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The Science Behind the Growth through Play System
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Transcript of The Science Behind the Growth through Play System
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SCIENCEBEHINDGROWTHTHROUGHPLAYSYSTEMEmpoweringParentsandProfessionals
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CONTENT
Overview...........................................................................................................................................................3CurrentNeuroscienceandAutism ................................................................................................. 3ApproachestoAutismTreatment.................................................................................................. 3TheRoleofParents ....................................................................................................................... 3
Autism:TheViewfromCurrentNeuroscience ...................................................................................................4BrainsDevelopThroughDynamicInteractionwiththeEnvironment ............................................. 5TheBrainisMalleable ................................................................................................................... 5
AutismTreatment:WhatWorks ........................................................................................................................6NaturalisticBehavioralApproaches ................................................................................................. 6DevelopmentalApproaches ............................................................................................................. 6Convergence..................................................................................................................................... 7
ComparingApproaches ................................................................................................................. 7InteractiveStyle................................................................................................................................ 7Curriculum ........................................................................................................................................ 8
AutismTreatmentSummary ......................................................................................................... 8
Parents:TheMissingLink ..................................................................................................................................9ParentsareEssential ..................................................................................................................... 9ParentalWell‐BeingisCritical........................................................................................................ 9
TheGrowththroughPlaySystem ....................................................................................................................10
References ......................................................................................................................................................11
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OVERVIEW
Current Neuroscience and Autism Neurosciencehasshownusthatautismisnotcausedbyafundamentaldifferenceordeficitinbrainstructureas
previouslyassumed.Instead,currentresearchtellsusthatautismisthebehaviorallevelmanifestationofa“miss‐
wired”brain,abrainwithinsufficientinterconnectivityandsynchronizationamongmultiple,disparateregions.
Asaresultofthis,childrenwithautismtendtofocusonactivitiesthatrequireminimalcoordinationamongbrain
regions(e.g.,recitingisolatedwordsanddetails,orfocusingonstaticstimuliandrepetitivetasks)andavoid
activitiesthatrequiredcoordinationofmultiplebrainregions(e.g.,comprehendingstories,seeingthe‘bigpicture’,
orlearningnewtaskswherepreviouslylearnedrulesdon’tapply.)
Thisfocusinturnreinforcesthepartsofthebrainthatfacilitatelocalinterconnectivityattheexpenseoftheparts
ofthebrainthatfacilitateglobalinterconnectivity;anacceleratingfeedbackloop.
Thegoodnewsisthatresearchhasshownthatthefeedbackloopcanbereversed;throughvariousformsof
interaction,childrencanrewiretheirbrainstoimproveglobalinterconnectivityandtheircommensurateabilityto
performtasksthatinvolvemultipleregionsofthebrain.Aconvergingbodyofevidencefrompsychologyis
showinguswhattypesofinteractions(withpeopleandobjects)helpreducethecoresymptomsofAutismand
facilitateincreasedsocialinteraction,communicationandrangeofinterests.
Approaches to Autism Treatment Whileresearchersworkonidentifyingwhysomanychildrenhavemiss‐wiredbrains,thoseofusworkingdirectly
withfamiliesaffectedbyautismcanapplythisunderstandingtohelpingchildrennow.Basedontheneuroscience
ofautism,theeffectivenessofatreatmentapproachcanbegaugedbyitsabilitytocausethedesiredchangeinthe
interconnectivityandsynchronizationofdisparateregionsofthebrain.
Therearefundamentallytwoschoolsofthoughtregardingautismtreatment,BehavioralistApproachesand
DevelopmentalApproaches.Themostsignificantdifferencesamongtheseapproachescanbecalibratedinterms
ofprescribedinteractivestyleandthecriteriabywhichcurriculaareselected.Interactivestylesvaryfromhighly
directivetohighlyresponsive.Curriculaselectionvariesfromage‐appropriatecriteriatodevelopmentally
appropriatecriteria.
The Role of Parents Therapidlyescalatingnumberofcasesofautismhasmadethepreviouspractitioner‐centeredmodelofautism
treatmentimpracticalinmostregions.Tobeeffective,childrenrequireintensive,dailyinputfromemotionally
attunedanddevelopmentallyinformedadults.
Withprofessionalguidance,parentscanbecomethebesttherapistsandprogramcoordinatorsfortheirchildren
withautism.
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AUTISM: THE VIEW FROM CURRENT NEUROSCIENCE Autismresultsfromapoorlyconnectedandpoorlysynchronizedbrain.
Themostrobustfindingintheneuro‐anatomyregardingautismisthatpeoplewithautismhaveincreasedbrain
volume.Thisincreasedbrainvolumeiscomposedprimarilyofcerebralwhitematter,thematerialthat
interconnectsdifferentregionsofthebrain.Cerebralwhitemattercanbedividedintoanouterzonecontaining
theradiatecompartment(thematerialthatinterconnectslocalbrainregions)andaninnerzonecontainingsagittal
andbridgingsystemcompartments(thatinterconnectdistantregionsofthebrain).Inautism,enlargementis
localizedtotheradiatewhitematter,whereasinnerzone
whitemattercompartmentsshowednovolume
differencesfromcontrols.Inotherwords,peoplewith
autismhavebrainswiredinawaythatfavorslocal
communicationoverglobalcommunication.
Inpeoplewithautism,thispatternofincreasedlocal
interconnectivityanddecreasedglobalinterconnectivityis
evenmorepronouncedinpre‐frontalareas,theareasof
thebrainthataretypicallymostgloballyinterconnectedas
theyareresponsibleforintegratinginformationfrom
multiplebrainregionsforhigher‐orderorabstractprocessing(seeHerbert,2005).
Brainareasthatareunder‐connecteddonotprocessinformationinamannerthatissynchronizedwithotherbrain
areas,aprocessthatisnecessaryforprocessingmulti‐sensoryinformation.Mostrecentreviewssuggestthatthe
symptomsofautismmaythereforebetheresultofbrainsthatareunder‐connectedandpoorlysynchronized(see
Gepner&Féron,2009).
Intheabsenceofstrongglobalinterconnectivityandsynchronization,tasksthatrequireintegrationofdynamic
informationfrommultiplechannels(suchassocialinteraction,communicationandabstractreasoning)arevery
challengingforpeoplewithautism.Whereastasksthatinvolveprocessingofmorestaticinformationfrom
minimalchannelscomesmoreeasilyduetotherelativelystrongerlocalizedinterconnectivity.
ChallengesforPeoplewithAutism
Activitiesthatrequiresignificantcoordinationamong
regionsofthebrain
• Higher‐orderprocessingchallenges,suchasstory
comprehension
• Noveltaskswhichrequirenewprocesses
becausepreviouslylearnedrulesdon’tapply
• Shiftingtonewtasksorstrategies
• Activitiessuchassocialinteractionthatinvolve
integrationofmulti‐sensory,dynamicstimuli,in
particular,eyemovements,facialexpressions
andspeechsounds.
StrengthsofPeoplewithAutism
Activitiesthatrequireminimalcoordinationamong
regionsofthebrain
• Encapsulatedcognitivestrengths,suchas
hyperlexic(isolated)wordreadingorfocusingon
individualdetails(ratherthanthebiggerpicture)
• Hyper‐focusonstaticstimuli,suchasphysical
objectsorhighlyrepetitivetasks
• Tasksthatrequirelearningrules
• Stickingtoandcompletingrepetitivetasks
• Excellenceinvisuo‐spatialormemorytasks
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Brains Develop Through Dynamic Interaction with the Environment Asinfantsinteractwiththeworldofpeopleandobjects,theirbrainsorganizeandwirethemselvestosupport
adaptivebehavior.Achildwho’sbraindoesnoteasilyprocessmulti‐sensorydynamicinformationrequiring
integrationwillinteractwithpeopleandobjectsinatypicalways.Thismaybeverysubtleatfirstbutbeginsto
becomenoticeablebytwelvetoeighteenmonthsofagewhenmajorcommunicationmilestonesaremissed.
Asaninfantspendslesstimeprocessingmulti‐sensory,socialinformationandsubsequentlymoretimeprocessing
lesscomplex(usuallynon‐social)information,hemissesoutonthe“socialeducation”beinggainedbyhistypically
developingpeers(seeMundyandAcra,2007).
Astimegoeson,thischild’sdevelopmentaltrajectorybecomesincreasinglyremovedfromthatofhisorhermore
typicalpeers.Thealteredpatternsofinteractionwiththeworldleadtothedevelopmentofneuralcircuitrythat
supportsmoreofthebehaviorsymptomaticofautisminarapidlyacceleratingfeedbackloop.
The Brain is Malleable Muchresearchhasbeenpublishedoverthelasttwodecadestotellusthatourbrainsaremalleableandthat
neuronsre‐wiretheirconnectionsinresponsetoourinteractionswithourenvironment(Doidge,2007).
ArecentfMRI(functionalMagneticResonance
Imaging)studycapturedimagesofwhitematter
growingtoformmoretypicalconnectivity
betweenpreviouslyunder‐connectedbrain
regionsinchildrenwithlearningdifficulties.After
intensivereadinginstructionthesechildren
showedincreasedwhitematterconnectivityand
significantlyimprovedreadingability(Keller&
Just,2009).
Studiessuchasthisandothersindicatethatby
regularlyandconsistentlyprovidingchildrenwith
autisminputthatstimulatesprocessingof
dynamic,multisensoryinformation,wecanhelpthemtorewiretheirbrainsinawaythatimprovesglobal
interconnectivityandsynchronization.
Toeffectsignificantneurologicalchange,autisminterventionsmust:impacthowachildinteractswithhisorher
physicalandsocialenvironmentbyprovidingfocused,intensivemultisensoryinputandstimulationonaregular
(daily)basis.
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AUTISM TREATMENT: WHAT WORKS Autismtreatmentisadynamicandevolvingfieldwithmanyapproachesthatvaryinmanyways.However,ata
highleveleachoftheseapproachesfallsintooneoftwocategories:BehavioralandDevelopmental.Themost
recentevolutionoftheBehavioralApproachesasknownasNaturalisticBehavioralApproaches.
Naturalistic Behavioral Approaches Autismtreatmentbeganinthe1960swithbehavioralbasedmodelsthatevolvedintowhatwenowknowas
AppliedBehaviorAnalysis(ABA).Theseapproachesarebasedontheassumptionsoflearningtheory,thatall
voluntarybehaviors(e.g.play,socialinteractionandcommunication)arelearnedandmaintainedthrough
antecedents(whathappensbeforethebehavior)andconsequences(whathappensafter).Newskillsaretaught
throughmanipulationoftheantecedentsandsystematicapplicationofreinforcementoftargetedbehaviors.Early
behavioralapproacheswerehighlystructuredandadultdirected(e.g.
Lovaas,1973)andincludetheuseofdiscrete‐trialtraining.Sincethen
thefieldhasevolvedtoimprovechildoutcomesandgeneralizationof
skills.Newerversionsofbehavioraltreatmentsareemployingmore
naturalisticenvironmentsandmorechild‐centeredapproaches.
ResearchonboththeearlierstructuredABAprograms(Rogersand
Vismara,2008)andthelaternaturalisticapproaches(Schreibman,
2005)havefoundpositiveoutcomesforabouthalfthechildren
involved.Generalizationandmaintenanceofskillshasbeenfoundto
improvewhenparentsaretrainedinsupportingbehavioral
techniques(IngersollandGergans,2007).
Developmental Approaches Anothergroupoftreatmentshasemergedinparallelsincethe1980s,theseareknownasdevelopmental
approaches.ThesetreatmentsemergedfromacombinationofPiagetiandevelopmentaltheoryand
psychoanalysis(e.g.GreenspanandLourie,1981)andsocial‐pragmatictheoriesoflanguagedevelopment(Bruner,
1983).Theyarebasedonthecoreassumptionsthat:
• Social‐communicationskillsarelearnedinasimilardevelopmentalsequencebyallchildrenregardlessof
theirability
• Childrenlearnprimarilythroughaffect‐ladenrelationshipswithresponsiveprimarycaregivers
Beingnewer,lessresearchhasbeenperformedondevelopmentalapproachesthanbehavioralapproaches.
Studiesthathaveassessedtheefficacyofdevelopmentalapproacheshavefoundpositiveresults(e.g.Aldred,etal,
2004;Kasarietal,2008;Gerber,2003;MahoneyandPerales,2003;DawsonandGalpert,1990).
NaturalisticBehaviorApproaches
• Incidentalteaching• Milieuteaching• Naturallanguageparadigm• PivotalResponseTraining
DevelopmentalApproaches
• SCERTS• DenverModel• Floortime/DIR• ResponsiveTeaching
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Convergence Thesetwofieldsofautismtreatmenthavedevelopedoverthepasttwentyyearslargelyindependentlyofone
anotherduetodifferingphilosophicalbackgrounds.However,recently,peoplerepresentingeitherperspectiveare
comingtomutualrecognitionofthecommonalitiesinimplementation.Asaresult,newhybridapproachesare
emerging.
PositiveresultsarebeingfoundinapproachessuchasEnhancedMilieuTeaching(KaiserandHester,1994),
ResponsivityTrainingandPre‐linguisticMilieuTraining(YoderandWarren,2002),Parent‐mediatedApproaches
(IngersollandDvortcsak,2006)andmostrecentlytherandomizedcontroltrialoftheEarlyStartDenverModel
(Dawson,etal,2009).
Comparing Approaches Althoughdevelopmentalandnaturalisticbehavioralapproachestoautismcomefromdifferentphilosophiesand
researchtraditions,inpracticethereislittledifferenceintheirgeneralimplementation(Ingersoll,2010).The
primarydifferencescanbecalibratedintermsof:
• InteractiveStyle:Themannerinwhichanadultworkswithachild
• Curriculum:Thecriteriabywhichgoals,metricsandactivitiesareselected
Interactive Style Althoughmostpractitionersengagechildreninavarietyofways,InteractiveStylecanbedividedintoto
fundamentalcategories:aDirectiveStyleandaResponsiveStyle.Thesearecharacterizedbelow.
Noapproachtoautismtreatmentprescribesoneortheotheroftheseinteractivestylesexclusively.However,
variousapproachestendalignmorewithonethantheotherinamannerconsistentwiththegoalsofthe
treatmentprogram.Notably,aresponsivestyleofinteractionhasbeenfoundtoincreasechildren’ssocial,
emotional,communicativeandcognitivedevelopmentinnumerousstudies(Trivette,2003).
AResponsiveStyle
• Allowingabalanceofchildandadultinitiationsandresponses
• Teachingepisodesfocusonchild‐selectedobjects,activitiesortopics
• Emphasisplacedonaffectandemotion‐sharing
• Pausingorindirectinvitationsforchildtoperform
targetbehaviors
• Higherratioofdeclarative(“Whatanicetruck!”)
toimperative(“Givemethetruck”)adultlanguage
use
• Adultbehaviorsensitivetochild’sdevelopmental
levelandcurrentstateofsensory‐regulation
ADirectiveStyle
• Emphasisonadultinitiationsandchildresponses
• Teachingepisodesfocusonadult‐selected
objects,activitiesortopics
• Emphasisongoalachievementandtask
accomplishment
• Promptingordirectrequestingoftarget
behaviorsfromchild
• Higherratioofimperative(“Givemethetruck”)
todeclarative(“Whatanicetruck!”)adult
languageuse
• Adultbehaviorgoal‐directed
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Curriculum Anothersignificantdifferenceamongvarioustreatmentapproachesliesinthecriteriabywhichacurriculum(aset
ofgoals,activitiesandmetrics)isestablishedforaspecificchild.Criteriafortheselectionofcurriculafallinto
basiccategories:
• AgeAppropriate:activitiesandgoalsdeterminedbyachild’schronologicalage
• DevelopmentallyAppropriate:activitiesandgoalsdeterminedbytypicaldevelopmentalsequence
Researchinchilddevelopmenthasshownthatchildrenwithautismfollowadevelopmentalpathsimilartothatof
typicallydevelopingchildren.However,childrenwithautismaredelayedintheirprogressalongthispath(not
deficientaspreviouslyassumed).Studieshavefoundthistobethecaseforsuchkeysocialdevelopmentareasas
expressivelanguage(Tager‐Flusburg,etal,1990),imitation(Rogersetal.,2008)andsymbolicplay(Lifter,etal,93).
Typically,thesetofskillsbeingtaughttoachildis
age‐appropriate(definedbyhisorher
chronologicalage).Achildatagefouristaughtone
setofskillsandachildatagesevenanother.
Childrenwithautismoftenskipdevelopmental
stepsmakingitdifficulttolearnskillsdefinedby
theirage.Therefore,teachingchildrenwithautism
skillsthataredevelopmentallyappropriate(i.e.,
skillsdefinedbythetypicalsequenceof
developmentalstepsratherthanchronologicalage)
allowsforfasterlearningandamoreenjoyable
learningexperienceforbothchildandadult.Forexample,teachingverballanguageskillstoachildnotyetusing
gesturesisnotdevelopmentallyappropriate(regardlessofhisage)asalltypicalchildrendevelopgestural
communicationbeforeverballanguage.
Furthermore,ongoingresearchisidentifyingafew“pivotal”skillsonwhichmanyotherskillsdepend.Acquisition
ofthesesskillsimpactswiderareasofdevelopment.Forexample,teachingsymbolicplayskillsorjointattention
skillsproducesincreasesinexpressivelanguageevenwhenexpressivelanguageisnotdirectlytargeted(Kasariet
al,2008).
Autism Treatment Summary Modernapproachestoautismtreatmentcanbedividedintotwobasiccategories,NaturalisticBehavioral
ApproachesandDevelopmentalApproaches.Althoughphilosophicallydifferent,inpracticethesetwoschoolsof
thoughtareonaconvergencepath.Acrossthesecategories,variousapproachestoautismtreatmentcanbe
distinguishedintermsoftheirprescribedInteractiveStyleandCurriculum.Interactivestylesvaryfromhighly
directivetohighlyresponsive.Selectionofcurriculavariesfromcurriculathatareage‐appropriatetocurricula
thataredevelopmentallyappropriate.
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THE MISSING LINK
Parents are Essential Toaccessitsinnateneuroplasticity(changeability)adisconnected,unsynchronizedbrainrequiresregular
engagementinmotivating,meaningful,affect‐ladenactivitieswithamoreadvancedsocialpartner.
TheNationalResearchCouncil(2001)recommendedthatparentsbeincludedintheirchildren’streatment.Siller
andSigman(2002)foundthat,whenmotherswerenaturallymoreresponsive,theirchildrenwithautismmade
significantlygreaterimprovementsinjointattentionandlanguageoverperiodsofone,tenandsixteenyearsthan
didchildrenwhosemotherswerelessresponsive.
Areviewofthirteenseparatestudiesfoundthat
caregiverresponsivestyleofinteractionfacilitated
significantimprovementsincognitiveandemotional‐
socialdevelopmentforchildrenwith,oratriskof,
developmentaldelays(Trivette,2003).
Parentsareessentialtothesocial,emotional,
communicationandcognitivedevelopmentoftheir
children.Numerousstudieshavefoundthatparents
canbetrainedtoeffectivelydeliverinterventionsfor
theirchildren(e.g.Ingersoll,2007;Solomon,etal.,2007;Solomon,2008).Giventhelackofqualifiedprofessional
providersandthealarmingincidencerateofautism,andotherneurobiologicaldisordersofchildhood,theroleof
parentsasprimarytherapistscannotbeunderestimated.
Parental Well-Being is Critical Parentsofchildrenwithautismhavebeenfoundtosuffermorestressthanparentsofchildrenwithother
diagnosesorthosewhoaredevelopingtypically(Estes,2009).
Aparent’semotionalstateaffectstheirchild
througheveryinteraction.Infact,thepositive
benefitofprofessionallydeliveredtreatmentsis
reducedforchildrenwhoseparentshavethe
higheststresslevels(Osborneetal,2008).
Parentswhohavecometoanemotionalresolution
abouttheirchild’sdiagnosisaremorelikelytouse
ajoyful,playful,supportiveandresponsive
parentingstylewiththeirchildren(Wachteland
Carter,2008).
TheGrowththroughPlaySystemsupportsparents
tohelpthem:
• Gainemotionalresolutionaboutthediagnosis
• Reducestressandincreasewell‐being
• Adapttheirparentingstyletofacilitatetheir
child’sdevelopment
• Identifypivotalsocial‐communicationmilestones
fortheirchild
• Engagetheirchildinjoyful,meaningful,
reciprocalinteractionstoincreasechildlearning
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THE GROWTH THROUGH PLAY SYSTEM TheGrowththroughPlaySystem(GPS)isdesignedtooptimizetherewiringofachild’sbraintofacilitateimproved
globalinterconnectivityandsynchronizationbyfocusingonintensive,multisensory,interactiveactivitiesthat
stimulatehighlevelsofinter‐regionbrainactivity.Thesystemhelpsparentsandpractitionerstoidentifypivotal
developmentalstepsthatachildhasmissedandthenprescribesactivitiesthatcanbeconductedbyparentswith
thechildinaresponsiveinteractivemannertohelpthechildfilldevelopmentalgaps.
Byfocusingonmissingpivotalskillsanddevelopmentalsteps,theGPSindirectlyaddressesothermissingor
challengedskillsthatdependonthepivotalskillsmakingthoseskillseasiertoacquireanddevelop.
TheGPSisfocusedonenablingandempoweringparentsasprimarytherapistsintheirchild’streatmentprogram
byprovidingsimpleandeasy‐to‐implementguidelinesrelativetocurriculumandinteractivestyle.Itconsiders
parentalwell‐beingtobeacriticalsuccessfactorinchilddevelopment.
FormoreinformationonthescientificfoundationsoftheGrowththroughPlaySystemoraboutrelateto
autism,pleasevisitwww.relatetoautism.comorwriteusatsupport@relatetoautism.com.
GETTING STARTED • Tolearnmorevisitwww.relatetoautism.comandsignupforafreetrial30‐daymembership
• Read“TherelatetoautismMemberTools”
• Read“TheGrowththroughPlaySystemforParents”
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REFERENCESAldred,C.,Gree,J.,Adans,C.(2004)Anewsocialcommunicationinterventionforchildrenwithautism:Pilotrandomizedcontrolledtreatmentstudysuggestingeffectiveness.JournalofChildPsychologyandPsychiatry,45(8),1420‐1430.Abstract
Bruner,J.(1983)Child’sTalk:Learningtouselanguage.Oxford:OxfordUniversityPress.
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Dawson,G.,Rogers,S.,Munson,J.,Smith,M.,Winter,J.,Greenson,J.,Donaldson,A.,andVarley,J.,(2009)Randomized,controlledtrialofaninterventionforToddlerswithautism:TheEarlyStartDenverModel.Pediatrics,125(1),17‐23FullText
Doidge,N.(2007).Thebrainthatchangesitself:Storiesofpersonaltriumphfromthefrontiersofbrainscience.NewYork:Viking.
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