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Empathy First


Managing Behaviors in Developmental Challenges: Newer Research for Better Methods for Therapy or 'Research says: Empathy First’ Winter 2017 Joshua D. Feder, MD Child and Family Psychiatry, Solana Beach California University of California at San Diego School of Medicine Interdisciplinary Council on Development and Learning (ICDL) American Academy of Child and Adolescent Psychiatry Early Years International Network for Peace Building with Young Children SymPlay, LLC Family Games for Autism Fielding Graduate University Profectum


Thank You: Virginia Spielman Kingkaew Pajareya Bobbi Laufer


We try to help people with developmental challenges‌


More typical therapy for typical kids‌


But our kids are different‌


It is hard to know how to help…


A common approach is training the person‌


There is a common philosophy behind this‌ There is research to support this approach. But new research questions that philosophy.


We need to rethink the problems‌


We need to understand stress responses‌


This understanding points to a different approach to therapy‌


And so We Must Use Empathy First


Empathy First


Tech 1: Telehealth Online Resources


affectautism.com


monadelahooke.com


kidsattuned.org


Tech 1: Telehealth Free Online Toolkits


www.profectum.org


early-years.org


www.icdl.com


www.profectum.org


San Diego State University San Diego Regional Center Rady Children’s Hospital University of California at San Diego


Tech 2: Online Research and PhD Worldwide


Tech 2: Online Research and PhD Fielding Graduate University


Tech 3: Video Game Design to support social communication


Family Games for Autism


INTRODUCTION

Research Question How can an iPad game provide a range of supports to encourage social engagement.


ANALYSIS

Social Engagement strategies DIR model (capacity 2) built into Zody


STUDY DESIGN

Study Design • Single subject design • 8-11 year olds with autism • Pairs alternated play Legos and the Zody iPad game • Forty-eight 10- minute sessions over 4 weeks


STUDY DESIGN

Build Together • Legos were used as control condition • Pairs were give a 401 piece Lego set with a book of instructions placed in a bin • Instructions were “build together”


STUDY DESIGN

Play Together • The Zody iPad game intervention • Pairs were given an iPad running Zody’s World • Instructions were “play together”


STUDY DESIGN

Data Collection • Observations of social interactions in the control condition and intervention • Interviews of participants at the end of the study


ANALYSIS

Data Analysis • Coded social interactions • Coded comments from interviews • Aligned cooperative gestures with our observed social interactions • Clustered our findings in build a framework


ANALYSIS

Technical Mechanics of Cooperation


RESULTS

Framework of Social Relationships Partnership

Friendship

static presence

sustained cooperation

shared joy

taking one turn

parallel responsibility

commiserating

Membership


RESULTS

Membership

static presence

taking one turn

Lego Play Proximity Pairs sat together and played, sometimes build together, sometimes play apart.


RESULTS

Membership

static presence

taking one turn

sustained turn taking

iPad Game Play Zody Maze Game The cooperative gestures of serial, asymmetric provided a specified turn for each member and rapidly changing roles.


RESULTS

Partnership

sustained cooperation

parallel responsibility

iPad Game Play Zody Treasure Hunt Game Ongoing collaboration and communication require pairs to stay involved in play beyond taking their own turn.


RESULTS

Friendship

shared joy

commiserating

iPad Game Play Cooperative gestures are parallel and asymmetric allowing for shared victory.


DISCUSSION

Implications By thinking of terms of relationships and affect, we can leverage the affordance of digital cooperative gestures to rapidly practice a variety of skills in dynamic social contexts‌


DISCUSSION

…and begin to reveal unique skills of collabora tive play.


DISCUSSION

Future Work • Develop digital mechanisms to support self regulation--a prerequisite to sustain membership in face to face interactions.


THANKS!

Thank you

Journal paper reference: Boyd, L. E., Ringland, K. E., Haimson, O. L., Fernandez, H., Bistarkey, M., & Hayes, G. R. (2015). Evaluating a Collaborative iPad Game's Impact on Social Relationships for Children with Autism Spectrum Disorder. ACM Transactions on Accessible Computing (TACCESS), 7(1) 3. doi>10.1145/2751564


Are we connected? How to use everyday video to track developmental progress in social communication. Fall 2016 Joshua D Feder, MD Associate Clinical Professor, Department of Psychiatry, University of California at San Diego Adjunct Professor, Infant and Early Childhood Development, Fielding Graduate University Medical Director, SymPlay, LLC, Family Games for Autism Marion Clough Child Psychology, Doha, Qatar; Fielding Graduate University Stephanie Nilsen Early Childhood Special Education, AZ, USA; Fielding Graduate University


Gratitude, Disclosures and Objectives Thanks to the many graduate students at Fielding Graduate University (Formerly the ICDL Graduate School), Professor Devin Casenhiser, as well as the clinicians, video coders, the people at SymPlay, the UCI Human-Computer Interface Program, and most of all to the families who have kindly participated in this work Dr. Feder is a clinician who teaches at Fielding Graduate University and works as Medical Director at SymPlay, LLC. I hope you will appreciate the importance of regulation, connection, and flow of interaction in our efforts to help people with developmental challenges and learn how a simple video coding paradigm can give helpful feedback to clinicians and caregivers to guide intervention.


Abridged History: Video Coding Interactions: Ainsworth, Main – attachment, strange situation Brazleton – moment by moment interactions Trevarthen – video interaction guidance, attachment based therapy Emde – emotional availability research Tronick – Still Face and messy interactions Stern – vitality affects/ musicality (timbre, rhythm, etc.) Mahoney – Responsive caregiving Adamson, Kasari – joint attention, ETC. Feldman – connection: you know it when you see it Spinrad – empathy: responsive mother yields responsive child Lord - Brief Observation of Social Communication Change (BOSCC)


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Connection and interaction are messy and necessary Messy and necessary: breaks in connection lead to efforts to repair and then a sense of both ‘me’ and ‘we’ and the ability to tolerate stress and learn. So we need to look at: Length of connection: connection implies regulation and longer connection means what is happening is meaningful. Balance of effort: who is doing the work of connecting? Both need to be doing some, not too much or too little.


Video examples: 1. Dad and baby: Who is doing the work? When do they become connected? 2. Mom and adult daughter: Are they connected? Who is doing the work? 3. Boy with transformers: Are we connected? Is he regulated? 4. Hide n Seek: Regulated? Connected? Balanced effort?


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Simplified Coding: Connection and Repair 2012: Pilot: Coders blinded to timing of intervention found an association between DIR intervention and increasing time of connection and better balance of repair in children with disorders of social communication 2013: Feasibility study: Blinded coders rated total connected time during 5 minute clips and noted who repaired when connection was broken. High interater reliability (IRR) with intraclass correlation coefficient of 0.92 (awaiting publication)


Video Coding of Connection and Repair 2014-2015:Interlude: Feder developing intervention models using similar concepts for children growing up in conflict zones. 2016: Reliability: Repeat study compares external rating of social engagement (CARS) with video scoring. Validity: High IRR and reported good correlation between external measures and scoring rubric. Doing confirmation work pre-publication. Overall Qualitative Feedback: Coding is easier, and people learn so much from doing this - the information is useful for improving intervention for self-regulation, resilience, social communication, empathy and tolerance.


And now there’s an app for that‌ Ease of use in natural settings such as home, school or clinic Take video and code it on the smart phone screen Rates time connected and balance of repair/ initiation of interactions: limited, ok, good to give simplified feedback Secure file management for uploading for sharing Several studies planned for Fall 2016.


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Southeast asia march 2017 (2 1)  

Managing Behaviors in Developmental Challenges: Newer Research for Better Methods for Therapy t͛Winter 2017

Southeast asia march 2017 (2 1)  

Managing Behaviors in Developmental Challenges: Newer Research for Better Methods for Therapy t͛Winter 2017

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