Biological and Environmental Influences BiologicallyBased Individual Differences

Family, Community, Culture

ChildCaregiver Interactions

Functional Developmental Capacities y Focus and attention y Engaging and relating y Simple two-way gesturing y Complex problem-solving y Creative use of ideas and symbols y Analytic/logical thinking The Greenspan Floortime Approach – Early Identification

Lecture 13

Biological and Environmental Influences BIOLOGICAL CHALLENGES

CNS Processing Capacities •Auditory Processing and Language •Visual-Spatial Processing •Motor Planning and Sequencing •Sensory Modulation

ChildCaregiver g Interactions

Functional Developmental Capacities •Focus and attention •Engaging and relating •Simple two-way gesturing •Complex problem-solving •Creative use of ideas and symbols •Analytic/logical thinking

Diagnostic Patterns •Deficit D fi it iin affect-motor ff t t planning-symbol l i b l fformation ti connection ti •Deficit in different processing patterns The Greenspan Floortime Approach – Early Identification

Lecture 13

The DIR®/Floortime™ Model DIR®/Floortime™ Model

Screening Developmental History

Motor & Perceptual Motor Functioning

Family F il Patterns

Sensory Modulation

Sensory P Processing i

Functional Developmental D l t l Evaluation

Auditory Processing

Educational Programs/ Peer Interactions

The Greenspan Floortime Approach – Early Identification

Biomedical A Assessment t

Review of Current Functioning

Child/Caregiver Interactions

Lecture 13

Greenspan Social-Emotional Growth Chart

A validated, lid t d norm-referenced f d screening of key social-emotional milestones in infants and young y g children from birth to 42 months of age

Greenspan, SI Greenspan SI. 2004 2004. Published by PsychCorp, www.PsychCorp.com

The Greenspan Floortime Approach – Early Identification

Lecture 13

Greenspan Social-Emotional Growth Chart

™

Short 35-item questionnaire designed to be completede by parents or caregivers in less than 10 minutes

™

Easy to administer and score by any professional involved in clinical or p educational work with children and their families

The Greenspan Floortime Approach – Early Identification

Lecture 13

Conceptual framework, Domains, and Number of Items

Functional Emotional Milestones

Age in months

# of questions

S Stage 1

S Self Selff-regulation & interest in the world

0-3

11

Stage 2

Engages in relationships

4-5

13

Stage 3

Uses emotions in interactive purposeful manner

6-9

15

Stage 4a

Uses series of interactive emotional signals or gestures to communicate

10--14 10

17

g 4b Stage

Uses series of interactive emotional signals g or gestures to solve problems

15--18 15

21

Stage 5a

Uses symbols or ideas to convey intentions or feelings

19--24 19

24

Stage 5b

Uses symbols or ideas to express more than basic needs

25--30 25

28

Stage 6

Creates logical bridges between emotions and ideas

31 31--42

35

www.stanleygreenspan.com S.I.Greenspan, M.D. The Greenspan Floortime Approach – Early Identification

6

6 Lecture 13

Early Signs and Identification Developmental Stages

THE SOCIAL-EMOTIONAL GROWTH CHART Greenspan, S.I. – Excerpted from Building Healthy Minds, Perseus Books, 1999.

6. Logical bridges 5b. Ideas beyond basic needs

5a. Ideas (words/symbols)

Quicker progress 4b. Comp. problem-solving 4a. Simp. problem-solving

Sl Slower progress

3. Purposeful interaction 2 Engagement 2.

Problems increase with age

1. Attention/focus

Age in Months

0

3

The Greenspan Floortime Approach – Early Identification

5

9

13

18

24

30

36

42 48

Lecture 13

Early Signs and Identification Developmental Stages

THE SOCIAL-EMOTIONAL GROWTH CHART Greenspan, S.I. – Excerpted from Building Healthy Minds, Perseus Books, 1999.

6. Logical bridges 5b. Ideas beyond basic needs

5a. Ideas (words/symbols) Norm

4b. Comp. problem-solving 4a. Simp. problem-solving 3. Purposeful interaction

Regression

2 Engagement 2. 1. Attention/focus Early Onset Age in Months

0

3

The Greenspan Floortime Approach – Early Identification

5

9

13

18

24

30

36

42 48

Lecture 13

Social Emotional Growth Chart Index Scores New Cutoff Scores Age Bands

Developmental Challenges Immediate Referral Needed

Mastery

0 3 Months 0-3

0 14 0-14

15 28 15-28

29 55 29-55

4-5 months

0-34

35-46

47-65

6-9 Months

0-45

46-57

58-75

10-14 Months

0-52

53-63

64-85

15-18 Months

0-59

60-76

77-105

19-24 Months

0-68

69-86

87-120

25-30 Months

0-81

82-106

107-140

31-42 Months

0-91

92-124

125-175

Significant Challenges

Moderate Emerging Challenges

Mastery

1-3

4-6

7-18

Scaled Scores

The Greenspan Floortime Approach – Early Identification

Lecture 13

Social-Emotional Growth Chart Sensitivity & Specificity as a Screening Tool for ASD Total Growth Chart Score 6 or less 86 6% 86.6% 90.2%

Scaled Scores SENSITIVITY SPECIFICITY

™ ™

Good sensitivity, correctly identifies about 87% of ASD children G d specificity, Good ifi it correctly tl id identifies tifi about b t 90% off typically t i ll developing children, but 10% can falsely fall in this category

The Greenspan Floortime Approach – Early Identification

Lecture 13

Social-Emotional Growth Chart Sensitivity and Specificity Sensitivity

Specificity

SEGC

.87

.90

ADI

.79 79

.71 71

ADOS

.92

.81

Ages Stages

.70-.90

.76-.91

Batelle

.72-.93

.79-.88

CHAT

.38-.65

.98-1.00

CDI

.80 80-1 1.00 00

.94 94-.96 96

SCQ

.85

.75

The Greenspan Floortime Approach – Early Identification

Lecture 13

Early ID Study Age of First Observation 30

Age in Month hs

25

No significant i ifi t difference

20

TD ASD

15 10 5 0 Purposeful Interaction

1st Social Smile

Cooing

Reduplicated Complex Babbling Babbling (BABA) (BAGA)

Bayrami, Greenspan, & Casenhiser, 2007

The Greenspan Floortime Approach – Early Identification

Lecture 13

Early ID Study Typical Means ™

About 70% of the TD kids show their first purposeful interaction (not necessarily an initiation) before 10 months. At the same time about 70% of ASD kids show their first interaction (again, not necessarily an initiation)) after 10 months.

™

About 70% of the TD kids show their first social smile before the age of 3 months. 86% of the ASD group shows their first social smile (if at all) after 3 months.

™

For complex babbling, there were no segments before 2 years (when we stopped coding) in which children with ASD produced complex babbling (“bada” as opposed to reduplicated babbling “baba”) on tape. About 67% of the typical children showed complex babbling on tape before 12 months months.

Bayrami, Greenspan, & Casenhiser, 2007

The Greenspan Floortime Approach – Early Identification

Lecture 13

Early ID Study Interaction Types 1.5 minute segments were reviewed at 2.5 to 3.5 months of age to determine whether there was a difference in the number of interactions of the following types of interactions ™

Eye contact alone

™

Eye contact plus vocalization

™

Eye contact plus arm/leg movement

™

Eye contact plus vocalization plus arm/leg movement

Bayrami, Greenspan, & Casenhiser, 2007

The Greenspan Floortime Approach – Early Identification

Lecture 13

Early ID Study

Number of occura ances in 1.5 minute segment

Comparison of types of interaction for ASD and TD Groups. 16 14 12 10 TD

8

ASD

6 4 2 0 EC

EC/NV

EC/V

EC/NV/V

EC=Eye Contact, EC/NV=Eye Contact + Non-verbal action, EC/V=Eye Contact + Vocalization; EC/NV/N=Eye Contact + Non-verbal action + Vocalization Bayrami, Greenspan, & Casenhiser, 2007

The Greenspan Floortime Approach – Early Identification

Lecture 13

Can Autism Be Prevented: Reliable li bl Early l Indicators di Early Identification and P e enti e Intervention Preventive Inte ention

The Greenspan Floortime Approach – Early Identification

Lecture 13

The Earliest Signs of Autistic Spectrum and Related Developmental Disorders What to Encourage Shared attention and regulation (begins at 0 0-3 3 mo.)

Early Signs Leading to ASD Lack of sustained attention to different sights or sounds.

Engagement and relating No engagement or (begins at 2 to 5 mo.) only fleeting, expressions of joy, rather th than th robust, b t sustained, engagement

The Greenspan Floortime Approach – Early Identification

Associated Symptoms Aimless or selfstimulatory behavior Self-absorption or withdrawal

Lecture 13

The Earliest Signs of Autistic Spectrum and Related Developmental Disorders What to Encourage

Early Signs Leading to ASD

Purposeful emotional No or only brief backinteractions (begins at 4 - and-forth and forth interactions 10 mo.) with little initiativetaking Long chains of back back-andand No or fleeting forth emotional signaling engagement and (begins at 10 -18 mo.) expressions of joy, rather than robust robust, sustained, engagement

The Greenspan Floortime Approach – Early Identification

Associated Symptoms Unpredictable (random and/ or impulsive) behavior Self absorption or Self-absorption withdrawal

Lecture 13

The Earliest Signs of Autistic Spectrum and Related Developmental Disorders What to Encourage

Early Signs Leading to ASD

Creating ideas (begins at 18 - 30 mo mo.))

No words or scripted use of words (eg (eg, mostly repeats what is heard). Building bridges between No words or ideas: Logical thinking memorized scripts, (begins at 30 - 42 mo.) coupled with random, rather than logical logical, use of ideas.

The Greenspan Floortime Approach – Early Identification

Associated Symptoms Echolalia and other forms of repetition of what’s heard or seen Illogical or unrealistic use of behaviors and/or ideas ideas.

Lecture 13