommodations: OT consultation monthly, sensory diet and strategies for home and school, staff facilitation of interactions with peers including during unstructured times, typical ADHD accommodations.

2. Rigid Thinking/ Shared Attention: • Baseline: XXXXX is on the ‘same page’ as others about __% of the time during a given 15 minute observation in class (“C”) and about __% of the time during unstructured time (“US”).

• October 2005 Goal: __% C/ __% US • March 2006 Goal: __% C/ __% US • June 2006 Goal: __% C/ __% US • Responsible persons: teacher, staff, counselor (DIS) • Suggested interventions and accommodations: social skills group, facilitation of interactions in class and at lunch and on the playground, typical ADHD type interventions such as non-verbal prompts.

3. Sharing Ideas/ Social Reciprocity: • Baseline: XXXXX tends to focus in his own ideas in play and conversations, and engages in actual mutual building of ideas about __% of the time during any given 15 minute period while in class (“C”) and __% during unstructured time (“US”).

• This can be assessed by examining a 15 minute sample of conversation and scoring the percentage of times that XXXXX’s initiation or responses take into account and/ or respond to other people present. Tape recordings or videotape

• • • • •

may be needed to best assess this, although it can be done by observation as well.

I am happy of assist in the training of persons to do this.

October 2005 Goal: __% C/ __% US. March 2006 Goal: __% C/ __% US June 2006 Goal: __% C/ __% US Responsible persons: teacher, staff, counselor (DIS).

Suggested accommodations and interventions: social skills group, staff facilitation in class, at lunch, and on the playground.

In summary, if we ask ourselves, in order, whether XXXXX is: a) calm and focused; b) on the same page; and c) is he working with together with other people or more focused on his own ideas, we will naturally be in position to facilitate XXXXX’s social-emotional function. It is likely that his improvement will be easier in class, and with adults, but it is truly critical that he improve.

DIRŽ DATA TRACKING SHEET – DRAFT Name: Date: Time:

In Class (am) Recess In Class again Lunch Afternoon

Regulation (calm enough?)

Joint Attention (on same page as us?)

Social Reciprocity (true back and forth?)

Fill in #minutes/15 min sample for tracking regulation and joint attention Use hash marks to count number of times child initiates or responds appropriately for social reciprocity

Estimate % time for each goal at each time