Addressing Behavioral Issues: Starting with Self-regulation

Transcription

1 Addressing Behavioral Issues: Starting with Self-regulation Jenna Gordon, MS, OTR/L Occupational Therapist Children s Developmental Health Services Albertina Kerr Disclosure Nothing to disclose 1

2 Overview Why Self-Regulation? Role of Self-Regulation Self-Regulation and Social Competence The Sensory Stuff Treatment Approaches (within OT Domain) Application in Practice What can you do? Why Self-Regulation? 2

3 Why Self-Regulation? Individuals who display a greater capacity to self-monitor their physiological arousal and emotional state are more able to maintain social engagement, to problem solve, and to communicate effectively My primary emotion is and has always been fear. Temple Grandin (2006) Self-regulation is a dynamic system Self-Regulation Begins with Co-Regulation (parent-child interaction) Regulation facilitated by the caregiver, providing comforting stimulation to the infant in response to the infant s profile Develops into Self-Regulation with referencing to regulatory partner (caregiver) Co-constructed function that arises from co-regulating interactions between parents and infants Further develops into internal regulation ( selfregulation ) and control of his or her behavior 3

4 Self-Regulation Caregiver continues to provide regulation support through interaction; amount of support diminishes over time Social Competence and Self-Regulation Social emotional competence plays a major role in our success or inability to form those relationships that allow us to function happily and effectively in the communities within which we live. (Marans, Rubin & Laurent, 2005) Self-regulation is needed to support social-emotional competence. 4

5 Foundation for Social Competence (thus self-regulation) 6 months child begins to follow gaze and can recognize that they have lost their caregiver s attention 7 months Gestural communications, demonstrate intent behind actions 10 months child begins to gaze shift from a caregiver to objects of reference to predict and anticipate the actions of others Foundation for Social Competence (thus self-regulation) 12 months child will initiate shared attention on desired items or items that are of interest to the child months Representational Play (re-enacting their lives, inner world expressed) 6-18 months Sensorimotor > Social Play > Functional Play > Symbolic Pretend Play 5

6 Typical development of social competence from self-regulation Drawn toward social (versus non-social stimuli) Derive pleasure from this engagement Notice attention shifts in others Initiate bids for engagement, actions, and objects of interest Imitate actions of others Develop language about people and intentions to share these messages, and Typical development of social competence from self-regulation Engage in interactions using expected social behaviors (e.g., adhering to social norms) in order to maintain relationships over time 6

7 Rhythm of the Relationship is based on -- Arousal Level Ability to maintain alertness & transition or adjust arousal to meet the demands of the environment or expectation Attentional Level Ability to focus selectively on desired stimulus or task Affect Emotional component of behavior; sensation elicits emotion Action Ability to engage in goal-directed behavior (ideas, plan, sequence, execution, adaptation) Interoception 7

8 Development of Sensory Processing Adaptive Response Sensory Input Processing Development and learning occurs when the child receives sensory input and meets a challenge in the environment; the child organizes information into an adaptive response (new skill). (Case-Smith, 2005) Development of Sensory Processing As learning and development occur, the child begins to attach meaning to multiple sensations and becomes increasingly adept at shifting attention to meaningful input and tuning out irrelevant input. attention learning through play and daily skills emotional regulation Learning comes naturally with a competent sensory system and inner drive. 8

9 Treatment Approaches within OT Domain DIR Floortime Model Autism Parent Training Program Zones of Regulation Social Thinking Curriculum Sensory Integrative Approach (or exploring sensory systems) Therapeutic Listening/Integrated Listening Systems Wilbarger Brushing Protocol Treatment Approaches within OT Domain Reflex Integration Qigong Mindfulness-Based Interventions 9

10 DIR Floortime Model Created by Stanley Greenspan, Ph.D. DIR is the Developmental, Individual-differences, & Relationship-based model that has become the foundation for understanding child development and providing support and intervention that helps children reach their fullest potential. DIR Floortime Model A specific technique to both follow the child s natural emotional interests (lead) and at the same time challenge the child towards greater mastery of the social, emotional, and intellectual capacities. Emphasizes the critical role of parents and other family members because of the importance of their emotional relationships with the child. 10

11 Autism Parent Training Program Anna Dvortcsak, M.S., CCC-SLP & Brooke Ingersoll, Ph.D. Teaches parents and families techniques that will enhance a child s social engagement, language, play, and imitation skills through a direct training model Helps parents set appropriate goals for their child, based on developmental milestones, family interests, and therapy recommendations Zones of Regulation Leah Kuypers, MA, OTR/L A systematic, cognitive behavioral approach used to teach self-regulation by categorizing all the different ways we feel and states of alertness we experience into four concrete zones. The Zones curriculum provides strategies to teach students to become more aware of, and independent in controlling their emotions and impulses, managing their sensory needs, and improving their ability to problem-solve conflicts. 11

12 Application in Practice Reduce or increase the foundational sensory components of the environment depending on the child s profile Warning Signs Strong startle response (responsive blinking, retracting from touch, leaning away from interaction) Posture (Leaning on objects, posturing on others) Breath Control (Short breath patterns, difficulty expelling air for longer speech patterns) Difficulty with particular self-care/play tasks (e.g., dressing, feeding, bathing/grooming, avoiding swinging) 12

13 Warning Signs Excessive Touching (self-picking, touching others, poor body awareness) Head Banging/Changing Head Position (head tilts, banging head on wall) Excessive tantrums (>15 minutes) Accommodation versus Long Term Change Accommodations modifying the environment, modifying interactions, providing additional support in order to promote more effective learning Compensatory Strategies -- environmental modifications or behavioral designed to bypass persistent impairment in attention, memory, executive-function, and/or other cognitive skills Long Term Change therapeutic approaches, parent training, and/or additional modalities supporting long term neurological changes 13

14 What Can You Do? The Sensitive Child Reduce visual stimuli cover items with blankets, remove unnecessary items, clutter or distractions Reduce auditory stimuli avoid sudden sounds, provide preparatory statements Reduce tactile stimuli provide preparatory statements for anticipation of touch, able to exert control if touch is needed What Can You Do? The Sensitive Child Follow the child s lead imitate or join in with the child s area of interest and see if you get improved social responses (initiation or response to eye contact, joint attention, shared enjoyment) 14

15 What Can You Do? The Overactive Child Provide increased visual stimuli flashy, shiny items, visual tracking toys Increase auditory input provide music, rhythmic music (possibly heavy beats) Increase tactile stimuli provide deep touch versus light touch, heavy work activities Provide tasks for the child to do Follow the Child s Lead References Case-Smith, J., Allen, A. S., & Pratt, P. N. (2001). Occupational therapy for children. St. Louis: Mosby. Greenspan, S., MD. (2007, August). What is DIR? - ICDL - DIR Floortime. Retrieved November 30, 2016, from Kuypers, L., OTR/L. (2015). A Concept to Foster Self-Regulation & Emotional Control. Retrieved November 30, 2016, from Laurent, A., EdM, OTR/L. (2016). "Enhancing Communication and Social- Emotional Abilities in Children with Autism Spectrum Disorder: Engaging Family-Professional Partnerships." [Powerpoint Slides]. Retrieved from Sensory Processing Disorder Symposium 15

16 References White, R., OTR. (2016) "Strategies For Arousal Regulation: The Therapeutic Use Of Self". [Powerpoint Slides]. Retrieved from Sensory Processing Disorder Symposium CME Topic for the next Project ECHO tele-clinic: What are signs of a language disorder? How is a language disorder different than a social communication disorder? Christine Moore, MS, CCC-SLP Speech-Language Pathologist Children s Developmental Health Services Albertina Kerr 16