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Social Connections in Early Childhood Relationships

Tory Everhart, LISW

Sylvia Sarmiento, MS, CCC-SLP

Christine B. Vining, Ph.D., CCC-SLP

Imagine ConferenceApril 7, 2016

Albuquerque, NM

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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

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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 obtain appropriate services and supports due to

• Lack of accessibility to systems of care

• Lack of trained providers

• Language and cultural differences

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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%

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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)

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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)

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Family and Community

• 43% of NM children live in single-parent families

• 21% of NM children live in areas where the overall 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)

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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.

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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)

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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

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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

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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/

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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

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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

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Parent Home Training Topics

• Understanding ASD

• Accessing resources

• Improving Skills

• Communication

• Social skills

• Transitions

• Toilet training

• Behaviors

• Sensory

• Feeding

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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

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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

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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

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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

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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

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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 FocusedIntervention is based on family priorities, parents

participate in planning and implementing

Promotes family choice and control over desired resources

• Strength Based

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The First Social Connection

Relationship between infant and primary caregiver

• Initially a means for survival of the infant, but plays a central role in social and emotional development and well-being

• Based on reciprocal exchanges (communication)

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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

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Communication between infant and caregiver

Eye Gaze

Facial Expression

Body language

Voice

Touch (Affective exchanges)

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The Importance of the young child and caregiver relationship

• Children don’t exist independently, they require on support of others through the juvenile period.

• Young children and their development should be understood within the context of their caregiver relationships.

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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)

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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

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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).

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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)

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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 of change in development

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Risks

• Environmental factorsPoverty

Violence, trauma

Caregiver health, substance abuse

Prolonged separations

Social Supports

• Health/development of child

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Working through risk

• Family Centered, relationship and strength based practice

• Supporting the parent-child relationship supports the child’s development

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Focusing on Strengths

Increases a parent’s confidence

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

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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

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Mutual Competence

• The premise of mutual competence is that any interchange that contributes to the parent and child feeling secure, valued, successful, happy or 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)

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Looking to the Future

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

Creates greater resilience against risk

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Thinking across levels

• Application in other relationships, in addition to child and caregiver:

Parent and provider

Provider and supervisor

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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

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HOW?!?!

• How to develop increasingly effective communication between the parent and the infant or toddler that is struggling with social communication?

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How do we increase Social Communication….

• With a child showing red flags of Autism Spectrum Disorder (ASD)?

• With a child diagnosed with ASD?

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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

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Common Social Communication Challenges cont.

• Difficulty with eye gaze for communication

• Preference for objects rather than people

• Receiving nonverbal communication

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A key to increased social communication is Social Engagement!

A key to increased social communication is Social Engagement!

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Elements of Social Engagement

• Shared interest

• Imitation

• Joint attention

• Turn taking

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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!

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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’slead and THEN the child is then encouraged to follow the adult’s lead

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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 other person’s attention

• When the child directs someone’s attention for social purposes

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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

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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

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A key to increased social communication is PLAY!

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Before Engagement, Essential Do’s

1. Attention level

2. Communication

level

3. Structure the

play space

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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

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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

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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

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Mutual Competent Interactions begin when…

• The child is in a place of calm and in a place of alertness (Kalberg, Laurel, & Taylor 2013)

• When the child is in this space, he is now ready to engage with a parent

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Where To Start?

follow the child’s lead…

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Follow the child’s lead to build shared interest

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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

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Bubbles

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Blocks

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Mirrors

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Sensory Games

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Songs and Rhymes

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Play is best when ……

• There is a clear beginning

• The addition of structure in the activity for a brief time

• There is an end

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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

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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!

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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.

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Thank you!