2/27/2011. Lecture 12. Follow-Up Study. Follow Up of Long-Term Outcomes. Follow Up of Long-Term Outcomes. Major Findings:

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1 Lecture 12 Follow-Up Study The Greenspan Floortime Approach Follow-Up Study Lecture 12 Follow Up of Long-Term Outcomes Major Findings: We can break the mold! Core deficits are reversible for certain children Once past certain levels l of competence, results hold up long after intervention has stopped. Follow Up of Long-Term Outcomes Report on cases originally used to validate outcomes with the Vineland and FEAS in our 1997 Chart Review of 200 Cases Current Ages 12 to 19 years 15 boys All NDD Type I First concerns between 12 and 24 m. All diagnosed as PDD or Autistic Spectrum between 24 and 30 months 1

2 First Words So amazing when I think about who he was A miracle child happy and sweet and sensitive. He s doing great, fabulously, no one knows there was anything wrong We moved and the gap closed a little more and a little more He s happy, out there, playing with everyone else, so creative and accomplished. I m not parenting a child with special needs, just an adolescent boy.. First Words: Empathetic and Compassionate He has a great heart, as great as a city. He is sweet and kind and sensitive to others he can just put himself in someone else s shoes He is sweet, empathic, accommodating and earnest. So caring and observant, so humorous He is in touch with himself and others So compassionate, just wants to help. Chart Review of 200 Cases Developmental Patterns and Outcomes J. of Developmental and Learning Disorders, 1997 Presenting Patterns: Engagement: 5% - no affective engagement 31% - only intermittent engagement 40% - intermittent engagement and some reciprocity 24% - intermittent engagement and reciprocity and islands of symbolic capacity 100% - lacking long chains of reciprocal interactions Auditory Processing 100% Motor Planning Dysfunction 100% Reactivity: 39% Under-Reactive, 19% Hyper-reactive, 36% Mixed 2

3 Chart Review of 200 Cases Developmental Patterns and Outcomes J. of Developmental and Learning Disorders, 1997 Presenting Patterns: CARS DIR Outcome Score Severity Population Good to Outstanding Mild 25% 37% Moderate 39% 43% Severe 36% 20% Chart Review of 200 Cases Developmental Patterns and Outcomes J. of Developmental and Learning Disorders, 1997 Overall Outcomes of DIR Intervention n = 200 n=92 All degrees of Fully Implementation Implemented Good to Outstanding 58% 66% Medium 24% 27% Ongoing Significant Difficulties 17% 7% Validation of DIR Intervention Outcomes Sample of 15 Children with Good to Outstanding Outcomes Vineland Higher than age levels in communication 93% Higher than age levels in socialization 87% Higher than age levels in daily living skills 53% FEAS Functional Emotional Assessment Scale Average %Ranking 15 outstanding outcomes 73.7 of 76 90%+ 10 normal comparison 72 of 76 90% + 10 Continuing difficulties 17 of 76 below 50% 3

4 Comprehensive Intervention Profiles Intervention DIR Consultation Floortime at home Floortime therapy Play Dates Speech & Language Occupational Therapy AIT/Tomatis Visual Spatial Therapy Nutrition/Bio-Medical Frequency Ages 2-4 times/year times/day times/week times/week 2-6, times/week 2 times/week 2 times/week 76% 15%/62% Current Study Follow Up Study included: Parent Interviews and FEDQ Ratings Child Interviews Independent Clinician Ratings School and Cognitive Reports Vineland Scales CBCL Achenbach Case Studies (Results will be presented) Academics School Reports Math and Science 23% gifted 39% superior 38% average Language Arts 30% superior 53% average 15% below average Truly love reading- 46% Creative Writers 46% Social Studies-History 62% superior 38% average Intellectual Functioning Bright Average to Superior Ranges (not all scores available yet) Executive Functions all mild to moderate challenges Handwriting difficulties- 62% 4

5 Sports and Games All played individual sports skiing, swimming, tennis and riding All picked up team games Many joined teams baseball, basketball, hockey, soccer and football Preferred strategy games chess to fencing All enjoyed video games Talents and Creativity Gifted in math and science Gifted in music play many instruments, join bands and even compose Creative writers prose and poetry Enjoy history and social studies Enjoy drama and oration Resourceful and enterprising in business For Some, Residual Learning Challenges Motor Planning: Executive function and organizational challenges Poor handwriting Poor time management Auditory Processing: Reading comprehension getting hidden meanings making inferences relatively weaker Reading mechanics more challenging 5

6 Effects on Families Increased stress on some marriages Remember you are also a couple Rallying for other marriages pulled together to provide the intervention More stress and anxiety related to finding the right school Siblings became good friends but some later revealed their distress and concerns Became more assertive had to be advocates Looking Back Parents Views As Most Helpful: DIR consults and Floortime therapy Floortime at Home Play Dates OT and Speech and Language therapy Regular Education The bulk of it was from us when you add up all the hours we really believed all of you and did what you told us and believed it would help getting the subtle distinction between following his lead and making it more complex was the key Looking Back Parents Views As Most Stressful: Not knowing what is wrong, what can be done, and what the future would hold Not knowing how things would turn out, especially with the terrible prognosis we were given Not knowing whether therapies would work Not knowing what s normal what wasn t, what was fixable and what not 6

7 Future Hopes Anything he wants I want him to enjoy life and enjoy what he chooses. I thinks he will find something he likes to do and will stick with it When he wants something he usually finds a way to get it The sky s the limit! Future Hopes Happy and confident; social skills are in place, academics are strong; he can be whatever he wants to be. I believe the future is open and I believe he will be able to do it all His potential is very great potential No fantasy of a profession, but see education, individuality, relationships, marriage and family.. The Big Picture Conclusions This study breaks new ground for a subgroup of children for whom core deficits are reversible! Results hold up long after intervention has stopped once certain levels of competence reached. Initial profiles predict to some degree but do not determine outcomes 7

8 The Big Picture Conclusions Some challenges continue but they are in the range of issues seen in typical children Define potential as you work and do not impose ceilings or constrictions Support and include families in all interventions All the children progressed out of their core symptoms and are warm, related, sensitive and empathic young people who now have a foundation of core developmental capacities to take on life and live as fully as possible. 8