PHOTO CREDIT: Los Muertos Crew
On this Episode…
Dr. Angel Belle Dy is a DIRFloortime® Expert Training Leader in the Philippines who started The Growing Brain PH, a DIR® accredited clinic that began as a social media page. She is a medical doctor who has a background in public health, community-based programs, and program development and fell into the world of infant mental health and parent coaching through finding Floortime. She teaches both online and on site courses for the International Council on Development and Learning.
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How Did Dr. Angel Find Floortime?
Dr. Angel, as her patients call her, has both a medical and a business degree, which brought her into the field of public health. She initially thought she would do pediatric training and work in a hospital because she loves kids, but she ended up working in a developmental center where she ended up being the clinic manager. They were thinking about early intervention when Dr. Virginia Spielmann came to the Philippines and taught DIR 101: An Introduction to DIR® and DIRFloortime®. She realized that this relationship-based framework was something she wanted to learn more about.
What Are Autism Services Like in the Philippines?
The climate for autism services in the Philippines is still more behavioural in nature, but when she thinks about being in communities and working with families, DIR® matches the culture which is very family-centred and community-based, but it’s not often the approach taught in academics in interventions like occupational therapy, speech, and psychotherapies, which are mostly cognitive and behavioural in nature.
The Demand for Floortime
Now that Dr. Angel is introducing DIR® to the Philippines, she loves the reactions of some of her therapists who say the DIR® framework feels so much more meaningful than what they know. It’s very novel for the communities there including families and practitioners. I asked if her YouTube channel brings people to Floortime. Dr. Angel says that there is a community in the Philippines that follows social media and YouTube, but most Floortime there has been by word-of-mouth. She often has a waitlist, which she doesn’t like because it means people are waiting for services.
The request for Floortime coaching is growing and professionals are asking when her next Floortime class is. They had to close registration the last time she taught DIR 101 because it filled up so quickly. She tells participants who ask if they can practice Floortime after taking DIR 101 that they can always practice a relationship-based approach with your families, but there is so much value from taking the certificate courses and growing as a professional.
There are two types of participants: those who say, “When is the DIR 201 (DIRFloortime® Basic Certificate Course)?” and those who want to take time and think about it. There are also many who have a financial barrier as well. They earn much less there than therapists in the United States, Dr. Angel explains. It’s why I created Affect Autism, I offered: to provide the rich discussions with DIR-Experts about topics like attunement, a child-led approach, and following the child’s lead which are so often misunderstood.
Dr. Angel’s Typical Week
In Dr. Angel’s typical week, her clinic is about a third of what she does. She sees patients and does parent coaching as part of that as well as a mix of medical consultations. She also is an academic teaching medical students. Finally, she also does research. She is trying to grow a body of data for autism in the Philippines and would like to make DIR® more relevant. She might see 4 to 5 patients in a given day. She meets with families as a whole for a developmental screening, consults, or check-ups.
What she loves about getting to do Floortime is to demonstrate the interactions in parent coaching. When parents find this helpful, she’ll see them for a few more sessions after that to support them in order to foster the building of the relationship between parent and child. The benefit of being an accredited DIR® organization, she explains, is that the parents understand that all of the people in the growing brain clinic are trained as Floortimers.
How Is Autism Seen There?
I asked Dr. Angel how the neurodiversity movement and awareness of autism is in the Philippines. There’s a growing awareness, she says, and there’s an autism society which she’s a member of. Neurodiversity is in its emerging stage in terms of advocacy and self-advocacy for autistic individuals. She has to be careful when discussing it because there is still a lot of sensitivity around language.
In the ICDL community the language is to call someone “an autistic individual,” but there it’s still person-first language and there is still a stigma around autism, thinking of it like a disease. It is moving closer to a strength-based approach, though, she says. She had a practitioner recently apply for a job because she was seeking a neurodiversity-affirming place to work, which was nice.
Has She Seen Progress With Families Over Time?
The Growing Brain PH clinic itself is about 5 years old and Dr. Angel has had some clients for as long as 3 years after they were referred from a developmental pediatrician. Dr. Angel can’t do diagnoses because she’s not a developmental pediatrician, but as a medical doctor, she does get to talk about the “symptoms” from a medical perspective and looks at them in terms of “strengths and vulnerabilities.”
Dr. Angel said that she watched one father go from simply observing the sessions to coming down on the floor to play. She provides hand-outs and workbooks. The father came back and announced to Dr. Angel that it also works with his teenager! Fast forwarding a few years later, the mother of the same child brought the child to a session with another practitioner but the child didn’t want to leave Mom.
The teacher said, “You can just sneak out now” and the mother said she just wanted to say “bye” to him and that it was ok if he cried. She asked the teacher to please befriend him and let him know he’ll be ok and to tell him she would be back in an hour. When Dr. Angel heard that, she realized this was a mother who valued the strengths of the child and knew what would bring anxiety for him.
I found it so interesting that the mother said that it would be OK if he cried as so many of us parents are scared to see our children cry and be upset. I referred listeners to the recent episode on limit-setting and how it is OK if the child cries. We get the opportunity to co-regulate which is so valuable. Parents can learn how to sit through those hard moments of emotional disruption. A lot of us parents never had that as kids. We had to deal with emotional disruptions on our own.
Biomedical Concerns Including Feeding
It’s so nice to see a medical doctor trained as a DIRFloortime® Training Leader. In thinking about the biomedical aspect that Dr. Greenspan talked about in his books and ruling out medical causes for undesired behaviour, I asked if this is part of Dr. Angel’s work? For instance, maybe the child has gastro issues or seizures and this is causing the behaviour. Dr. Angel says that this is one of the research projects she’s working on.
Her team is looking at the gut microbiome of autistic individuals and non-autistic to see if what they think of as just behaviours might be co-occurrences with gastro, digestive, or metabolic concerns. The gut-brain access causing inflammation can affect how the brain interprets information how it receives and absorbs nutrients that are supportive of brain development, she explains. It’s a growing field and is very novel.
Many of the clinicians follow functional medicine, which is very new in the Philippines. It’s supporting families who are interested in supporting the biomedical piece. It’s part of the “I” in the DIR® model, she explains. The picky eating, for instance, has repercussions on health. McDonald’s is common and there are many autistic kids who would prefer to just eat chicken nuggets. She wants to look at the entire medical picture of the child and coach parents how to introduce healthy eating in a relational way.
I explained that before we began recording this episode, I was wolfing down my breakfast omelette and Dr. Angel reminded me to chew slowly. This made me laugh because my son eats too quickly and shoves so much food into his mouth at once, that it’s a choking hazard. Apparently his father used to do that same as a toddler. Our occupational therapist thinks that perhaps he has low registration in his mouth so he’s not feeling the urge to swallow until his mouth is very full. It could be part sensory and part medical.
We want him to chew slowly and to pause between bites, but he’s impulsive, so you have to sit next to him and this is where you can really pull in the DIR® playfulness, I explained. Besides food selection, there’s the process of eating, Dr. Angel says. There, “fed” is what parents want. They’ll give their children milk to drink if they won’t eat a lot just so they get the calories. It’s about getting the calories in. Digestion starts in the mouth, Dr. Angel says. You need to chew to break food down, but in the Philippines they are only thinking about getting enough calories in.
Dr. Angel meets the family where they are at. She might introduce these concepts if they bring up feeding issues. Parents might want to approach toileting issues before feeding issues, though, she tells us. It’s a privilege that she gets an hour with her patients in her clinic so she can sit down and have these conversations to support parents meeting their children where they are at as well and to support their relationship. The DIR® framework is a great companion to the issues families face, she asserts.
What Does She Do To Combat Pseudoscience?
Dr. Angel brought up vaccines and this circles back to the functional medicine topic. Functional medicine is gaining so much popularity but it’s also associated with a lot of naturopathic practices that are pseudoscientific. I asked Dr. Angel how she navigates all of the misinformation, such as the overuse of useless supplements.
Her disclaimer is that she’s not a functional medicine practitioner. What overlaps with DIR® is looking at the individual as a whole. When parents ask about protocols or information from books or supplements they saw on social media (social media is very popular there–especially Facebook), she always goes to the individual differences of the child. There’s no “one size fits all,” so that’s how she approaches the family. She can do a physical exam and realize there are no nutritional deficiencies so the child doesn’t require supplementation, for instance.
She is always trying to balance it out from an evidence-based practice perspective and for those who want to try something, she educates them about what results could be attributed to that protocol versus to other factors. It’s about the relationship she gets to form with families to get into a more reflective conversation with them. Having that trust in their relationship allows her that luxury of understanding why they were looking for these supplements and protocols in the first place. She realizes parents want to do the best for their children. She’ll gently guide them to what might be more supportive for their child.
I certainly take some supplements like vitamin D and magnesium, given my age, but what bothers me so much, I explained, is when I hear about a parent trusting an unregulated supplement sold online over science-based research because they saw a TikTok video. I probably get triggered about this because I went through it myself after my son’s brain inflammation and recovery that was mixed in with a new autism diagnosis, which I document in my new book.
When you have that idea of trying to “cure” your child in your head, I continued, it’s a “you” issue versus a child issue. That was hard for me to separate in the early years of my journey. It took awhile to get through that phase to accepting my child as he is, I get triggered when people believe in “magic cures.” Of course science-based medicine isn’t always perfect, either. I referred to a past episode where Dr. Josh Feder discussed how there are side effects to every medication and how it’s a risk/benefit analysis.
A True Appreciation for Floortime
Dr. Angel fell into the world of Floortime. It’s been a growing experience beginning with thinking of Floortime as a tool she could use in an intervention program with a child to journeying with so many families and thinking of DIRFloortime® as the basis for any interaction she has with families. She invites families to continue to be curious in supporting their children. While there might be a desire to look for remedies, DIR® allows caregivers to see their child in a new light, which is the beauty of it, she offers. It’s a goal of Dr. Angel’s to grow Floortime in the Philippines and in Southeast Asia.
I demonstrate the process I had to go through before I saw my child in a new light in my Floortime documentary series, We Chose Play. I shared how, over time, I went from seeing my son’s deficits to seeing his strengths. Parents always wish they found Floortime sooner, but when you find it, you move forward. If you’re in the Philippines, you can visit The Growing Brain PH online at their website, on Facebook, YouTube, or Instagram to contact them!
DIRFloortime® provides a framework to see your child in a new light.
This episode’s PRACTICE TIP:
Let’s reflect on what we seek from our medical professionals?
For example: Supporting our child’s medical conditions can prevent suffering but let’s reflect. Are we seeking information and tips for supporting our child and their challenges or are we seeking ways to change our child? Let’s build our relationship as we get to know our child so we can tell the difference.
Thank you to Dr. Angel Belle Dy for sharing her experience using the DIR® model in her medical clinic. If you found this episode helpful and informative, please consider sharing it on social media.
Until next time, here’s to choosing play and experiencing joy every day!
Thank you to Swedish recording artists Тhen Comes Slience for the intro/outro song permission.
