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 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 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 meaningful structural changes in formerly underactive and overactive areas of brain functioning among  participants in the targeted treatment 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 activity in subcortical area (e.g., reduced size and activity of the amygdala responsible for All or Nothing responses); increased activity and functioning in FFA (fusiform face area of the fusiform gyrus responsible for reading and interpreting the emotions/faces of others). New areas of activity in brain functioning were consistent with what we see with typical healthy developing children. These change directly correlated with social-communication gains which were demonstrated in the targeted treatment group vs. the community group where little if any neuronal changes were observed.  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

Published preliminary and follow up data on the 2011 MEHRI Foundation study (cited above) and other previous and/or ongoing 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 international renown Occupational therapist and the DIR/Floortime approach, Rosemary White., OTR/L. This talk and video presentation is extraordinary useful for both families and clinicians as Rosemary explains in a remarkably concise and detailed perspective the theory of DIR/Floortime methodology in everyday practice.

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

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 which 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 DIR/Floortime).  It is co-authored by many of the foremost professionals within the biopsychosocial sciences. 

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

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

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 behavioral based models (ABA) but rather comprehensive evidenced-based Developmental approaches, such as DIR/ Floortime, which address not circumscribed behaviors but the primary core Developmental challenges associated with ASD.  The latter unlike traditional behavioral based models do not render or conflate a false evidentiary equivalence between the biopsychosocial complexity of each child's core Developmental milestones and individual sensory-affect-motor processing differences with the acquisition of the child's conditioned responses or what colleagues and I refer to as "surface trained behaviors. "

Instead, developmental approaches such as DIR/Floortime focus on the core Developmental foundations of social-emotional relating, thinking and communicating . Thus, they are entirely centered around the child's executive functioning (child's emerging "sense of self") guided by the child's individual processing differences and addressed in the context of child/primary caregiver relationships.  It is not the isolation or generalization of trained or memorized "targeted behaviors"  but the synchronization of  primary caregivers' guided to learn how to connect and engage with their child's developmental and sensory-affect-motor processing challenges that significantly enables the strengthening of underlying neuronal pathways that lead toward the formation of new synaptic connections and meaningful Developmental milestone advance.

Neurotypical Development:  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:  The nature of child/caregiver deepening affect reciprocal attachment and complex two-way reciprocal emotional problem solving (i.e., motor planning and sequencing; co-referencing with affective gestures) with respect to building the 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 communicating) have been well established in the fields of infant mental health, clinical and developmental psychology.  Since the 1990's this has been corroborated by the evidenced based research in the neurosciences which clearly demonstrates that the healthy integration of each infant's sensory and motor connections and how these inchoate connections (loosely formed neural pathways) from birth form into complex synaptic patterns (the wiring of the neural pathways) are directly dependent upon highly emotionally attuned and responsive primary caregiver interactions.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318551/

This overarching  epigenetic framework can be conceived of in terms of a bridging of developmental psychology and interpersonal neurobiology. In other words, an integration or triune confluence of biological-psychological-social relationships.  Due to the advances in technology over the last twenty-five years  we can now consistently measure in real-time (i.e., fMRI )the impact between actual neuronal activity (i.e., synaptic formation and interconnectivity across different part of the brain) and healthy child/caregiver nurturance based practices 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

Provided below are several 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:  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 neuroscience is the co-regulated partner or "adult higher brain" (the primary caregiver) with the post utero or newly forming brain of the child. This is the foundational social-emotional symbiotic relationship critical for all infant/toddler development otherwise known as the infant/parent dyad.  

Again, what is required to bring the emerging "social brain" of the infant online with respect to basic executive functioning (social-sensory-affect-motor planning and sequencing) into simple to increasingly complex back and forth patterns of co-engaging/co-communicating with others is the more experienced or  higher brain of the primary caregiver,  Every human infant is born with 100 billion neurons. The human infant is born equipped with basic primitive reflexes. senses and emotional responses.  However, the vast majority of those neuronal pathways are not substantively wired together at birth and only begin to form into synaptic connections/patterns post utero. The brain is experience-user/interdependent, that is, the strength of the connectivity and resiliency of 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 dyadic interaction of deepening attachment, attunement and reciprocal emotional social engagement (i.e., beginning from birth with wooing/pleasurable co-affective back and forth emotional signaling between parent and infants such as "peek-a-boo", etc).

However,  it is notable that 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 (i.e., at the start of early intervention) is the neuroscientific fact 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 biological based functional emotional developmental and processing challenges) that does in fact significantly help re-construct new healthy neuronal pathways in the brain.

Guided pleasurable and affectively emotionally-engaging relationships not just with infants 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). 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

Dr. Stuart Shanker discussing from a biopsychosocial perspective the true definition, meaning and nature of what Self-Regulation is:   https://www.youtube.com/watch?v=84GHcfzXsmw

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 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,"The Neurological Basis of Behavior, the Mind, the Brain and Human Relationships." 

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

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

https://www.youtube.com/watch?v=LK-Y2_eMfgw

Dr. Steven Porges,  Human Nature and Early Experience (an in-depth discussion on the  neurophysiological correlates that comprise the foundation of a biopsychosocial understanding on how typical and non-typical babies begin to learn, grow and thrive.)

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

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

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

Dr. Stephen Porges Website: Infant Developmental Update Study

http://stephenporges.com/index.php/infant-development-study-updates

Dr. Stephen Porges:  "The Polyvagal Theory."

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

Dr. Stephen Porges, 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