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Start screen recorder before playing this video 5th Annual New York Conference Capturing the Power and Potential of Play, Movement and Creativity The DIR Model Sets the Stage

Serena Wieder, PhD Alisa Vig, PhD Sunday, October 18, 2015

Moving from the Visual Space of the Outer World to the Inner Space of Symbols Through Play

© Serena Wieder, PhD & Alisa Vig, PhD

Let’s dance and play to celebrate symbols and creativity!

Today we will climb the symbolic ladder together!

It is a journey from outside-in as we separate our perceptions of people and objects in the environment as they become the images we see in our mind’s eye and turn into symbols. Inside we can create our own ideas, visualize what we hear and feel, imagine and dream, understand our feelings, overcome our fears, experiment with emotions and plan ahead.

Inside, Outside and the Space In-Between

Through PLAY we also move inside-out as we use the symbols we invested with meaning to communicate in the real world to others. And in-between inside and outside, there is the space-in-between, also known as “transitional or potential space”*, where we PLAY and Practice what we experience both outside and inside to develop emotionally and cognitively using symbols throughout development. *Winnicott, Playing & Reality 1971 t

Play

Einstein Piaget

Vygotsky

Montessori Mr. Rogers A.

Freud Erikson

Winnicott Melanie

Klein

“Imagination is more important than knowledge….” Einstein

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n Most everyone enjoys sensory-motor playfulness –tickles, bubbles, chase and hide and seek, etc. n Some believed that in autism- children lack affect – lack fun and enjoyment n Some believe you can teach children to perform the mechanisms of play • But can it be taught ?

– Teaching a child to pretend is not the same as pretending in play

Do children with autism PLAY? Or, perhaps do they play differently?

We put symbolic play at the heart of DIR intervention for special needs and ASD

Today we will discuss: n What does a symbol represent n How does it become meaningful in a child’s mind n What is the role of visual-spatial processes in symbolic development n What is the process of outside in, inside out and the space in between through watching a dyad at play n Is it real, not real, episodic? n  And do all children play symbolically? n Why is it so important?

Just what is a symbol? n A symbol represents “the real thing” but is not the real thing!

n Symbols have many forms and go back many years

n There are so many ways to tell your story Why build a symbolic world? Goal is to learn we have to substitute reality through symbols or images

n If you can imagine – you can be anyone, you can vanquish your enemies or discover a new world

Functional Emotional

Developmental Structure •  Regulation and shared

attention •  Engaging and relating •  Simple two-way

gesturing •  Complex problem-

solving •  Creative use of ideas -

symbols •  Analytic/logical thinking

Biological Individual

Differences

•  Sensory Modulation

•  Auditory processing & Language

•  Visual Spatial movement & thinking

•  Praxis-Motor planning & Sequencing

Relationship based Child –

Caregiver Interactions

•  Affect based interactions

•  Activate development - initiation, intention

To understand symbolic development, we need to examine what development means in The DIR Model

Let’s look at Development of Symbolism in the DIR Model

I Visual Spatial

Capacities

R Internal world

Affect / emoions Relationship

D

FLOORTIME

• Mental images / basic

symbols

• Episodic Symbols

• Elaborated Symbols and

abstract thinking

Visual Spatial Capacities

n Body awareness and senses n Location of body in space n Relation of objects to self, other objects, and people n Conservation of space n Visual logical reasoning n Representational thought

Wieder. S. and Wachs, H. (2012). Visual/Spatial Portals to Thinking, Feelings and Movement: Advancing Competencies

and Emotional Development in Children with Learning and Autism Spectrum Disorders. Profectum Foundation, New

Jersey.  

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Visual Spatial Challenges § “Lost in space” § Unable to direct vision in purposeful way

(wander, repetitive, line up items) § Bound by what they can predict and rely on this memory § Every bus stop, metro station, highway…. § World becomes rigid § Especially difficult when things are moving in the environment § May tantrum, become aggressive, become repetitive or shut down

§ May be locked in developmentally delayed visual patterns § Poor eye contact § Use of peripheral or central vision § Cannot point or follow gaze § Visually sweeping the room rather

than looking at or finding specific items § Looking past rather than at people

and objects § Have difficulty with same and not

same, etc y.  

Functioning in the real world

•  Construction of internal

representation

•  Fantasies

•  Symbols & abstract thinking

Potential space

Development of Potential Space Conceptualization

Sensory functioning (output) B

ody functioning

When it Doesn't Work When it Does Work Synchronization: Emotions, Body, Space

?

Comprehensive Treatment Plan Case Study

Occupational Therapy n "Hey, I saw something"

Parents  consulta-on  

Speech  and  Language  Therapy  

Mental  Health    

Home  program  and  Inclusion  

Social  group    

Addiional  Therapies  

(Hidrotherapy)    

Mental Health Therapy q  "A funny/ scary alligator? "

Social Group q  "Yes, I’m listening, Yes, I can

see" q  "We are lion’s cubs" q  "It’s our Castle" q  "The witch from the destroyed

world"

Intervention OT  

Part I: The Development of Mental Images

n Coregulation – In the dynamic movement between chaos and crying, tenderness and peaceful, the parent "opens the door" to bring a child into the symbolic world by bringing him beloved object (teddy bear or "binky"). n Gradually the object represents the “good parent". n Later the child becomes “a good parent” and consoles the bear or “the crying doll”.

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Sensory-Motor functioning Affect

Part I: The development of Mental Images Anticipatory mechanisms

Coregulation & Synchronization

Part I: The development of Mental Images Anticipatory mechanisms

FELDMAN, R. & GREENBAUM, W.C. (2000). AFFECT REGULATION AND SYNCHRONY IN MOTHER-INFANT PLAY AS PRECURSORS TO THE DEVELOPMENT OF SYMBOLIC COMPETENCE. INFANT MENTAL HEALTH JOURNAL, VOL. 21, PP. 4-23

Symbol Sign

"“Hey, I saw Something • Background:

– Age: 2 – Dx: hypotonic (8 months) and language difficulties (between 12-18 months)

• Family composition: – The first child – Expecting another child

• Difficulties: – Daily routines: transitions, food - very selective and difficulties in transition to solids – Communication: Difficulty with initiating and pointing – Play: limited. Narrow emotional and affective range – Sensory Motor Profile: visual distractions, movement, hypotonia, auditory sensitivity

• Treatment plan: OT and later SLP

Interactive and emotional components

n Tracking a child's interest (hoop)

n Tracking the initiation of voice (rocker) and movement (throwing / taking the hoop)

n Following affective cueing (Search, interest, curiosity, enthusiasm)

n Vivid and welcoming company (smiling, joyful, playful)

Sensory Motor Components

n Slow pace

n Waiting for him (circuits, sedatives)

n Gives clues / clear visual frame

n Visual anchor

n Simple auditory stimulus

n Creation of patterns (e.g. auditory)

Floor Time Strategies

Perceptual World (points)

n Movment with no purpose n No focus n No significant communication

The emergence of the meaning and the potential space (lines)

n Static postures n Moments of synchronization and organization n The creation of the internal representation n Moments of shared attention

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Background

n Background: •  Age 2-5 : special-ed program specializing in language issues. •  Age 3: Treatment intermission •  Age 4.5:

– ASD and return to Treatment – Preschool program reported emotional and social difficulties – parents request for an intensive program – OT and social group (MH) – going from group of 2 to 4

A Funny/Scary Alligator

n Over focus on the alligator (perception) - points

n Difficulty changing the visual focus of attention to the “hidden scared mother " - Triangle

n Global and less distinct movements (Voting and, bending).

n excitement affects the tone of the body (hand, etc.) and the vocal cords. difficulty to separate the perception from the ideas.

n Visual distractions.

n Over focus and a limited range of vision (bus, airplane) - point

n The girl's affect and her entry into the

boy’s visual field - line

n Expanding the visual field - Triangle

n Emergence of connection between body

and space ("Head Down")

n Internal representation of the girl

Yes, I’m listening; Yes, I can see

Part II: Episodic Play and Basic Symbols Moving from the experience to it’s symbol

The development of episodic and basic symbols

n The children’s experience in the sensory and emotional world (see, feel, hear, smell

in emotional context) turns to an internal representation.

n The child expresses things that are interesting, impressive, frightening, or intriguing

to him.

n The symbols reflect the inner world and emotional state of the child at that time.

n Everyday experiences such as phone conversations , cooking, doctor, sibling “fights”

begin to be represented in the child’s play

Difficulty in visual, auditory, or motor processing and emotional patterns create difficulty in formation of a episodic and basic symbols

We Are Lion’s Cubs

n Two-dimensional reference - (therapist, child)

n Maintaining the Space- reference to the unseen space - the ability to

preserve the space and imagine what's going on behind the door.

n Imagine what the girl/ he will “do later” (knock, knock, knock)

n Reference to three-dimensional space and it’s emotional meaning, "If we

Cubs, We are low and unthreatening"

n Integrating the dimension of time and space ("go behind the door and come

back)

The Space and the Potential Space expand

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Visual Spatial Capacities Required It’s our Castle

n Improved ability to distinguish and perceive visual and auditory stimulus (expressions and intonations of the girl and the therapist)

n Stay focused on one idea while looking around the room

n Reference to the bi-dimensional space (child and therapist)

n The ability to explore, notice and discern the girl’s affective cueing and relate to them.

n Body posture gradually more differentiated (upright)

n Connection between body’s postures and emotional components (assertive)

n Construction of three-dimensional realm (Palace high, closer, further away)

n Moving between fantasy and reality (barrier, scotch tape)

The ideas expressed in the space and the potential space expand

Between reality and imagination

The Witch from the Destroyed World

n Elaborated inner world - evil, aggression, destruction .... that can be resolved using new tools

like imagination and magical thinking ("Eat the dinosaur")

n The ability to distinguish between perception and imagination enable to build a new emotional

symbol (sharp fingers + "evil voice" + playfulness= witch)

n Using the real space and objects (Lava)

n Sometimes difficult distinction between reality and imagination, and hence challenges in

playing with symbolic solutions (girl).

n Differences in the emotional profile affect the symbolic capacities (fear and control).

n Slow pace and co-regulation affect the child's ability to enter the symbolic world.

You can not talk about the potential space or symbolism without talking about the real space and the child's ability to function in this space !!!

So, think about space when you play!

n Always help the child look and move up ... but also down

n Look in front of and sideways ....but also behind and under

n Go and look inside things but also outside them

n Play, play and play ...... This enables connectivity!

n Do not forget intensity ..... !!!

n Can we agree there is no such thing?

n Did the chidren believe they were real? Will they always?? n  What will develop to change the real witch to the symbolic witch? Or Frankenstien to a story?

n The development of symbolic function and reality testing

n How symbols reflect emotional development n It doesn’t begin with witches and monsters!

Where do witches come from?

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Earliest Symbols

•  “Blankie” to Teddy Bears

•  Barney, Sesame Street, Pooh….

•  Dora and Steve •  Farms, zoos and

jungles •  Dinosaurs and

Dragons

Earliest Emotional Themes

•  Comfort and reassurance

•  Real life learning and feelings

•  Explore and think •  Safety and danger –

a tiger is not a kitty cat!

•  Entry to “good and bad guys

“Good” Guys

•  Kings and Knights •  Princesses •  Fairy Godmother •  Wizards •  Batman •  Superman •  Star Wars •  Harry Potter… •  Power gets embodied

“Bad” Guys

•  Scar – the evil lion •  Pirates •  Giants •  Stepmothers •  Witches •  Joker •  Dracula •  Frankenstein… •  Nature captures the

unpredictable

Earliest Symbols

•  Goodnight Moon •  Goldilocks and the

Three Little Bears •  Three Little Pigs •  Billy Goats Gruff •  Jack & Beanstalk •  Cinderella •  Bambi

Emerging Emotions

•  Separation •  Getting lost •  Fear and Danger •  Rescue and safety •  Joy •  Anger •  Disappointment •  Sadness •  Danger and loss

n It is the safe n It is a way to create ideas, signal intentions and feelings n It is a way to practice, re-enact, understand, and master the full range of emotional ideas and experiences n And it has a hierarchy! n It is a path to reality testing? n But do all children play symbolically?? n Why not?

What does symbolic play do for you?

Discovering the “King”

Ned Manny n Perhaps you will borrow stories and scripts, even repeating whole books n Or, wander aimlessly not able to organize your intent n Or, flit around from thing to thing n When you can create an idea, you might use a costume and just move yourself, or draw a picture, or play the drums and dance, or drape your body upside down n Language, comprehension, space, movement….can impede play n But also look for the choice of symbols and what they are enacting as they practice in potential space

Everyone can be symbolic!

When development is uneven….with visual spatial and auditory-language or gestural and movement difficulties…what can you do?