This week we have Serena Suman to discuss Individual differences and Floortime in different environments, including in the pool. She is an evolutionary psychologist, a functional psychomotorist (which is similar to an Occupational Therapist in North American), and an Expert and Training Leader in the Developmental, Individual differences, Relationship-based (DIR) Model. She was an elementary school support teacher for almost ten years and works mainly with autistic children and with children neurodevelopmental differences. She has a private clinic that includes a speech therapist, a psychotherapist and a learning tutor for children with dyslexia or generalized learning challenges who all use the DIR Framework in the north of Italy in Piemonte between Milan and Turin.

Individual differences and Floortime in the Pool

by Affect Autism | affectautism.com

Individual differences

Last year Serena went to the STAR Institute to deepen her knowledge of sensory processing disorders and is completing the Sensory Processing Proficiency courses with Temple University, having completed part 1 of her internship at the STAR Institute in Colorado with part 2 being delayed due to Covid-19. She refers to each child carrying their own small backpack in which their Individual differences are always present that needs to be taken into consideration in every context of a child’s life. This year’s annual conference of the home of DIR/Floortime’s Interdisciplinary Council on Development and Learning (ICDL) is Floortime all the time and everywhere, so this couldn’t be a more perfect topic.

Serena thinks of DIR as a philosophy. We know that Individual differences, or the ‘I’, have an impact on the ‘R’, the Relationship. The ‘I’ could prevent the child from forming a relationship due to their sensory differences. Where there are a lot of things to look at, hear, and understand, such as in a school setting, it might be very challenging for a child to keep up with their peers. 

The individual differences can be behind behaviour that comes out when a child gets dysregulated. It’s both the physical environment and the mental environment of the child that are affected, Serena says. A child who has difficulty with sensory processing will have difficulty with core relations. We know that the first step for good development is the ability to stay calm, regulated and engaged with the world

But if a child can’t understand what happens outside of themselves due to the challenges in their body, (the posture, the motor control, ideation, body awareness) it’s not a cognitive process. We only see the behaviour, not the subcortical process inside the brain. But we can change something in the environment–how we interact with the child.

Click on the photo to enlarge

Sensory systems work together

The pool offers sensory experiences that affect the child’s visual-spatial capacities, proprioceptive and vestibular capacities, and these are all inter-connected, Serena says. Let’s delve into vision as an example. The visual capacity is not the vision, but the function of the vision: the capacity to converge, track, see in three dimensions, etc. It’s the vision functionality, Serena says. This can affect the child’s movement and vice versa. The vestibular system works hand-in-hand with the visual system. 

I gave an example of my child’s visual processing challenge where the developmental optometrist explained to us that although his anatomy of his eyes are all working, the place in the brain that processes vision was not yet integrating his peripheral and central vision. He is suppressing his eyesight in one eye. It affects schoolwork because if my son is monocular (using only one eye), when he writes, he is turning his head to the eye that he favours. (Yes, he does this!) Both eyes need to track the words as he reads.

Also, as children write, Serena continues, they are changing their fixation from paper to the blackboard, which is more difficult with monocular vision. They write very big, very small, and/or asymmetrical letters. When the eyes aren’t working together and they’re trying to track an object moving in space, it’s hard to understand where it is (thus my son’s difficulty in catching a ball, for instance). The stimuli in the environment can be dysregulating for such a child. 

The Set Up for the Session

When doing Floortime in the pool, Serena says, first you are closing off the visual field which lowers distractions. This is especially helpful for kids who have not integrated peripheral and central vision, she adds. The pool itself is a boundary. The child uses their vision a lot, but now it’s focused on the therapist. The increases the capacity for attention. The practitioner will use the close Relationship to engage the child through the attention and attunement to get back-and-forth communication.

Next, when the therapist holds the child, it supports their trunk/torso so their body is in a good position, which aligns their eyes which also improves the vision capacity. In addition, the pressure that the water puts on the body also improves the body awareness (i.e. proprioception). So, in this moment, Serena explains, the Individual differences (the ‘I’) are taken care of, and this is the first and foremost important consideration before starting the session. This supports the child’s regulation and allows us to move up the developmental ladder.

Today's blog photo

The child in today’s blog photo was a four-year-old child diagnosed as autistic who is quite hyperactive. The pool provided an environment for regulation, but it still took some time to work on regulation. Serena was coaching the therapist in the pool from the side. Typically, the mother would be in the pool nearby but during Covid the mother had to stay behind a window. Despite the child having difficulty being apart from his mother, the water helped the child stay regulated with the therapist, Serena says, who used emotional regulation alongside sensory integration to engage the child.

Serena describes the connection between the child and therapist like wifi, which reminded me of the Self-reg program’s description of the ‘interbrain’ where the adult and child co-regulate. This allows a connection between the higher part of the brain, Serena says, and the subcortical part of the brain (or as Dr. Shanker explains, the ‘blue’ and ‘red’ brain).

The child can then stay in the play with a great recognition and pleasure, Serena says. The idea of ‘being‘ in the moment is us being in the pool with the child. This will be in their memory as a pleasurable experience. Wait, watch and wonder works well in the pool because the therapist becomes the best toy. They seek the therapist to play with, especially when the therapist remembers not to speak too much.

In terms of auditory processing, Serena explains that the sounds of the pool’s waves and the entire auditory experience is different in the pool. They don’t even require many objects because the child has a relational need once the Individual differences are accounted for. 

Floortime in the pool

In Floortime they’ll use rhythm and speed along with vestibular stimulation–linear or around–to work on sequencing. Sometimes they will work on tactile stimulation with different objects. They start on gross motor activities for activating the vestibular, and proprioception systems, and even visual discrimination. They might sing and vocalize in rhythm and move in different ways to get interactions while stretching the attention and engagement.

They will use some floating pillows in the pool as well to work on muscle tone for those children who might have low tone (i.e., difficulty keeping their posture straight). Some of the children have great difficulties moving outside of the pool, so it is quite a different experience being in the water. The best way to work is integrating the sensory systems. They can do exercises depending on the child’s individual needs. She always tends to focus her therapy on motor planning, especially with older children.

To work on strength for instance, she might have them push her arms with their arms. She prefers to use her body rather than objects, and the relationship to engage this kind of activity in the session. Movement is so important, Serena says. We can connect our minds with our bodies in the sessions. And all children wish to connect with us. Serena believes that using the DIR framework is the best way to increase a child’s developmental capacities in this way.

Serena says, outside of Covid, they usually work with the parents, so the session tends to be a very enjoyable time for the parents too. It is an outing that is an entire experience from the change room to the pool since most families in Italy do not have home pools. They work out of a community centre that supports Serena’s work with neurodiverse children.

Thank you to Serena Suman for the podcast. If you have any questions for Serena, feel free to contact me and I can put you in touch with her. I hope you enjoyed it. Please consider sharing it on Facebook or Twitter and if you have related comments, experiences or questions, please put them below in the Comments section below.

Until next time, here’s to affecting autism through playful interactions!

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