This is Part 3 of our three podcasts featuring the Developmental, Individual differences, Relationship-based (DIR) Floortime multi-disciplinary clinic, Professional Child Development Associates in Pasadena, California. Dr. Brandt Chamberlain is a licensed psychologist and the head of Child and Family Counseling services at PCDA, and he is here to discuss the goals the clinicians address in their services to families. His team provides amazing support and parent coaching to families with children who have more complex needs by doing two-part therapy sessions including 1-to-1 parent sessions and also Floortime sessions with parent and child. He will also tell us about the Young Adults Group that focuses on self-advocacy and vocational exploration.
'DIR' Child & Family Counselling
The Goal of Child and Family Counselling
The Child and Family Counseling Department provides support for families where the primary emphasis is on relationship issues, and emotion management. Dr. Chamberlain has been with PCDA for 15 of its 25 years and thus has been able to seen some children grow up. He has the added perspective of being the father of a 32-year-old autistic son and wishes he would have known about Floortime when he was little. So much of what their department does, he continues, is so different than what our culture tells us to do as parents. They try to get away from the reward and punishment mindset.
Dr. Chamberlain prefers not to diagnose, although he can and does. He prefers to work with families. Usually there’s some tension that’s built up between parents and child and they have escalated the punishments. In this case, Dr. Chamberlain’s team helps the parents reflect with the child. They take into account the developmental capacities and help them work through a meltdown. Ideally, they want to catch the emotion before it goes over the top. Usually you can see some minor things that start to build up before you see a meltdown.
Through the back-and-forth emotional affective exchange, they want to help the child stay in the range of ‘functional distress’. Being able to stay at this point where they can handle it, but have the back-and-forth with the parent is building in a calm, emotional response. The parent is recognizing the child’s reaction, is attuning with them, and then is also interweaving the calmness with what the child is experiencing. The whole process of managing emotion gives the child a skill that they can use in other situations, and it strengthens the bond between parent and child. Using attunement and co-regulation in that way is an essential goal.
Attuning to the Family
Brandt gives an example of a young woman whose mother had a different idea than he did. The mother really knew how to connect with her child. The goal was for her to shower on her own and she believed her daughter would benefit from videos aimed at a young child. Dr. Chamberlain felt that she was an adult and would benefit from adult experiences, but he trusted the mother. The mother was correct. The young lady responded very well to their virtual session where they shared and discussed the videos.
Other situations involve aggression in youth. Dr. Chamberlain gave a horrifying example of what happened to his own son in a group home that used behavioural methods. He loves Floortime because it’s the opposite. In Floortime, we have to be aware of what our emotional, affective communication is at the time that we set limits and expectations. In PCDA’s Child and Family Counseling, they work with families to enhance their communication and understanding of each other in such a way that they’re able to manage the strong emotions and difficult behaviours in a way that is emotionally meaningful, and that ultimately leads to stronger relationships in the family.
The misuse and misapplication of behavioural principles is very, very dangerous. It’s very harmful. The amount of damage that can be done to young people should not be underestimated.
Dr. Chamberlain says that sometimes they’ll just do a one- or two-time consultation, and hopefully they get something valuable from them. To get deep changes, it’s about a year minimum. It’s not unusual to work with families for two to three years. They might have families who return during adolescence or when starting college. An example of another type of consultation was a case they had where a seven-year-old child had seen a very violent video. Dr. Chamberlain suggested watching it again with the parents. They could code each part of the video as being ok, getting a bit too much, and not appropriate because it’s too violent.
It is about helping the parents and child put it together, in the case where the child has already seen something so violent. Watching it with the parent to put it in a context is helpful in reducing the level of distress that the child’s feeling about it. This reminded me of David Bowie’s son, who is now a filmmaker talking about watching A Clockwork Orange with his father when he was quite young. Bowie sat with him, explained everything that was going on, and made him feel completely safe. It was a transformational experience for him. Imagine if you don’t have a context to put that in as a child. Brandt says it’s so important to reassure the child that they’re safe and loved.
Young Adults Program
PCDA’s Child and Family Counseling also runs a Young Adults Program. They are building on what they did with the Teen Club. Small groups meet and do activities and they also meet in large groups where they get to do public speaking, and interact with others who aren’t in their small groups. They meet on a week night and do activities, and meet in the community on the weekends — before Covid. The young adults have more of a focus on vocational exploration, figuring out what they want to do, who is doing this kind of work, how they got there, and what is the preparation to get there. What is important to be successful on the job?
The group members have identified jobs they’d like to do including working in an office with a computer, a nurse, a cartoonist, a baby cuddler in an NICU. There is a huge range of abilities in the group. Some are very verbal, others less so. Some are functioning at a high level of abstraction. With the virtual meetings they have found parents in the group who have worked at similar jobs in the past who have provided information about the jobs. They had a podcaster come in to talk about comic books, as one member wanted to sell comic books. One guest speaker started a YouTube channel about his interest, geography, and has over two million subscribers. Hearing about all of these possibilities has been really exciting for the group.
They also have learned about life skills. They were interested in learning how to shave so on the virtual meeting with the support of the parents, they all shared what they use to shave. Some had electric shavers, while others used manual razors. There is also friendship development where they’ve been making their own Kahoot quiz games which allows them to share their interests and enjoy social time together. They are encouraged to share phone numbers. They’ve had sessions to discuss etiquette around texting do’s and don’ts. Outside of the pandemic they have seen some of the participants travel to outings together on public transportation, or in a car if one drives (which involves a lot of consent).
They’ve also worked with people to help them make good decisions and figure out autonomy and self-direction (including conservatorship). Dr. Brandt has learned a lot from the Autistic Self Advocacy Network (ASAN). There are programs in California and other states where young adults can develop a person-centered plan to tailor services to what the person needs where they can set goals that they want. In watching so many clients grow, Dr. Brandt asserts that you can never predict where a person will go. You can’t underestimate, but you also have to be careful about setting unrealistic expectations–it’s a fine line, he says. Everything has to be individualized.
Dr. Chamberlain gave an example of one older client who loves the Wiggles. Even though it might be driving the parents crazy, let’s figure out how to use the interest to build skills. What they did was figure out when they were coming to a concert, then figure out how to get tickets, how to pay for them, how to get to the show, etc. Working through all the steps made them use this interest to build age-appropriate skills. I gave an example of a boy I know who loves Mickey Mouse. When the family brought him to Disneyworld, it was too much for him and they had to leave. He still likes Mickey though.
Working Towards Self-Advocacy and Self-Regulation
Brandt said that when he brought his son to Disneyland around age 5, his son was overly excited–so much so, that he had to spend an hour in the locker room opening and closing the locker to regulate himself before he could go enjoy the park. It’s what he needed to do before he could enjoy the rest of the day. He gave another example of his son being so overly excited about Christmas, that for a number of years, someone got bitten. One year he was so excited about a gift he got for his sister, that he had to run out of the room right after he gave his sister her gift. It was his way of self-regulating, by going to a quiet room, so nobody got bit.
Brandt says that this is what they aim to do in their programs; the core of what they do: use relationships in our life to help us manage our own feelings so we can build enriching relationships. I asked Dr. Chamberlain how they convince clients who are more resistant to recognizing behaviours like biting that aren’t malicious but due to upregulation, or other behaviours. They have used artwork in classrooms to help children express themselves.
In Head Start programs with younger children, they help the teachers understand the ‘why’ behind some of the non-compliance behaviours. They’ve not only trained the teachers, but also have consulted on individual cases. They’ve shown them how to build those interactions around a toy to look at the developmental capacities by starting with engagement moving into back-and-forth communication and how important the early capacities are to help the child regulate.
They aren’t really funded to do marriage counselling, but they can work with parents around their relationships and communication with the child, especially when one parent is using less of a relationship-based approach. Dr. Chamberlain said you have to build up a good relationship with families to gain the trust when challenging beliefs that some parents may have about this not being the way they were raised, and helping them understand that this way doesn’t undermine their authority as a parent in setting limits and boundaries.
This week's PRACTICE TIP:
This week try to identify some of the signs your child exhibits before they have a meltdown, or become dysregulated.
For example: Think about what your emotional affect was, what demands you might have been putting on your child, and how that may have been too challenging for your child, and how they struggled to express that to you.
Thank you to Dr. Brandt Chamberlain for taking the time to describe the valuable work that his department does. If you missed parts 1 and 2 of the PCDA podcasts, please go back to give them a listen! If you enjoyed and found this week’s interview useful and helpful, please do share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below. Next week, it’s Canadian Thanksgiving, so stay tuned in two weeks for the next podcast!
Until next week, here’s to affecting autism through playful interactions!