Neil Samuels Developmental Therapy
Neil Samuels Developmental Therapy
A DIR/Floortime based approach for children diagnosed with ASD and other Developmental based challenges.

Comprehensive Developmental based approaches such as DIR/Floortime are strongly grounded in infant and early childhood mental health, clinical and developmental psychology and the neurosciences. They are peer reviewed evidenced based Developmental neuroscientific approaches to treat children and older with autism spectrum disorder and other biopsychosocial based challenges. Below are several resources that validate a comprehensive DIR/Floortime developmental based approach to treat children with ASD and other biopsychosocial based challenges and the developmental neuroscientific foundations that justify its use as a primary intervention approach with children and families.

In 2011 preliminary results from a fully randomized control trial of 51 children with mild to severe autism, ages 2 years 0 months to 4 years 11 months, were published by the MEHRI Foundation at York University, Canada. Participants were assigned to either a target treatment group (DIR Floortime, 25 children) or community treatment group (26 children, 16 received ABA). The study evaluated a social-communication based approach to autism.  PET scans of all children were taken prior to trial start and post trial to record any neuronal changes. What was quite remarkably demonstrated were clinically significant and clinically meaningful structural neuronal changes in formerly underactive and overactive areas of brain functioning  demonstrated among participants in the targeted treatment vs. control group.

Data sets among participants in the targeted DIR/Floortime treatment group (one child here presented in video below) revealed significant increased activity in the prefrontal cortex area (e.g., executive functioning  responsible for emotional regulation, ideation, motor planning and sequencing); significantly reduced adverse subcortical functioning (e.g., significant dampening of the limbic hypothalamus, pituitary and adrenal axis, reduction of size of amygdala responsible for All or Nothing responses); increased significant activation of the FFA (fusiform face area of the fusiform gyrus), which is responsible for scanning, reading, interpreting and processing the intentionality and facial affective (emotional) expressions of others. After treatment, changes in neuronal activity was found to be more consistent with what typically observe in healthy developing children.  These prefrontal and subcortical changes were directly correlated with specific milestone increases in simple to increasingly complex circles of social-pragmatic child/parent interactions and were demonstrated in the targeted treatment group vs. the community group.  Re-analysis of trial result data in 2015 further revealed that the targeted treatment group considerably outperformed the community group on number of utterances produced and various speech act categories.  

https://www.youtube.com/watch?v=4TRL1TMwsuA&t=11s

The published preliminary and follow up data on the 2011 MEHRI Foundation study (cited above) as well as separately other previous and current controlled randomized trials supporting a comprehensive developmental based approach, such as DIR/Floortime as a primary treatment methodology for young children and older diagnosed with ASD can be found at  http://www.icdl.com/research 

The following is a one hour and forty minute talk with video presentation given by one the most experienced, internationally renown DIR/Floortime Occupational therapist,, Rosemary White., OTR/L. This talk and video presentation is extraordinary useful for both families and clinicians as Rosemary explains in a remarkably detailed and nuanced perspective the theory of DIR/Floortime methodology in everyday practice.

https://www.youtube.com/watch?v=lp3o2yqYPWs&t=2349s

The following white paper by Diane Cullinane, M.D. is an overview of  the scientific evidentiary support for the  DIR/Floortime methodology to treat infants, toddlers and older with ASD and related affect-sensory and social pragmatic communication based challenges:

http://www.adaptmanitoba.ca/wp-content/uploads/2014/04/Evidence_Base_for_DIR-2014.pdf    Updated,  July 2017:  https://docs.google.com/a/icdl.com/viewer?a=v&pid=sites&srcid=aWNkbC5jb218aWNkbHxneDozNzJiNGQxYzQyMWEzZTIx

Below are the Clinical Practice Guidelines of the  Interdisciplinary Council Developmental Learning (ICDL) published in 2001.  It is a comprehensive overarching view of the biopsychosocial components that form the neuroscientific foundations for a comprehensive Developmental assessment and treatment approach for individuals diagnosed with autism spectrum and other biopsychosocial challenges. The chief  editor is the late Dr. Stanley Greenspan, M.D. (former head of NIMH, Mental Health Study Center and the Clinical Infant Development; co-founder of Interdisciplinary Council Developmental Learning and the DIR/Floortime methodology).  It is co-authored by many of the foremost professionals within the biopsychosocial sciences. 

http://www.icdl.com/bookstore/icdl-clinical-practice-guidelines

Now, it is  extremely valuable for all primary caregivers and clinicians working with infants, toddlers, older children and adults with ASD  to begin to read the voluminous evidenced-based research that supports not the older traditional and essentially simplistic surface behavioral based models (ABA) but rather comprehensive evidenced-based Developmental social pragmatic approaches (DSP) such as DIR/ Floortime. DIR/Floortime addresses not selectively targeted or circumscribed behaviors but rather the primary core Functional Emotional Developmental challenges associated with ASD.  Unlike traditional applied behavioral based models DSP approaches neither render nor conflate a false evidentiary equivalence between the heterogeneous and biopsychosocial complexity of each child's core Functional-Emotional Developmental stages, individual sensory-affect-motor processing and relationship based differences with each child successfully”redirected” to execute selectively targeted behavioral/academic performance tasks on cue (e.g., the ability for each child to produce on adult command from declarative memory a set of functionally-scripted responses or what colleagues and I refer to as socially compliant "surface trained behaviors”).

Despite half a century of smashingly rewarding behavioral and-pharmaceutical marketing campaigns (i.e., two-prong approach of psychotropics and ABA or CBT) resulting in widespread public acceptance of masking symptoms by heroic and resplendent attempts to shape or “redirect behaviors”, what is in fact conveniently and egregiously ignored are the affective neuroscientific biopsychosocial foundations. What this involves is deepening reciprocal attachment, attunement in simple to complex social-emotional interactions and thus addressing the underlying core primary emotional-developmental relationship based challenges found in ASD and related disorders (e.g., subcortical functioning and autonomic nervous system regulation and arousal states). These challenges are not brain to-body but bi-directionally body-to-brain /brain-to-body and are co-structured through the dynamics of relationships.

Developmental social pragmatic approaches such as DIR/Floortime focus on the core biopsychosocial underlying foundations that constitute healthy relating, engaging and communicating in the context of child/primary caregiver and peer-relationships both in typical and non-typical development. What has been clearly demonstrated over the last twenty-five years of research in Developmental Affect Neuroscience and infant, toddler and early childhood mental health through neuroanatomical and neroendocrinological studies made vastly improved by functional neuroimaging in utero infancy and toddler development between two brains.

The latter phrase is often referred to in the field by the term, “interbrain.” These biopsychosocial formed connections which begin in utero, especially during the last rrimester, involve the mother’s right orbital frontal cortex with the infant and toddler’s right subcortical limbic, anterior cingulate and hypothalamus, pituitary and adrenal axis dynamically connected to the central and autonomic nervous system. How these connections form are seen and measured in real-time through neural imaging. Basically, the way the prenatal, infant’s and toddler’s subcortical areas begin to synpatically connect with the under-developed prefrontal areas (executive functioning)is through child/parent emotional-bodily based communicative interactions. The epigenetic connections (the set of molecules that sit on top of the genome and regulate gene expression, what genes are turn on or off and produce proteins that form synapses) are critically dependent for healthy growth and development on secure and consistent dyadic child/parent reciprocal emotional interactions. This begins with the biopsychosocial processes of infant/toddler/primary caregiver emotional deepening attachment and attunement through simple to complex back and forth social-emotional reciprocal visual-facial, auditory-prosodic and tactile-gestural. interactions.

Therefore, evidenced based Developmental social pragmatic treatment approaches, such as DIR/Floortime, concurrently address both typical as well as non-typical developing children are entirely focused around the integration of  the child's subcortical with cortical functioning  (e.g., child's emerging "sense of self with others" guided by the child's emotional individual sensory processing differences and addressed in the context of child/primary caregiver relationships). Now, in either typical challenging behaviors (i.e., challenged institutional child facility care or child/parent insecure avoidant and ambilvalent attachement) or in non-typical development, such as ASD, it is not the isolation or an inventory checklist of the child's circumscribed or “problem behaviors” targeted for modification but rather guiding primary caregivers to use their natural emotional intelligence to learn how to slow down and emotionally connect and engage with their child's constitutional developmental and sensory-affect-motor processing challenges that significantly enables the strengthening of  these underlying neuronal pathways that lead toward the formation of new synaptic connections and meaningful Developmental milestone advance.

The Autonomic Nervous System Regulation Foundations Underlying Psychosocial Development.

The justification for an evidenced based developmental biopsychosocial relationship based approach, such as DIR/Floortime, garnered new appreciation by the tremendous advances made in the fields of neurophysiology, neuroanatomy and neuroendocrinology during the mid 1990's.  At this point in time there was conceptualized a radically new understanding of the traditional bifurcated autonomic nervous system to one that is socially-emotionally phylogenetically and hierarchically structured through co-regulation with respect to maintaining healthy affective states of homeostasis or under conditions of perceived threat recruited to fight, flight, freeze or feint responses by three distinct nervous system circuits of the unmyelineated and myelineated vagus nerve (i.e., sub-diaphragmatic and diaphragmatic and supra-diaphragmatic).

Traditionally depicted was a single mammalian vagus nerve (the vagus nerve is the longest nerve in the body. It runs from the abdomen to the brain stem with efferent pathways to all major organs and direct connects to our central and autonomic nervous system). Our autonomic nervous system previously had been identified as a bifurcated peripheral system, sympathetic, when faced with danger, our fight or flight responses and parasympathetic, which functionally serves as the “brake” expressed in terms of growth, rest and restoration. However, what was now neuroanatomically re-conceptualized was an additional and much more primitive parasympathetic unmyeliniated dorsal vagus motor pathway, although dominant in reptiles, phylogenetically expressed feautures are connected to our own mammalian brain stem (i.e., functionally expressed with respect to a death-feigning or a freeze/immobilization response as we see, for example, when people at times with severe trauma experience states of extreme fright, anxiety or panic).

Overall, what was revealed was a much more complex, phylogenetically developed and heirarchically structured understanding of two parallel vagus nerve pathways in our own neuroanatomy and neurophysiology with respect to the evolution of our mammalian social-emotional engagtement system (a newer and myelineated vagus with connections to larynx, pharynx, middle ear, face and head) and its evolved adaptive functional role that inhibits earlier autonomic regulatory circuits, sympathetic fight/flight responses and parasympathetic rest and restoration responses (but when both higher and earlier mammalian social-emotional regulation circuits fail) a primitive unmyelinated vagus which is activated (i.e., a repitilian freeze or immobilization response).

The more advanced myelineated vagus nerve pathway beginning with mammals is directly connected in the brain stem (the nucleus ambiguus in the upper medulla oblongata) with efferent pathways to the striated facial muscles, ocular muscles, auditory system/middle ear muscles and the pharyngeal and laryngeal muscles required for speech and represents a new understanding of the biopsychosocial foundations that constitute early mammalian to human primate social-emotional engagement-and-autonomic regulation of our socially mediated nervous system with respect to inhibiting or down-regulating neuroceptive (i.e., bodily-emotionally sensed) perceived cues of safety or threat.

A new understanding of this phylogenetically distinct myelinated vagal pathway (ventral vagus) from an older unmyeleniated dorsal vagus in all mammals but most myelineated and evolved humans had provided for the first time an indepth biopsychosocial understanding of the pivotal role that social-emotional engagement directly has in hiearchically down-regulating sympathetic stress flight, fight, freeze or feint responses and the related or associated reduction of excessive stress hormones, such as testosterone, vasopressiin and cortisol or conversely a positive increase in hormones, such as dopamine, endorphins, serotonin and oxytocin,

In mammalian and human caregiver nurturance based practices, the myelinated ventral vagal pathway functioning in autonomic regulation entails an understanding of the critical role of emotional-bodily based, pleasurable back and forth co-regulated/regulated parent with child face to face engagement; auditory-prosodic, tactile-gestural in healthy secure based attachment and attunement. The latter results in critical homeostasis (e.g., the child’s auditory attunement, sympathetic mobilization for play/up-regulation of joy as well as parasympathetic calm and restoration) or conversely, fight/ flight responses in insecure avoidant and dismissive attachment a potential life threat, feinting or death feigning response. The latter, we sometimes see, for example, in instances of moderate to severe trauma (neglect and abuse) and a potential sudden activation of a more primitive unmyelineated reptilian vagal pathway, a parasympathetic freeze or feint response.

Now, quite separately, in non-typical development in utero, for example, due to immune or endocrine system compromises by the mother’s exposure during pregnancy to neurotoxins can result in an array of heterogeneous affect developmental disorders, such as Autism spectrum or related developmental challenges. Individuals with such psychobiological histories can similarly result in fight/flight or feint and freeze responses. Identical subcortical and autonoic nervous system regulation pathways have been found to be affected in the above (e.g., corpus callosum hippocampus and limbic hypothalamus pituitary adrenal axis).

Although, in neurodevelopmental challenges such as ASD we can clearly identify or indicate a separate set of biological-genetic etiological factors resulting in a diathesis of neurophysiological traumatic stress, what should be noted is that we see in both typical unhealthy child/parent dyads and non-typical development in utero we often see very similar downstream biopsychosocial etiologies with respect to vagus nerve auditory attunement or auditory shut down;  functional-emotional expressive use of facial, bodily gestural reciprocity and the ability to optimally regulate the  laryngeal  and pharyngeal muscles required for vocalization, that is, the emotional or prosodic elements of speech which comprise 93% of spoken language.

A new understanding of the evolutionary significance of this myelinated vagal branch (e.g., striated facial, middle ear, ocular, vocalization) represented a huge paradigm shift towards a much more expansive and nuanced understanding of how social-emotional engagement came to serve a new and hierarchical transformational role in regulating autonomic functioning, beginning with the evolution of the earliest parasympathetic shut down, feigned death or immobilzation response in the reptilian brain to the fight/flight and newer and more myelineated parasympathetic vagus response (rest and restoration) in the mammalian brain and how each of these features are hierarchically structured (primitive, limbic, neocortex) in our own phylogeny and either optimally regulated (e.g., calm, well-regulated deepening  back and-forth social-emotional engagement, including complex ideation and expressive language - that is core human executive functioning) or circumvented and recruited to primitive or regressive functioning (e.g., fight, flight or immobilization and reptilian death feigning response) by these two contiguous but evolutionary distinct parasympathetic vagal pathways (see, Porges, S. 1995. The Polyvagal Theory).*    Dr. Stephen Porges: 2014 Human Nature and Early Experience https://www.youtube.com/watch?v=SRTkkYjQ_HU Porges, S. 2009 The Polyvagal Theory: New Insights of Adaptive Actions of the Autonomic Nervous System https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108032/ S. Porges, S. Furman 2011 The Early Development of the Autonomic Nervous System Provides a Neural Platform for Social Behavior, A Polyvagal Perspecive. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079208/

Neurotypical Development, The Maturation Of The Brain:   Birth To Three

The neuroscientific evidence over the last several decades clearly demonstrates a direct correlation between forming healthy neuronal [brain] patterns of connectivity and child/primary caregiver nurturance based practices (and as noted brain stem and autonomic nervous ystem regulation):  The nature of child/caregiver deepening affect reciprocal attachment and complex two-way reciprocal emotional problem solving (e.g., back and forth co-referencing with visual-facial, auditory prosodic and tactile gestural exchanges) with respect to building the emotional foundations of the child's healthy core "sense of self" and correspondingly the child's intact, integrated and healthy emerging developmental milestones (i.e., social-emotional relating, thinking and nonverbal to verbal communicating) have been well established in the fields of infant mental health, epigenetic research on deepening reciprocal attachment and affect regulation on right to left brain development beginning in utero and early childhood, clinical and developmental, psychotherapy and psychoanalysis.

For example, since the 1990's this has been corroborated by extensive neuroscientific research that clearly demonstrates that the healthy integration of each infant's sensory and motor connections and how these inchoate connections, incipient neuronal pathways from birth, turn on genes, produce proteins and form into complex synaptic patterns (the maturation of the wiring of the neuronal pathways) including the maintenance of healthy cardiac vagal tone (i.e., heart rate variability) are directly dependent upon highly emotionally attuned and responsive primary caregiver interactions.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318551/ 

For the seminal ground breaking work that began to transform the former disparate fields of neuroanatomy, neurobiology, early infant child mental health, psychoanalysis, family law and Developmental psychology into a new understanding and synthesis, an over-arching theoretical framework and a new foundation for Affect Developmental evidenced based treatment practice see, Schore, Allan, 1994, Affect Regulation and the Origin of Self: The Neurobiology of Emotional Development.

Absolutely brilliant presentations by Allan Schore, 2017, The First 1000 Days of Life: A Critical Period For Shaping Our Emotional Selves and Brains: https://www.youtube.com/watch?v=lY7XOu0yi-E&t=6s

Allan Schore, 2017, The Development Of The Right Brain Across the Lifespan. What’s Love Got to do With It? https://www.youtube.com/watch?v=u_B6WekX75s&t=5030s

The understanding of this fundamental and highly nuanced child/primary caregiver dyadic, triadic and multi-social framework (indeed, if we look at the extended family system) can be correctly conceived of in terms of a significant paradigm shift or the bridging of the fields of Developmental psychology and neurobiology with respect to a new and comprehensive understanding of the formerly viewed disparate biological, psychological-and-social components. This critically encompasses the relational (epigenetic factors) of early infant/toddler/primary caregiver secure or insecure attachment practices that significantly determines the trajectory of what and how genes turn on and off, produce proteins and form and maintain healthy or unhealthy neuronal connectivity (what internationally renown attachment researcher and psychiatrist, Dr. Dan Siegal defined as,, “Interpersonal Neurobiology”).

Justifiably, this is now conceptualized as the underlying foundation of developmental social pragmatic evidenced based treatment practices, such as DIR/Floortime, with respect to understanding and guiding primary caregivers in facilitating and maintaining healthy dyadic affecr reciprocal emotional relationships in early infant and childhood mental health as well as treating children with autism spectrum challenges. The latter is a fundamental move away from the past traditional cognitive dissonance of brain treated apart from body (e.g., in traditional practice treating cognitive, language, arousal, autonomic and sensory motor functions as separate components) or as in applied behavioral analysis (ABA), a focus on targeting “selective behaviors”, toward a truly integrated biopsychosocial mind-brain-body approach in accordance to the last twenty-five years of research in Developmental Affect Neuroscience.

Due to the advances in technology over the last twenty-five years  we can now more accurately measure our data (i.e., adult-child inter-brain communications and how the subcortical and cortical areas of the brain in infant and toddler development epigenetically begin to form in real-time (i.e., PET, fMRI ). We can specifically show a direct correlation between neuronal growth (e.g., synaptic formation and interconnectivity across different parts of the brain-and-autonomic nervous system regulation and cardiac vagal tone) during healthy child/caregiver nurturance or conversely impaired neuronal activity due to unhealthy nurturance practices. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968319/  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181066

I have provided at the end of this section several additional links to some audio and video discussions for families and clinicians working in the field on what actually constitutes the healthy affective basis of childhood development (i,e., the roots of emotional intelligence). Now, given a child's  healthy underlying biological and immune system, the perennial question prior to 1990's was, "What is it that brings the early developing parts of the infant's brain (primitive reflexes, senses and emotions:  heart rate variability, breathing, blinking, sensations to sense of touch warmth; auditory, soothing or alarming voice, vision, etc.) into organized and meaningful affective patterns of simple reciprocal co-regulated engagement (optimal arousal for attending, relating and engaging)?" The answer given by Developmental affect neuroscience is the co-regulated partner(s) or "adult higher brain(s)" (the primary caregivers) with the prenatal and postnatal newly forming brain of the child. This is the foundational social-emotional symbiotic relationship absolutely critical for all infant/toddler social-emotional-cognitive development.

Again, what is required to bring the emerging "social brain" of the infant/toddler online with respect to basic executive functioning  from simple to increasingly complex engagement with others (e.g., regulated/co-regulated sensory-affect-motor ideation, sequencing and engagement) is the more experienced or  higher brain of the primary caregiver or more specifically the child/primary caregiver dyad,  Every human infant is born with approx. 84 billion neurons. The human infant is born biologically equipped with a set of basic reflexes. senses and primitive emotional responses. However, the vast majority of neurons that will form into synapses hooking up these complex neuronal pathways (sensory-affect-motor) are highly malleable and thus only loosely connected at birth and only begin to increasingly coalesce into complex neural networks beginning in the last trimester through the first few years of life.  

The brain is experience-user/interdependent. The strength of the connectivity and resiliency of the brain's foundations (primitive, limbic and neocortex) are directly co-determined or co-regulated by the "higher brain" of the parent or the child/primary caregiver dyad.  This necessitates for optimal integration and resiliency secure based attachment, attunement and reciprocal back and forth emotional social engagement (e.g., beginning from birth with the simplest wooing/pleasurable back and forth emotional signaling between parent and child, connecting, breaking and re-connecting child/parent affect facial expressions, games as simple as "peek-a-boo", etc), all of which help co-structure for the child internally well-regulated biopsychosocial patterns with respect to his/her sympathetic-and-parasympathetic and primitive parasympathetic regulation and increased executive functioning. Again, this must begin with healthy child/parent dyad of secure based attachment and deepening expanded attunement by up-regulating joyful states through play and down-regulating stressful states through soothing. The latter creates the interpersonal neurobiological foundations for increased optimally regulated and not just malleable (which all brain pathways are) but resilient complex emotional signaling (e.g., co-emotional gestures, primitive co-prosodic vocalizations, sensory integration, simple to expanded ideation and social-pragmatic expressive language)..

The following absolutely brilliant presentation addresses the emotional basis of attachment, affect regulation and cognition, which biopsychosocially exponentially forms during the last trimester into the end of the second to third year of life and which constitutes the unfolding nature and degree of empathy and resiliency of the primary Functional-Emotional Developmental milestones beginning in infancy throughout the lifespan.

Dr. Allan Schore, Modern Attachment Theory: The Enduring Impact of Early Right Brain Development on Affect Regulation, 2012 . https://www.youtube.com/watch?v=c0sKY86Qmzo

Dr. Allan Schore, The Neurobiology And Neuroendorcinology Of Boys At Risk, 2017. https://www.youtube.com/watch?v=P451kiWSBic&t=12s

2018, Dr. David Willis, Reflections on Dr. Allan Schore’s presentation above: https://www.youtube.com/watch?v=qkJe1dwmbM4

Dr. Allan Schore: The Neurobiology of Attachment , 2013 (brief clip on explanation of Nurture and Nature; Parent/Child interactive regulation which is crucial in turning on genes to produce proteins which help construct and maintain healthy synaptic growth and development.)

https://www.youtube.com/watch?v=0RGWjs7SIfw

Autism Spectrum And Related Biological-Psychological-Social Developmental Challenges.

What has been far too long ignored in practice by special educators and other clinicians working with children with autism spectrum and other related challenges and too often if at all conveyed to parents (e.g., at the start of early intervention) is the neuroscientific evidence that it is precisely these same principles of healthy nurturance based practices - necessary and indeed critical for each child's core functional emotional developmental milestones (i.e., calm, attentiveness, co-regulated patterns of back and forth emotional regulation, playfulness, ideation) when applied in a therapeutic context (i.e., adjusted or tailored to each child's functional emotional developmental and processing biological based constitutional challenges) that does in fact significantly help re-construct new healthy integrated neuronal pathways in the brain.

Because of the paradignatic shift in our understanding the immense and critical role of epigenetics (synapatic growth and structuring of the autonomic nervous ystem as experience dependent), the field of psychology and treatment both in autism spectrum and other related typical and non-neurotypical challenges has now shifted from behavioral to cognitive theory to affect based regulation theory or an understanding of the critical role of the emotions, particularly in infant/mother dyads but throughout the lifespan.

Guided pleasurable and affectively engaging relationships not just with infants and toddlers but with older children with mild to more involved autism spectrum challenges (due to the brain's enormous neuroplasticity) can not only help facilitate but again as the neuroscientific evidence clearly demonstrates actually re-wire the brain, that is build, strengthen and expand those healthy neural pathways (e.g., improved connectivity between the prefrontal cortex and subcortical functioning and overall integrated sensory-affect-motor functioning - where simple to complex social-emotional affective engagement and pragmatic language development, beginning from the emotional right subcortical to linguistic left prefrontal cortex can begin to re-build and strengthen synaptic connections).  An expanding database of evidence over the last decade on neuroplasticity is increasingly demonstrating the ability for individuals to re-construct new neuronal connections throughout the lifespan.  

The following is an  extremely enlightening discussion with regards to much of what I have discussed above with Dr. Stuart Shanker, Distinguished Research Professor of Philosophy and Psychology at York University, entitled Babies,  Brain, Nature and  Nurture.

https://www.youtube.com/watch?v=5bi6x-4aNmM

Stuart Shanker 2016, Todd Ouida Children Foundation Conference, Attuning The Mind Body Spirit, Recognizing Stress and Protecting the Spirit in Infants, Toddlers and Children.

https://www.youtube.com/watch?v=vXNWYoKuVS8

Susan Hopkins EdD and Elizabeth Shepherd MSc, "Masking Stress with Misbehavior."  This contains important definitions and research underpinning the neurophysiological and developmental understanding  of Self-Regulation, where challenges with a child's  ability to regulate bio-psycho-social interactions are commonly mistakenly defined as, "Misbehavior."   https://selfregulationinstitute.org/reframed-volume-1-issue-1-july-2017-masking-stress-misbehaviour/

American Academy of  Pediatrics, August 2018  Clinical Report on Play  http://pediatrics.aappublications.org/content/early/2018/08/16/peds.2018-2058

The following is a brief but essential overview of the six  core strengths necessary for healthy child development by Dr. Bruce Perry,  American psychiatrist, currently the Senior Fellow of the Child Trauma Academy in Houston, Texas and an Adjunct Professor of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine in Chicago, Illinois,

https://www.youtube.com/watch?v=skaYWKC6iD4

The Root of Empathy Symposium: 2017 . Dr. Bruce Perry, Born For Love:: Why Empathy Is Essential And Endangered

https://www.youtube.com/watch?v=5gU1wXbs5mc&t=9s

The following is an  extraordinarily important video clip with regards to a well-known experiment by internationally acclaimed, Developmental psychologist, Edward Tronick, Director of Child Development Unity and Distinguished Professor at University Massachusetts,, Boston.  He is a research associate in Newborn Medicine, a lecturer at Harvard Medical School.  He is well known for his research on infant/child caregiver dyadic attachment and what transpires when that emotional connection is disrupted or withdrawn:  The Still Face Paradigm:

 https://www.youtube.com/watch?v=bG89Qxw30BM

https://www.youtube.com/watch?v=apzXGEbZht0

The following  video clip, "Attunement and Why It Matters", by  David E. Arrendondo, M.D.,  briefly illustrates what happens between infant/primary caregiver with respect to neuronal connectivity and attunement during deepening reciprocal attachment and emerging co-emotional signaling.

https://www.youtube.com/watch?v=UHYaF8EHzVw

Below is one of the most important seminal papers written in 2004  by the late Stanley Greenspan, M.D. with respect to the role of affect (or the emotions) constituting typical and non-typical developmental pathways. It is absolutely critical reading:

"Developmental Pathways To and From Autism: The Role of Emotions in the Core Deficit in Autistic Spectrum Disorders-- The Affect Diathesis Hypothesis."

https://drive.google.com/file/d/0B4eYdf4hpBzyRi12eWp5OWx5NE0/view

Below are two very brief video clip introductions on the "Mirror Neuron System", by Dr. Dan Siegal, Distinguished Fellow of the American Psychiatric Association and is the Executive Director of the Mindsight Institute. Founding Co-Director of the UCLA Mindful Awareness Research Center. He serves as the Medical Director of the Lifespan Learning Institute.  The mirror neuron system is largely regarded as challenged with many individuals diagnosed with ASD. It is part of the brain directly responsible for the ability of individuals to empathically identify, register, interpret, understand and predict the  "intentionality" of another's action or what has been traditionally referred to as "Theory of Mind." 

https://www.youtube.com/watch?v=24fITRNWh1k&list=PLDCtwyPSjhlNEz4xuzxt6Tdsnyt2vChiB&index=8

https://www.youtube.com/watch?v=Tq1-ZxV9Dc4&list=PLDCtwyPSjhlNEz4xuzxt6Tdsnyt2vChiB&index=7

Dr. Dan Siegal presents below an in-depth discussion on interpersonal neurobiology, "The Neurological Basis of Behavior, the Mind, the Brain and Human Relationships." 

https://www.youtube.com/watch?v=B7kBgaZLHaA

***Dr. Dan Siegal, Roots of Empathy: Research Symposium, 2016. An Interpersonal Neurobiology Approach to Resilience and the Development of Empathy.

https://www.youtube.com/watch?v=2dmX6XBZ1GY

Dr. Allan Schore: 2014 The Most Important Years of Our Life: Our Beginnings https://www.youtube.com/watch?v=KW-S4cyEFCc&t=752s

Dr. Allan Schore. Roors of Empathy: Research Symposium, 2016.: Modern Attachment: The impact of Right Brain Development on Affect Regulation

https://www.youtube.com/watch?v=c0sKY86Qmzo

*The Polyvagal theory first introduced by Stephen Porges, M.D., in 1995  provided a new and transformative neurophsyiological understanding of  the necessary and indeed critical mammalian/human evolutionary factors of social-emotional engagement (executive functioning) that regulates autonomic functions that are a functional part of the myelinated pathway of the vagus system connected from the heart to the basal ganglia, striated facial muscles, auditory system and vocal system.

The Polyvagal Theory,  2009:  New insights into the adaptive reactions of the autonomic nervous system, Stephen W, Porges, M.D.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108032/

The Polvagal Perspective, 2007, Stephen Porges, M.D.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868418/

Steven Porges,  M.D., Human Nature and Early Experience (an in-depth discussion on the  neurophysiological correlates that constitute the foundation for a biopsychosocial understanding on how typical and non-typical infants begin to learn, grow and thrive.)

 https://www.youtube.com/watch?v=SRTkkYjQ_HU

Stephen Porges, MD.,, The Neuroscience and the Power of Safe Relationships                                 (self regulation/co-regulation)

https://www.youtube.com/watch?v=3pbVTla932Y

Stephen Porges, M.D., Polyvagal Theory: Co-Regulation in Therapy

https://www.youtube.com/watch?v=ivLEAlhBHPM

Stephen Porges, M.D.,,  "The Polyvagal Theory."

https://www.youtube.com/watch?v=8tz146HQotY     

Stephen Porges,  M.D.,, 2011, Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation.

https://books.google.com/books?hl=en&lr=&id=0-nxBGHj36oC&oi=fnd&pg=PR9&dq=definition+neurobiology+and+neurophysiology&ots=tfqEfhr6hn&sig=dzaQxjEPy9u4bY_wDZ2PCB_HyYg#v=onepage&q=definition%20neurobiology%20and%20neurophysiology&f=false

Dr. Stephen Porges: Discussion on "Misophonia."

https://www.youtube.com/watch?v=nB3nS4Gh_9k&t=7s

Colwyn Trevarthen, 2014 Pathways to Child Flourishing: The Love of Special Companions and the Importance Of Play. What is it Being Human and How Can It Survive.

https://www.youtube.com/watch?v=IYXAU2Bvfbw

Daniel Stern, 2010, A Developmental Perspective From Birth On. (a discussion on the synthesis of psychoanalysis and the developmental model)

https://www.youtube.com/watch?v=N_j4q45GHDY

Dr. Stuart Shanker: Self-Regulation: Roots of Empathy Symposium 2014

https://www.youtube.com/watch?v=84GHcfzXsmw

*General Psychiatry: published. online 2018, Oct. 31: Factors Associated with Parent Engagement in DIR/Floortime Treatment of Children with Autism Spectrum Disorder:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234967/

**The following  is an extremely important link for all primary caregivers and clinicians with respect to advocacy for their children, intervention guidance, ,public  policy, insurance coverage and  the adjoining supportive research evidence for  a comprehensive Developmental Relationship based approach such as DIR/Floortime, as well as included are answers  to common questions from families on ABA which is distortedly presented as the only evidenced-based treatment approach for children with ASD and related challenges.

http://www.icdl.com/advocacy