Managing Behaviors in Developmental Challenges: Newer Research for Better Methods for Therapy or 'Research says: Empathy Firstâ&#x20AC;&#x2122; 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 challengesâ&#x20AC;Ś
More typical therapy for typical kidsâ&#x20AC;Ś
But our kids are differentâ&#x20AC;Ś
It is hard to know how to helpâ&#x20AC;¦
A common approach is training the personâ&#x20AC;Ś
There is a common philosophy behind thisâ&#x20AC;Ś There is research to support this approach. But new research questions that philosophy.
We need to rethink the problemsâ&#x20AC;Ś
We need to understand stress responsesâ&#x20AC;Ś
This understanding points to a different approach to therapyâ&#x20AC;Ś
And so We Must Use Empathy First
Tech 1: Telehealth Online Resources
Tech 1: Telehealth Free Online Toolkits
San Diego State University San Diego Regional Center Rady Childrenâ&#x20AC;&#x2122;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
Research Question How can an iPad game provide a range of supports to encourage social engagement.
Social Engagement strategies DIR model (capacity 2) built into Zody
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
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”
Play Together • The Zody iPad game intervention • Pairs were given an iPad running Zody’s World • Instructions were “play together”
Data Collection â&#x20AC;˘ Observations of social interactions in the control condition and intervention â&#x20AC;˘ Interviews of participants at the end of the study
Data Analysis • Coded social interactions • Coded comments from interviews • Aligned cooperative gestures with our observed social interactions • Clustered our findings in build a framework
Technical Mechanics of Cooperation
Framework of Social Relationships Partnership
taking one turn
taking one turn
Lego Play Proximity Pairs sat together and played, sometimes build together, sometimes play apart.
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.
iPad Game Play Zody Treasure Hunt Game Ongoing collaboration and communication require pairs to stay involved in play beyond taking their own turn.
iPad Game Play Cooperative gestures are parallel and asymmetric allowing for shared victory.
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 contextsâ&#x20AC;Ś
â&#x20AC;¦and begin to reveal unique skills of collabora tive play.
Future Work â&#x20AC;˘ Develop digital mechanisms to support self regulation--a prerequisite to sustain membership in face to face interactions.
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)
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?
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 thereâ&#x20AC;&#x2122;s an app for thatâ&#x20AC;Ś 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.