3/30/2016 Social Connections in Early Childhood Relationships - - PDF document

3/30/2016 1 Social Connections in Early Childhood Relationships

Tory Everhart, LISW Sylvia Sarmiento, MS, CCC-SLP Christine B. Vining, Ph.D., CCC-SLP

Imagine Conference April 7, 2016 Albuquerque, NM

Objectives

• Understand unique New Mexico family

demographics

• Describe three ideas on early childhood

relationship development

• Identify four elements of social

communication engagement

• Identify three natural daily structured activities

in which to play to increase social communication

Introduction

• There at least 3.8 million children with

developmental disabilities, including autism in the US

• It is increasingly difficult for children and

adults with developmental disabilities to

• btain appropriate services and supports due

to

• Lack of accessibility to systems of care
• Lack of trained providers
• Language and cultural differences

3/30/2016 2 NM Demographics

• 5th largest

geographically

• 2010 census
• 36th in population
• 31% live in and around

Albuquerque

• One of four

“minority-majority” states

• Ethnicity/Race
• Hispanic - 46% (55%

children 0-19)

• White (non-Hispanic)- 41%

(28%)

• AI - 9% (10%)
• Asia - 1%

Child well-being

• 2015 KIDS COUNT Data

Book annual publication on the well-being of children in four domains:

• economic well being
• health
• education
• family and community
• Based on policy agenda

established in 2014:

• NM was 50th for child-well

being in national KIDS COUNT data as indicated in 2013 profile

NM KIDS are COUNTing on Us Policy Agenda (2014)

Health

• 8.7% of NM babies are born with low birth-weight

(<5.5 pounds).

• 9% of NM children lack health insurance
• Impact:
• Greater risk for developmental delays and health

problems.

• Children need regular well-baby/child checkups to

detect developmental delays.

• Without early intervention, developmental problems are

not addressed adequately.

NM KIDS are COUNTing on Us Policy Agenda (2014)

3/30/2016 3 Family and Community

• 43% of NM children live in single-parent

families

• 21% of NM children live in areas where the
• verall poverty rate is 30% or higher

Impact:

• High poverty areas likely to feel

disenfranchised and experience social problems e.g., crime, substance/drug use, substandard housing that may put children at risk

NM KIDS are COUNTing on Us Policy Agenda (2014)

Economic

• 31% of NM children live at the poverty level

(<$23,550 for a family of four).

• 25% live in low income – families earning 2x

the poverty level.

• 36% of NM children live in households that

spend 30% or more of their income on housing.

Education

• 62% of NM children ages 3-4 are not

attending preschool Impact:

• Brain development in first 5 years of

development and dependent upon nurturing and stimulating experiences

• High quality programs foster cognitive, social

and behavioral skills development and prepare children for school success

NM KIDS are COUNTing on Us Policy Agenda (2014)

3/30/2016 4 Kicked Out

• Preschoolers are 3 times more likely to be

“expelled” than children in grades K-12 (Gilliam, 2005)

Who gets expelled?

• 4-year olds 50% more likely than 3year olds
• Boys 3 ½ times more likely than girls
• African American 2 times rate of European Americans
• Forms of suspension:
• “Come pick up your child” when child is having a bad day
• “Child can only handle 2 hours/day
• We don’t collect data on this or call it suspension

“Data shows no kid getting kicked out when parent and teacher have a relationship”

Corso – 2016 Preschool ASD Institute

Education: Social- Emotional/Behavioral Challenges

• Children who are identified as hard to manage at

ages 3 and 4 have a high probability (50:50) of continuing to have difficulties into adolescence (Campbell & Ewing, 1990)

• Of the young children who show early signs of

challenging behavior, it has been estimated that fewer than 10% receive services for these difficulties

Corso – 2016 Preschool ASD Institute

Center on Social Emotional Foundations for Early Learning (CSEFEL)

• National Center

focused on promoting the social emotional development and school readiness of young children birth through age 5

• Incorporating an

Evidence-Based Framework: the Pyramid approach.

http://www.pyramidmodel.org/

3/30/2016 5 Ongoing Needs

• Coordinated, comprehensive systems of care
• Early screenings for developmental and special

health care needs

• Families in accessing services, information and

resources they need

• Families as partners at all levels of service

delivery

• Early diagnosis and early intervention for

children with ASD and other developmental disabilities

• Diverse workforce and cultural competency to

build capacity and address significant needs in a multicultural society

Parent Home Training

• Need for Parent Training
• Teach families skills for

promoting development

• Research shows numerous

benefits for both child and parent when caregivers are actively involved in intervention for children with ASD.

• Work within the strengths of

parent-child relationship

Parent Home Training Topics

• Understanding ASD
• Accessing resources
• Improving Skills
• Communication
• Social skills
• Transitions
• Toilet training
• Behaviors
• Sensory
• Feeding

3/30/2016 6 Evidence Based Practices

• Integrate research-based techniques into daily

interactions with their children:

• Functional communication
• Visual schedules/supports
• Social narratives
• Naturalistic Developmental Behavioral

Interventions (“NDBIs”) Features:

• Use natural contingencies
• Are implemented in natural settings
• Involve shared control between participants
• Use a variety of behavioral strategies to teach

developmentally appropriate and prerequisite skills

Schreibman et al. 2015

Common Features of NDBIs

• Child Initiated
• Environmental Arrangement
• Natural Reinforcement and Related Methods for

Enhancing Motivation of the Child

• Use of Prompting and Prompt Fading
• Balancing Turns Within Object or Social Play
• Modeling
• Adult imitation of the Child’s Language, Play or

Body Movements

• Broadening Attentional Focus of the Child

Schreibman et al. 2015

Relationships

• Children learn and

develop in the context of relationships that are responsive, consistent and nurturing

• Important to build

these relationships early on rather than waiting until there is a problem.

Building relationships are at the foundation of everything we do

Corso - 2016 Preschool Institute

3/30/2016 7

Remembering the Past, Looking to the Future

Trends in Intervention for Young Children

• 1. Professional Centered
• 2. Parent-Allied or Parent Focused
• 3. Family Centered

Past Models for Intervention

• Professional

Centered

• The professional is

the expert and holds the power

• Child Focused
• Intervention is child

and deficit (problem) focused

• Parent-Allied
• Parents participated

in order to implement at home

• Power remained with

the professional

• Intervention still child

and deficit focused

Family Centered Intervention

• Shift in power
• Parents are seen as the experts on their child
• Professionals bring knowledge from their area of

expertise

• Collaborative relationship between parents and

professionals

• Family Focused
• Intervention is based on family priorities, parents

participate in planning and implementing

• Promotes family choice and control over desired

resources

• Strength Based

3/30/2016 8 The First Social Connection

Relationship between infant and primary caregiver

• Initially a means for survival
• f the infant, but plays a

central role in social and emotional development and well-being

• Based on reciprocal

exchanges (communication)

This relationship develops within everyday natural routines

• Through caregiving

activities, feeding bathing, changing, playing…

• Infants’ earliest

communication is initiated to maintain proximity from caregiver to promote security, safety

Communication between infant and caregiver

• Eye Gaze
• Facial Expression
• Body language
• Voice
• Touch (Affective

exchanges)

3/30/2016 9 The Importance of the young child and caregiver relationship

• Children don’t exist

independently, they require on support of

• thers through the

juvenile period.

• Young children and

their development should be understood within the context of their caregiver relationships.

Nature vs. Nurture

• Most researchers now

conceptualize development as some transactional exchange between genetic, inherited factors and environmental factors

• Emerging evidence of

the effects of relationship experiences upon the brain (Schore, A.N., p. 10,12)

Attachment

• The relationship that

develops during the first years of life

• When an infant’s

communicative attempts are met consistently and appropriately, a secure attachment develops

3/30/2016 10 Why is attachment important?

• Growing evidence that the quality of

attachment is a fundamental mediator in child development

• Longitudinal research showing impressive

links between secure attachments in early childhood and social competence and successful adaptations in later childhood (Davies, D. p.3).

Key Benefits

• Enables the young child

to use his caregiver for developing:

• Emotional regulation:

for the relief of distress and developing coping skills for stress and novelty

• Provides a base for

exploration of the environment (development)

Relational Experiences

• Developmental skills

are learned within relationships

• The quality of a child’s

primary relationship can be either a risk or a protective factor in his development

• Relationships can also

be viewed as the agent

• f change in

development

3/30/2016 11 Risks

• Environmental factors
• Poverty
• Violence, trauma
• Caregiver health,

substance abuse

• Prolonged

separations

• Social Supports
• Health/development
• f child

Working through risk

• Family Centered,

relationship and strength based practice

• Supporting the

parent-child relationship supports the child’s development

Focusing on Strengths

• Increases a parent’s

confidence

• Helps parents

understand their child’s experience from within a developmental perspective, rather than achieving milestones

3/30/2016 12 Mutually Competent Interactions

• Any exchange

between parent and child in which both feel joy

• Interactions which

support a child’s development

• Interactions which

increase a parent’s confidence

Mutual Competence

• The premise of mutual competence is that any

interchange that contributes to the parent and child feeling secure, valued, successful, happy

• r enjoying learning together is good for the

development of the child, as well parent’s self confidence in being a parent (Bernstein, V., Strengthening Families)

Looking to the Future

• Supporting

relationships and mutually competent interactions sustains development in the moment and the future

• Creates greater

resilience against risk

3/30/2016 13

Thinking across levels

• Application in other

relationships, in addition to child and caregiver:

• Parent and

provider

• Provider and

supervisor

Setting the Stage for Social Communication

• Question: What type of

communication between parent and child is good for the development of the child and parent’s confidence?

• Answer: Any interaction

that enables both the parent and child to feel secure, valued, successful, happy or enjoy learning.

Susan Goldberg

HOW?!?!

• How to develop

increasingly effective communication between the parent and the infant

• r toddler that is

struggling with social communication?

3/30/2016 14 How do we increase Social Communication….

• With a child showing red flags of Autism

Spectrum Disorder (ASD)?

• With a child diagnosed with ASD?

Common Social Communication Challenges

• Limited imitation
• Difficulty with turn-taking
• Difficulty with joint attention
• Difficulty with shared interest
• Limited facial expression or facial

expression is seen when there is no engagement with another

• Does not use verbal or nonverbal means to gain

attention

Common Social Communication Challenges cont.

• Difficulty with eye gaze for communication
• Preference for objects rather than people
• Receiving nonverbal communication

3/30/2016 15

A key to increased social communication is Social Engagement! A key to increased social communication is Social Engagement!

Elements of Social Engagement

• Shared interest
• Imitation
• Joint attention
• Turn taking

Build on a Shared Interest

• Build on what the child has

already shows an interest in!

• Building on interests the

child has in the their natural environment will be naturally reinforcing for them!

3/30/2016 16 Imitation

• Research shows that

imitation is a foundation skill for children with ASD

(Stone and Yoder 2011)

• Children with ASD learn to

imitate with objects before they develop joint attention

(Carpenter, 2002)

• A powerful and well-known

strategy that parents can use - to follow their child’s lead and THEN the child is then encouraged to follow the adult’s lead

Joint Attention is…

• When the child initiates to

coordinate attention between people and objects through gestures and eye gaze

• When the child responds to

attention by following the gestures and gaze of another person to share the object of that

• ther person’s attention
• When the child directs someone’s

attention for social purposes

Joint attention is…

• A foundational skill usually emerges by first

birthday

• The cornerstone for the development of

intentionality and language development

• Essential for initiating social communication

interactions

3/30/2016 17 Turn Taking

• Turn taking = Reciprocity!
• Describes whatever the

child does to let you know that he is participating in the interaction

• A look at you
• Make a sound
• Say a word
• Does an action
• A foundational skill for

social communication

• Essential for building &

maintaining parent/child relationship

A key to increased social communication is PLAY! Before Engagement, Essential Do’s

• 1. Attention level
• 2. Communication

level

• 3. Structure the

play space

3/30/2016 18 List of DO’s

• 1. Do consider the attention level of the child
• Understand that everyday stressors may likely affect

child’s attention level (change of schedule, illness, a dysregulated state)

• Understand that a child may not orient attention by

turning head or body towards you or objects

• Understand that sustained attention from the child for

any new attempt to play will be limited in the beginning

• Understand that asking the child to shift attention to

reorient to a new object or person may likely be difficult

• Understand that disengaging is likely difficult for the

child

List of “Dos”

• 2. Do consider the child’s communication level
• Use clear non-verbal signals (facial expressions

& gestures)

• Use language slightly above the child’s current level

(the “one up” rule)

• Provide time for child to process
• Respond to all attempts from the child to

communicate

• Interpret the intention or the meaning of the child’s

behavior

List of “Dos”

• 3. Do structure the play space
• Limit auditory/visual distractions
• Keep play space organized (no clutter

is best, keep activities simple)

• Use visual supports around the play

space

• Create boundaries using rugs, tape,

boxes, tables, etc. to help the child know where to play

3/30/2016 19 Mutual Competent Interactions begin when…

• The child is in a place of calm and in a place
• f alertness (Kalberg, Laurel, & Taylor 2013)
• When the child is in this space, he is now

ready to engage with a parent

Where To Start?

follow the child’s lead…

Follow the child’s lead to build shared interest

3/30/2016 20

Successful play = mutual competent interaction

• Follow a child’s lead to build SHARED INTEREST,
• then IMITATE the child’s actions, sounds,

movement or song will naturally create

• JOINT ATTENTION and TURN TAKING

Bubbles Blocks

3/30/2016 21 Mirrors Sensory Games Songs and Rhymes

3/30/2016 22 Play is best when ……

• There is a clear beginning
• The addition of structure in

the activity for a brief time

• There is an end

Play is best when ……

• Built in naturally during daily

routines

• Putting on clothes
• Putting on shoes
• Washing face
• Brushing teeth
• Making a snack
• Bathtime
• Putting on pajamas

If at first you don’t succeed…..

• Try, try again! You may not

receive a glance or a smile in the beginning BUT remember the child learning how to play AND play with another is very difficult for children with ASD

• Celebrate small successes!
• Have fun!

3/30/2016 23 References

• Bernstein, V. (2002). Strengthening families through strengthening

relationships: Supporting the parent-child relationship through home

• visiting. Newsletter of the Infant Mental Health Promotion Project (IMP),

35, 1-5.

• Davies, D. (2005). Introduction to attachment. The Infant Crier, 109, 4-7.
• Sussman, F. (2004). More Than Words. Toronto, Ontario: Beacon Herald
• NM KIDS are COUNTing on Us Policy Agenda (2014). Retrieved from

http://datacenter.kidscount.org/.

• Schore, A.N. (2001) Effects of a secure attachment on right brain

development, affect regulation and infant mental health. Infant Mental Health Journal, 22, 7-66.

• Schreibman, L., Dawson, G., Stahmer, A. C., Rogers, S. J., Landa, R.,

McGee, G. G., Kasari, C., Ingersoll, B., Kaiser, A. P., Burinsma, Y., McNerney, E., Wetherby, A., & Halladay, A. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism Developmental Disorders, 45, 2411-2428.

• Sroufe, L. Alan (2000). Early relationships and the development of
• children. Infant Mental Health Journal, 21, 67-74.
• The New Mexico Association for Infant Mental Health, Issues Brief No 1.

Thank you!