Earlier this month I attended the12th Annual International Conference of the Interdisciplinary Council on Developmental and Learning Disorders. My mother was speaking and psychology is one of my new collection areas so I thought it would be fun to tag along. Below are my notes from a few of the programs.
Understanding Aggression from a DIR Perspective - Ira GlovinskyPh.D. Diane Selinger Ph.D. Stephanie Pass Ph.D.
Full room confirms importance of topic. Mixed room – occupational therapists physical therapists me
Stephanie
aggressive behavior is…
worrisomescarydangerousexcitingnormalnecessaryetc. etc.also
challengingessentialDIR model = development individual relationships
Diane
modulation of aggression mastering aggression at each level
level 1 (regulation and shared attention)
aggression occurs as an unorganized chaotic response or discharge and is experienced in relation to displeasurethere is also pleasurable non-destructive aggressive impulses. aggression promotes pleasure (tension releasing )parents can soothe and calm through co-regulationlevel II (engagement)
2-5 monthsthrough co-regulation parents learn to read the infant’s cues and the infant learns to signal to parents.self-regulationvideos - parents are experienced floor time plalevel III (intentionality and two-way communication)
6-9 monthsaggression becomes more intentional and thus is not experienced as random or overwhelming by infant or parentthe capacity to assert oneself increases tactile visual and motor exploration and developmentaggression helps motor system develop and vice versamastering stranger anxietyseparation anxietypeekaboo helpslevel IV (9-18mo)
shared social problem solving mood regulation formation of the selfthe toddler begins to lose sense of omnipotence and controlthe dance and the duelneed aggression to assert selfmotor skills had been container of aggression now words become new vesselimportance of not losing verbal skills when get angry or upsetlevel V (18+mo)
creating symbols – using words and ideasallowing them to be the bad guys (pirate)Stephanie
individual differences
it looks aggressive but maybe…
a child is overwhelmed by the environmenta child is seeking sensory stimulationmost of the time with impulse control haven’t mastered engagement (eye contact – evil look)
if they miss co-regulation they have difficulty learning to regulate no confidence he can be soothed a feeling the world is not a safe placesensory differences
fight/flight response - people living in a sympathetic overdriveworld feels too intense they live on high alertit looks aggressive but maybe
a child is frustrated because he cant get his body to do what he wantsa child is angry because he cant find the words to make himself understoodinitiative and the gestural system - initiative is key - if you don’t have body that you can rely on that supports you you can’t gesture
if you can’t feel aggression in your body you can’t organize around itget angry at mom when can’t rely on bodygetting the circles of communication rooted in early rhythms of reciprocity its hard to get that good co-regulated back and forth when you didn’t have it early on
language
the importance of being able to attach words to feelingsNOT just a matter of knowing the words (not just learned phrases)words. affect. action.communicative speech is functional and emotionalnegative of violent themes may be avoided or repeated in the service of mastery
difficulties at symbolic level
if you don’t become symbolic around aggression you never learn to control itaggression is held in storiesaggression is held in the bodysymbol of girl making her own food to let out aggression of not getting to go out to the restaurantworking with severely aggressive children ideas about dealing with aggression
personality qualities for parenting a child with a severe mood disorder
tenacityendurancethick skinsense of humorpatience of mother teresaserenity of buddist monkone size doesn’t fit all - what is the form of the aggression? anxiety proactive reactive etc.?
dealing with underlying cause - who are they acting out at?
a need for space in order to calm down when they feel dysregulated
targeting internal and external variables
never tell how to deal with a situation - always “what do you think you should do”? - them thinking it through
internal
social problem-solvingattributionsimpulse controlexternal
parents/familyneighborhoodsschoolsthese problems need to be regarded as chronic and continued intervention
working with the parent
definingtracking child behaviormonitoring themselvespositive reinforcementforms of extinction (ignoring negative)primary principles
safetycalmcounter-balancinghow do we get there?
situation selectionsituation modificationattention deploymentcognitive change (reframing)response modulationobservation informs the intervention
is this intentional an hostile?is it fulfilling a sensory need?is it a reaction to an environmental assault?slow down and think about how it got there
co-regulation - children at all ages frequently require co-regulation rather than punishment time-outs or behavior plans
kids learn to get excited and come down again – like rough-housing
talking with affect in floor time - not just giving them the word really holding the feeling - helps the child organize and get it
sometimes what looks like aggression can be excitement - example of little boy biting b/c he’s exited and in the oral stage
videos
playing assertive game lets boy feel in control and organize self and move on to words
helping children through anxiety
tempting to make children be nice when the kid wants to feed someone bad food - but its through play children learn to modulate
symbolizing aggression
identifying with power: doctors teachers and policemenfascination with the bad guysBook - Horrible Harry by kline
It’s part of integrating that they have bad feelings and what are they going to do with them
aggression has to be seen for some as a sense of achievement
when kids have reached the symbolic level we can use picture books to communicate
have to acknowledge the pleasure of aggression
more likely to be a problem later if you don’t let them act it out
strike when the iron is cold
revisit issues in a way kids can reflect upon them
aggressive language
the good news about “bad words”
“use your words” they won’t always be nice words
we need to observe our own feelings – all kinds
what are our sensory sensitivities? how do they effect the dynamic in the family? in the therapy session?
it can feel inappropriate to be angry at a very young child but it’s still normal feelings to come up
Is PDD Resolvable - A Comparison of Selected Interventions for Pervasive Developmental Disorders
Insurance often won’t fund PDD
they didn’t pick the title
they want to start with 2 questions
what brought you into this roomwhat do you think of the title?we all have quirks sensory preferences at what point do we say pdd?
well it’s at the point it interferes with our 6 levels (regulate symbolize)
audience member – saying “she’ll outgrow it” demeans it
clip
defining issues
‘upstream’ issues – genetic heritability congenital anomaly perinatal insult‘downstream issues’ – environmental toxicity relational mismatch postnatal traumaregulatory and sensory issues
sensory issues are observable as the behavior which an individual uses to function in her worldregulatory issues are not observable directly: behavior change of patterns of behaviors identify regulatory issuesmodels
a model can be defined as something that stands for or represents something else. the most general models – sometimes called world views world models or paradigms - offer statements and ideas about the nature of human life. these models rely on me
these models are me
me
core tendencies
peripheral
developmental statement
blue handout talks about 2 kinds of functional analysis of behavior
nice sneezing example - idea that a sneeze can be controlled behaviorally - but important to understand what’s going on underneath/behind that
concepts to use in a comparative analysis
models and me
core tendency of human functioning – (yellow hand out)
clip – doesn’t use eye contact doesn’t use words and has motor skill problems – cant walk at 19 mo
medical diagnosis – clumping – says he has autism
other way is to take it apart and treat each item separately
there is talk out there that the behavioral approach is best
ba
no strong evidence saying behavioral is better
model looks at back end – counts sneezing
open discussion of clip
doesn’t have eye contact
can say – we need to get this
or
why doesn’t he have this
kid lets dad touch stuff he touches – happy for interaction
I don’t have good notes from my mother’s presentation because I was helping with her videos. We had some technical set up problems.
One of her co-presenters had some nice ideas to steal from the corporate world:
need to see ourselves as leaders and align ourselves with leaders who have moral and ethical understanding
principles learned from son from corporate america
crowning – not a king or queen or 1 leader but organization is sovereignalways need to up the ante – focus the resources on a few big betstop of the bottle is always the bottle neck instead focus on processbuilding character – this project has a reputation of doing good – parents feel they’re getting good servicenavigating the bermuda triangle – cant direct the wind but an effect the sails – keep detail and big picture in minderect scaffolding along the way – go outside your own ideas and look at ideas of othersenlisting insultants – giving you unpleasant truths. always question your fundamental assumptions“If you want to build a ship – don’t drum up men to gather wood divide them and give orders. Teach them to yearn for the sea.”
grass root changes get new presidents
A Bioethical Approach to Overcoming Problems with Aggression and Misbehavior in Schools - Stanley Greenspan M.D.
a paradigm shift from solving problems to having a quality of life that is acceptable
new graduate school - 1st of its kind
an ethical approach begins with not separating emotional academic etc growth into separate categories
academic work builds stepwise and at the cornerstone is thought
if you don’t have causal thinking that’s going to be very difficult - if you can say want drink or open door but can’t answer why
at the first couple months of life babies are born with individual differences with how they take in what they see touch etc
they use their affect to turn towards mommy’s face
gets all their parts working together
an ability to take an interest in the outside world – beginning of academics
next - taking an interest in other human beings
brain working in a more organized fashion. pattern recognition – another step of academic work
that comes from emotional interactions in early stage of life
beginning of language development – is that another part of academic life? i should hope so
so these developments are academic as well as emotional
you’re learning about causality (reciprocating facial ex
4th stage – taking daddy’s hand to get a toy
foundation for quantity is being laid down (learning math)
learning 2 words together can be sequenced
language only has meaning to the degree it has affect behind it
(these are the D – the levels 1-6)
if you get involved with emotional signaling you go from catastrophic all or nothing towards free standing images
images move towards symbols as you get more experiences
and get deeper and deeper meanings
symbol formation – an essential part of academic life
and we haven’t even gotten to the point you’re leaning to use ideas
level 5 – ideas
have to be connected to affect or they’re just memorized sc
ability to regulate yourself to pay attention
also comes from these early interactions
attention is not a static state it’s active
learned by getting more and more circles of communication going
learning pretend play teaches creativity
creativity is important for being able to be a thinker
if we made this the core of our education
where affect moved us along at each step
this is the ethics of proper education
these steps are just quickly outlined here.
“the first idea” (book) goes through the theory of it
our education should focus on the broadest application of these core developmental steps
we see that social emotional and academic proceed together
and that’s the key
now to apply that to aggression
tailor educational environments to each child’s nervous system
let each child’s own learning curve determine his/her potential
provide learning relationships with trained adults
have a pre-planned strategy to help each child calm down
life skills and academics are part of the same process
don’t set limits don’t break kids into different groups
redefining potential
not breaking students into academic v. life skills
schools must be geared toward individual differences rather than standardized curricula
life long learning systems for adults. some of their nervous systems are still developing into adult hood
what if a child gets out of control
respect the child’s nervous system
switch to soothing self-regulating
ethics of medication usage
if medication is needed it should be used to facilitate the learning process to help the child reach his/her highest potential
if medication is just used for compliance in an an environment that is not tailored to him then it’s not ethical
dos and don’ts
don’t
over controlover loadremove empathy and respectbecome irritative or angrythrow fuel on the firebecome immersed in power struggles (need to get your way)over worry about spoiling the childworry about the child getting his or her wayworry about rewarding bad behaviorwith work of skinner et al – they were trying to teach a specific behavior in an animal - not trying to teach emotional understanding
dos
counter balance the child’s emotions e.g. calm and soothing when the child is storminginact the five-step plan:help the child calm downengage with the child in a warm and soothing mannerengage in a step-wises progression “up the developmental ladder” to the child’s highest level of functional emotional developmentafter the child has been calm for a while respectfully inquire abut what was going on in the child’s mind and feelings to the degree the child is capable of elaboratingthen or later play the thinking about tomorrow game or with a non-verbal child play the anticipatory rehearsal gameremove the situation from the child (the Agnes Principle) rather than the child from the situation (aside - my mom let me know that schools do this – will clear the class and leave the child there to storm)
if sanctions are necessary tailor them to the child and try as best as possible to make it a constructive learning experience
learn what pushes the child’s buttons
refrain from pushing those button or having other push those buttons (and again don’t feel the child is getting away with something)
create relationships and environments that enhance flexibility and coping
respect each child’s individual differences
respect the unity of social emotionaldevelopmental academicintellectual
recognize each child has their own way of calming down
recognize learning is a lifelong process
I believe this is the point at which it switched to Serena Wieder
aggression
a failure in relating and empathya failure in communicationa failure in problem solvinga failure in reality testingA FAILURE IN SYMBOLIZATIONnot enough to just say he/she is aggressive or acting out
the young child might hit fight bite push throw break things when feeling:
angryafraidconfuseddefensivefrustratedretaliatoryeasy to criticize the child rather than thinking what are we doing to help the child
does he/she understanddid she mean it?did she want to do that?did she get out of control?answer could be yes or no
so how to children develop the abilities e5ato experience these feelings safely express these feelings appropriately
how do children know what’s real and not real
a child who is acting aggressively and cannot self regulate and find ways to express symbolically has developmental challenges
parents go through parallel process
when we look at symbolic development we’re looking at emotional development
early symbols help understanding emotions
don’t overwhelm children with symbols they’re not ready for
when does a child know what is real or not?
develop reality testing between 3-8
emotional thinking must develop and cannot be taught
Glen Mcgee couldn’t come - Summer Johnson was his replacement
move towards early detection is an important ethical item – that will shape their entire life
that “label” process of being identified changes their whole world and that of their family
problem of emphasizing research over services
parents on both sides – ones that call their child cured when they become highly functioning others that embrace the communities
with other disabilities we try to make the world change for them
so looking at the spectrum from a disability standpoint moves towards that
ADA definition
not that there’s some pill cocktail that makes it so we don’t have to deal with them
disability v. disease
there’s also been a move to understand autism as a medical problem
this isn’t something healthcare can absorb the whole community needs to be involved
there’s a moral imperative here.
