Relationshiped-based Therapies

>> Sunday, March 22, 2009

Stanley Greenspan, a child psychologist, developed The Developmental Individual Differences, Relationship-based Approach (DIR). The DIR offers a framework to assist parents and professionals in creating a comprehensive, intensive therapeutic program. It is also fully compatible with other therapies including biomedical intervention, occupational therapy, sound-based therapy and let us not forget vision therapy. While DIR focuses on the individual, they also focus on the entire family to help resolve family issues that may be interfering with a child's growth and development. Components of DIR falls into six categories.
1.) Shared attention- Utilize all the senses and motor abilities, stretching the child's capabilities for interaction.
2.) Engagement- Follow the child's lead, building upon pleasurable interactions. Match the child's rhythm, deepen the warmth, add physical closeness.
3.) Two-way purposeful interaction with gestures- Exaggerate emotion, become animated, support initiative, facilitate goal achievement.
4.) Two-way purposeful problem solving interaction- Add extra steps to play, such as acting dumb, playing obstructively and creating barriers, forcing the child to solve problems.
5.) Emotional ideas- Encourage imaginary play, combining words with ideas and affect with action.
6.) Emotional thinking- Building bridges between ideas and development of abstract reasoning. Challenge with "wh" questions. This high level of development is the ultimate goal for all children.

The individual differences that affect learning and behavior. They are as follows: auditory processing, gestural non-verbal language, ability to understand and use language, visual spacial processing, motor planning and sequencing, and sensory planning and sequencing, and sensory reactivity and modulation. The Dir approach assists caregivers in developing adult/child relationships, which then allows a child to develop meaningful relationships with peers and siblings. According to Greenspan, all individuals categorize experiences by their sensory and affective qualities.

Sensory perception focuses on physical properties (bright, loud, big smooth, etc.) and emotional qualities may be perceived as soothing, jarring, happy, tense, etc. DIR focuses on the child's ability to interact with others. Our interaction malfunction would be getting along with each other (parents and sibling). Guess well be working on that one. We are riding a bumpy road, but with faith we will make it through. The primary goal of DIR-based intervention program is to enable children to form a sense of themselves as intentional, interactive individuals, and to develop cognitive language and social capacities. The heart of DIR is Floortime that have guidelines to allow the child to develop spontaneous interactive behaviors that are purposeful and intentional. They include:
1.) Follow the child's lead- do what the child does, he is the leader. If he spins, take his hand and do a little dance.
2.) Join the child's developmental level and build on his natural interests- treat whatever the child is doing as intentional and purposeful.
3.) Open and close circles of communication- When a child avoids or rejects adult interaction, treat is as an error. Say, "Oh you don't want this!Sorry! Here try this toy."
4.) Help the child do what he wants to do- Guide by putting hand over hand. Work face-to-face, or at a mirror so the child can see adult expressions. When a child is purposeful, hand him another object.
5.) Create a play environment- focus on creative interaction; avoid structured games.
6.) Extend the circles of communication- interact in such ways that help a child reach individual goals such as obtaining a toy.
7.) Broaden the child's range of interactive experience- extend the child's desire to expand upon emotional, sensory, and motor responses.
8.) Tailor interactions to a child's unique sensory processing differences- assess the child's sensory difficulties and add sensory play using balls, whistles, bubbles, etc.
9.) Mobilize the six developmental stages simultaneously- share attention, engage the child with gestures and pre-verbal problem-solving to encourage two-way purposeful interaction, emotions, ideas and thinking.

A lot of the DRI intervention takes place in the home. Parents, caregivers, and therapists typically interact with children in Floortime activities for at least 20 minutes eight or more times a day. For children attending school, the program can integrate into the classroom which allows interactions with typically developing children when the child was ready. A balanced DIR program includes both spontaneous and semi-structured activities designed to facilitate mastery of specific processing abilities, and emotional, congitive language and motor skills. DIR includes structured activities at least three times a day to address the following areas: motor and sensory skills, balance, coordination and left-right integration, rhythm, modulation, and visual-spatial skills. For those interested, go to

Relational Development Intervention ( RDI) was developed by Steven E. Gutstein. Like DIR, RID educates and coaches adults to interact and work with children on the ASD spectrum. The goal of RDI is the remediation of specific deficits that define ASD by creating numerous daily opportunities for a child to respond in a flexible thoughtful way. The RDI consists of nine different elements:
1.) Diagnostic evaluation
2.) Parent education
3.) RDI program planning
4.) Consultation
5.) Parents use RDI as a lifestyle and function as facilitators
6.) Children work individually with adults, and then in therapeutic peer dyads or groups when ready.
7.) Episodic memory
8.) Emphasis on Self Development
9.) The RDI Program is a primary intervention.

Goals of the RDI Program include: understanding and appreciate the many levels of experience sharing, become an equal partner in co-regulating experience sharing interactions, value the uniqueness of others' perspectives, ideas, and feelings, work to maintain enduring relationships, become adaptable and flexible in both social and non-social problem solving, and recognize that their own unique identity can continue to grow and develop.

Lyte Kaufman and his family, established The Option Institute and The Autism Treatment Center of America, where they have been offering the Son-Rise Program since 1983. The Son-Rise Program is based on the idea that adults must enter the world of autism instead of asking the child with autism to enter the "real" world. By mirroring repetitive and ritualistic behaviors and interacting with the child through play, accompanied by a optimistic, trusting, respectful, and non-judgmental attitude of love and enthusiasm, adults can gradually lead a child tword a more normal life. Parents are encouraged to explore their own belief systems and to question judgments that limit them. The guiding principles are listed and described below;
1.) Autism is a relational, not a behavioral-disorder- Son Rise views autism as an interactional disorder in which children have difficulty relating and connecting to those around them.
2.) Motivation, not repetition, hold the key to all learning- Son Rise strives to uncover each child's unique motivations, and use these to teach children the skills they need to learn.
3.) "Stimming" behaviors have important meaning and value- son-Rise accepts and respects children's behaviors.
4.) Parents are the child's best resources- nothing equals the power of the parent.
5.) Parents and professionals are most effective when they feel comfortable with a child, optimistic about a child's capabilities and hopeful about the child's future- caring professionals often do not have the resources, guidance, or support they need to help the children they are working with.
6.) All children can progress in the right environment- most children on the ASD spectrum are over stimulated by plethora of distractions that others do not even notice.
7.) A child's potential is limitless- Son-Rise focuses parents on their own attitudes striving to help them reclaim their optimism and hopefulness, and see the potential in their children.

Carol Gray developed Social Stories to help individuals with autism learn to "read" and understand social situations by answering questions, "who", "what", "when", "where" and "why" to a variety of situations presented in the form of stories. The goal of Social Stories is to impart accurate social information in a patient and reassuring manner, not to challenge an individuals behavior. Social Stories uses four types of sentences that are named to described below.
1.) Descriptive sentences- express what people do in a particular social situations. Ex. " When the bell rings, the children come in from recess and go to their classrooms, where the teacher reads a story."
2.) Directive sentences- move a person toward a desired appropriate social response. Ex. " When the bell rings, I stop playing and line up to come in from recess.
3.) Perspective sentences- present others' reactions to a situation so that the individual can learn how others' perceive various events. Ex. " The teacher is happy to see all the children line up quietly and walk to their classroom."
4.) Control sentences- identifies strategies the person can use to facilitate memory and comprehension of the social story. Ex. "I remember that the bell means it's time for recess to end by thinking of a teapot. I know that when it whistles, the water is done. The bell is like a whistle; when it rings, recess is done.

The Miller Method, developed by Arnold Miller, a Boston psychologist, gradually transforms a child's limited reality systems by expanding his/her repertoire of activities. As a child with autism gradually tolerates and accepts new reality systems through repeative activities, and can make transitions from event to event without distress, the ability to cope with different life situations improves dramatically. Miller has developed specialized training systems and instructional equipment to help children maximize their capability to learn. The Miller Method uses two major strategies to restore typical developmental progressions. The first extinguishes children's aberrant systems such as lining up blocks, and transforms them into functional behavior such as putting blocks into cups. The other introduces developmentally appropriate activities involving objects and people to fill in the gaps in development.
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