筆記(待譯)

“A good program need not be expensive. Human energy is the most important element in a program.”- Dr. Greenspan

Think of a tree growing. The roots of our tree are our foundation. If we don’t have strong roots we won’t grow-big, tall and strong. We are using DIR to build the child’s roots. The therapists are the fertilizer that come in and occasionally feed the root system. The parents are the sun and water-the constant food that feeds the tree. Without them the tree dies.

The root system is comprised of the sensory system, visual-spatial relations, etc.-all the systems that allow us to engage, communicate and relate. This is what we are working on.
1. When I am playing with my child how much do I playfully obstruct?
Playfully obstruct almost to frustration, BUT not quite to frustration. It is a very fine line, but after trial and error you will know when you are there. If you push to frustration you will lose the child and it will take some work to get her back.

2. My child seems to be engaged with an object instead of me. How do I get in there and become the toy (parent) my child plays with?
Example: A little boy is completely entranced with a fan. Things you can try to do is go over by the fan and stand in front of it and move to the side and repeat this until your child engages with you, hide behind the fan and then peek out, move your body like a fan . . .whatever your child is wrapped up in use as your tool to engage your child. Use the object to your advantage.

3. Want to work on your child’s speech and get things going at home, but don’t know where to start?
Try building a few words per week that your child needs:
Example: OPEN
Put a toy outside the door and keep working through gesturing and then “o” up to “open”. Your child will be learning the word through the emotional experience and then the word will become generalized.

4. What are some semi-structured Floortime things I can do at home to help my child work on visual-spatial, sensory and other processes?
Obstacle courses and treasure hunts can be great ways to get your child working on these types of issues.

5. Trying to figure out if your child is ready for inclusion?
Dr. Greenspan’s School Rule of Thumb: Be at solid level 4 and starting 5 before you do inclusion. If you are working on the lower levels then your child really still needs a 1:1 ratio. The child still needs that intense intervention and the 1:1 relationship. Even though, your child may do some parallel play she is not ready for inclusion in the school setting. The adult relationship is still the jost important at the lower levels.

6. How many playdates/wk should my child have when we are working on the higher levels?
If your child is on level 4 and higher then your child should have a MINIMUM of 4 playdates per week. 1:1 becomes more important than some therapies.

7. When might it be appropriate to start doing/introducing some medical and/or biomedical interventions?
Dr. Greenspan: You should have a solid Floortime program for 3-4 months before you consider starting to explore any medical or biomed interventions. DO YOUR INTERVENTIONS ONE AT A TIME.
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Rosemary White, OT, from Seattle gave an excellent presentation. She gave a very good explanation of PRAXIS, the vestibular system and how to do some OT work at home. She asked the audience to not take notes and just sit and listen so here is what I am able to remember and add to from my notes that I took from her talk on the sensory system presented in Fall ’05. :

Some suggested reading from Rosemary White:
On Intelligence by Jeff Hawkins
It will help you understand how your child’s brain takes in info. I have read it and it really helped me.
The Explosive Child by Russ Green
Google: vestibular system
Google: Dr. Margaret Baumen http://www.ladders.org/whatwedo.php
Read to find out about Mirro Neurons which new research tells us is the foundation for all our interactions. Both Serena Weidner and Rosemary White are very excited about this research. Check out this NOVA link for a 14 min. explanation

How can I do OT at home?
Seeing an OT for an hour/wk is fine, but it isn’t as valuable or useful as a parent’s interactions. You don’t need a lot of fancy equipment. You need make yourself available and be actively playing with your child.
Parents need to be a stronger magnet for their children. Do the OT work with your child at home. Join your child when lying upside down on the couch or jumping, etc. This will also help you learn your child’s rhythms. If your child is making very slow motions, make your voice and motions match your child’s very slow motion. This then allows you to join your child in a meaningful joint experience. If you are moving very fast and your child is moving slowly then you may be overwhelming your child.

Having a hard time understanding your child’s vestibular system and sensory system? Or don’t know what it is?
The proprioceptive, oral factory and vestibular systems are the earliest to develop in the course of evolution. Your vestibular system is in your ear canal, but connected to every other part of your body. It is very complicated. Basically, it is what allows you to feel grounded, centered and tells you where your body is in relation to the world. You have right and left vestibular systems. Inside there are tiny hair like follicles that bend. They can cause you to feel inhibited or excited. The vestibular system also allows you to move in space. Think about the proprioceptive (crawling, joint compression) give information to your vestibular system. Wow! That is a lot going on, especially when you are looking at your child!

Check out some links for more info and pics:
http://www.braintraining.com/vestibular.htm
http://thalamus.wustl.edu/course/audvest.html

Want to understand your child’s sensory system and how it affects them?
Our sensory systems give us a sense of whom and where we are in the world. Taste is how we interpret the world. Our sense of smell is very emotional. Your tactile system is the body’s ear- it is protective and a discriminatory system.

Let’s talk about the "I" in DIR, our individual differences. To do this we need to look at how we organize our bodies in response to stimuli (Praxis):
- Praxis is ideation, motor control/planning, flexibility, sequencing and adaptation. It allows you to problem solve.
-Ideation
-Sequencing
-Adaptation/Flexibility

When you have effective Praxis you can adapt your plan in response. If your body is not getting clear information then you can’t make a plan. We have to help our children use their bodies and clear out the junk so that they can be able to make a plan. We have to help them with a sensory diet and emotionally. Sensory and emotion are tied together. Many OT’s put too much emphasis on sensory and not enough on emotion.
When we look at the brain we should realize that the cerebellum plays a huge role in rhythm, pacing/timing, in being social humans and social expectations. The cerebellum is the organizer in the brain and this has deep emotional connections. If you don’t feel organized then you are an emotional mess.

Be aware of all of speech, visual, sensory etc. in all aspects of your child’s development. Think about more than just a sensory diet. The sensory system is also about emotional regulation. Being regulated means being calm.

To assess your child’s sensory system ask 3 questions
-What is the child attending to?
-What is the child over responding to?
-What is the child under responding to?

Think about: what are the components of your child’s “comfort zone” or what your child’s “magnets” are. Then as parent think about how you can become the bigger magnet than the object. This may involve playful obstruction with the object or moving like the object.

Remember that music can be very emotional experience.

Hyperfocusing allows your child to ground herself when her vestibular and sensory systems are on overload. That is why our kids often choose activities that are organizing: lining up cars, puzzles, etc.
Also, keep in mind that the visual system is a very dense system. Autistic children have a hard time linking their visual system to their other systems-vestibular, sensory, oralfacotory, etc. The visual system is often their anchor.

Harry Wachs, O.D. and author of Thinking Goes to School (about visual-spatial relationships and exercises) and Serena Weidner gave a presentation Building a Visual Spatial World.

How do we build a visual spatial world?
By building meaningful experiences in our world. Without visual spatial relationships we feel like we are lost-just floating in space. Pretty scary feeling!

Some children need to look in mirrors so they can watch a picture of themselves to do it. Ever wonder why your child may experience severe separation anxiety or always want you take the same route when driving? They may have visual spatial issues. Some children rely so heavily on their parents to know where they are located in space that when Mom leaves they feel immediately lost and are terrified. The parent has become their child’s guide in the world and without panic sets in. Imagine not feeling grounded or knowing where you are! If your child has memorized a certain route and then you deviate from it then your child may feel absolutely overwhelmed and not be able to sense where her body is in relation to everything else.

Harry Wachs believes:
Affect + Intellect = Knowledge

Affect is the triggering mechanism for developing knowledge. It starts the minute the child is born. It is very important. All knowledge requires meaningful intelligence. You create meaning by experience.