DIR Floortime® Model

Joy can be derived from numerous things, relationships, activities, foods, nature; the list goes on from the most miniscule pleasures to the grandest indulgences. What brings joy to you? What motivates you, inspires your creativity, connects you to those around you? Relating to those around us is an important aspect of daily life and for people with autism this can be particularly challenging.

Developmental, Individual Differences, and Relationship-Based Model of Intervention (DIR) uses affect-based interactions to encourage social, emotional, and cognitive development in children with autism focusing largely on the caregiver-child relationship.

FEDLs-Image-e1476381705346-2The DIR Floortime model provides some important and applicable points, especially in regards to music therapy. The basis of the DIR model surrounds the necessity to meet the child where they are at and encourages the caregiver to see the world through the eyes of their child. This is similar to the iso principal of music therapy, where the musical stimuli should match the emotional state of the participant. Both of these tactics require careful observation, assessment, and empathy. We learn what we care about, and therefore, a child will be more interested in what you are saying or doing if you follow their lead and build the interaction from there.

Another important aspect of both music therapy and the DIR Floortime model is scaffolding developmental expectations and goals for a child. It is important to observe small improvements in any aspect of the child’s behavior or relationship with others. Celebrate the small victories and give praise easily.

Thank you to Marlee Burgeson for coming to the MTCCA office to further educate our staff on the DIR Floortime model.

For more info on the DIR Floortime model check out profectum.org

 

Shannon Flaherty

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Gallup’s Strengths Finder

Many times in life we are asked to look at our weaknesses and see how we improve upon them. Although it is a good practice to be aware of our shortcomings, it can blind us to our positive qualities. Shifting focus to strengths can be difficult but the outcome can be beneficial for numerous reasons.

Before starting my internship with MTCCA, I was asked to take the Gallup Strength Finder 2.0 test. This test analyzes your strengths and gives a personalized report based on your answers. Each member of the MTCCA team takes this test, giving us a platform and common language to discuss potential ways to positively impact the team. I had the opportunity to participate in a team building exercise with the MTCCA staff. We were split into two groups, competing to see who could build the tallest tower using a paper bag, uncooked spaghetti, and 2 feet of masking tape in 15 minutes. Although my team did not win, we were able to observe each other’s strengths in action, whether it was in planning the tower, coming up with creative solutions to problems that arose during the process, or encouraging other team members. MTCCA is an incredibly positive environment, where the staff not only focuses and builds upon their own strengths, but constantly looks towards highlighting the strengths of their clients.

The idea of focusing on strengths instead of faults heavily aligns with positive psychology, a relatively new branch of psychology that looks at people’s strengths and focuses on positive functioning. I have attached a Ted Talk by Martin Seligman, the founder of positive psychology, which further explains its history and application.

https://www.ted.com/talks/martin_seligman_on_the_state_of_psychology

The book and related strength test MTCCA uses is:

StrengthsFinder 2.0 by Tom Rath

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Here are some questionnaires related to positive psychology including a free strength based test you can take:  https://www.authentichappiness.sas.upenn.edu/testcenter

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MTCCA team building exercise during the strengths seminar

 

Shannon Flaherty

Jam Session Benefits

In May, we wrapped up another successful Jam Session season. For any readers that are not familiar, Jam Sessions are group music therapy programs run by the non-profit Banding Together for teens with autism and other developmental disabilities. These programs take place bimonthly in three different locations throughout the San Diego area, with one in Carlsbad, El Cajon, and Point Loma. Each participant is paired with a volunteer mentor, usually receiving one-on-one attention as well as the chance to socialize with other mentors and participants in the Jam Session.

The typical Jam Sessions consist of a greeting song or exercise, a drum circle, a local guest musician, a song teaching a specific social skill, and jam time where the participants can pick a song, play instruments, and dance. Not only is this experience incredibly fun but parents and mentors observed significant social skill gains as measured by the Social Responsiveness Scale (SRS-2) assessment and a self-made assessment called Rockstar Reports. The SRS-2 is a standardized assessment that identifies social impairments related to autism spectrum disorder and measures its severity. The Rockstar Report was created by Banding Together to measure the goal areas specifically targeted by Jam Sessions.

The SRS-2 reports showed the most significant improvements in social communication, social awareness, and restricted interests and repetitive behaviors.

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The Rockstar Reports showed improvements in participants taking leadership roles, communicating feelings, and having conversations with other participants or mentors in the group.

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Jam Sessions start again in September but sign up now, as spots are limited! Don’t miss this amazing opportunity to volunteer or participate in an incredibly fun and rewarding program.

If you are unavailable to volunteer but would like to support Banding Together, you can donate here

 

Shannon Flaherty

Music and Language

Music and language share some of the same parameters – frequency, intensity, waveform and timbre, duration, rate, contour, rhythm and cadence to name a few. Speech is processed mostly in the left side of the brain while melody is processed in the right. Using music to rehabilitate a patient who may have lost language due to a stroke or TBI has proven to be a powerful tool. It’s often equated to the brains plasticity, or ability to use alternate neuropathways to process information.

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Figure 1: Areas of the brain involved in language

(Hickok, Bellugi, & Klima, 2001)

Music can be a powerful tool for anyone working on speech and language skills. It addresses various aspects of speech such as breath support, phonation, articulation, and prosody. Music also taps into multiple parts of the brain, promoting domains from memory to motor movement. Neurologic music therapy (NMT) uses music as a therapeutic treatment for various neurologic diseases and disorders. NMT has numerous speech and language interventions, which I have briefly summarized below:

  • Melodic Intonation Therapy (MIT), an intervention originally developed by speech and language pathologists used melody and left hand tapping to transfer language from left hemisphere of the brain to right hemisphere. This process works best with Broca’s aphasia and while it may take a long time to implement the whole protocol (from singing to generalized speech), it can be effective in providing the client with functional phrases.
  • Musical Speech Stimulation (MUSTIM) uses music’s anticipatory characteristics to stimulate reflexive speech with overlearned song.
  • Rhythmic Speech Cueing (RSC) a technique helpful for improving fluency. Metric RSC uses rhythm of equal duration to focus on articulation. Patterned RSC uses beat patterns that simulate the stress of normal speech.
  • Vocal Intonation Therapy (VIT) addresses pitch, breath support, timbre, loudness, phonation, resonance, and intonation. Interventions include breathing and scales.
  • Oral Motor and Respiratory Exercises (OMREX) uses sound vocalizations and wind instruments for articulatory control and respiratory strength.
  • Developmental Speech and Language Training Through Music (DSLM) uses music to facilitate speech and language development in children with developmental speech and language delays
  • Therapeutic Singing (TS) incorporates goals (such as initiation, development, and articulation of speech) from other therapeutic techniques and used as reinforcement exercises but focuses on goals less specifically. TS is often used as a complimentary technique.
  • Symbolic Communication Training Through Music (SYCOM) uses improvisatory performance exercises to teach dialogue skills such as listening, responding, speech gestures, timing of initiation and responding, starting and stopping conversations.

Many of these interventions have been developed off of speech and language pathologist’s protocols. For many people, music therapy and speech therapy are complimentary, especially when the therapists have an open line of communication regarding the client’s goals and progress.

Shannon Flaherty

References:

Hickok, G., Bellugi, U., & Klima, E. S. (2001). Sign Language in the Brain. Scientific American, 284(6), 58-65. doi:10.1038/scientificamerican0601-58

Thaut, M. H. (2008). Rhythm, Music, and The Brain: Scientific Foundations and Clinical Applications. New York ; London: Routledge.

We Are the Champions

2017-06-11 19.41.38.jpgAt a recent party, we realized that MTCCA interns numbers 11 through 18 were all in attendance (pictured left to right: Tara Harwell, Becca Paoni, Kristin Hurley, Marissa Phillips, Chiara Francolino, Brandon Wright and Shannon Flaherty).How great it was to have 7 of our current and former interns together at once. Click here to view their spontaneous musical performance.

Youth Helping Youth Coffeehouse Gig at Newbreak Cafe

On May 21st we had one of our Youth Helping Youth coffeehouse events benefiting MTCCA’s nonprofit – Banding Together at Newbreak Coffee and Café in Ocean Beach. It was an amazing event filled with multiple performances from clients, staff, and jam session crew.

Banding Together provides scholarships for individual music therapy sessions as well as Jam Sessions for teens and adults throughout the year. Jam Sessions give participants the opportunity to take an active role in creating and playing music in a group setting. This allows for them to work on social, psychosocial, and executive functioning skills. Each participant receives a volunteer mentor who encourages him or her to get involved in the musical experience. Over this past Jam Session season (Jan-May 2017) I was able to mentor a number of participants and observe astounding growth and development of various social skills in the jam session crewmembers. Not to mention that each of these sessions are provided at no cost to the participants or their families!

At the Youth Helping Youth event, a number of our Jam Session participants performed some songs we sing at Jam Sessions. The Kingsmen, a band consisting of 5 of MTCCA’s longtime clients, performed a set of songs. The Kingsmen have been together for seven years and have performed with acts like The English Beat at the Belly Up and Willie Nelson’s son, Lucas. Their hard work paid off and they sounded great! Guest artist, Hannah Quinn also performed and did an amazing job singing and playing piano covering some of todays pop hits.

To finish off the afternoon, a few prizes from generous sponsors were raffled off with proceeds from the tickets going to Banding Together. Jam session crewmembers and members of the Kingsmen got to pull the tickets and read the winning numbers. It was truly an afternoon to remember.

Check out Banding Together’s Facebook page here where you can see videos from this event and many others: https://www.facebook.com/bandingtogethersd/

There is one more Youth Helping Youth Coffeehouse Fundraiser on June 4th from 2-4pm at Brew Coffee Spot in El Cajon. Hope to see you there!

Here’s one of the videos from Facebook:

https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2Fbandingtogethersd%2Fvideos%2F10154739198714370%2F&show_text=0&width=560

kingsmen newbreak

Shannon Flaherty

 

 

ABA Presentation

Many of the clients we work with at MTCCA participate in multiple therapies on a weekly basis. This provides us the opportunity to co-treat and work on similar goals in a variety of ways. Recently, we observed a presentation by ABA therapist, Brittany Monclus, which shed light on the different behavioral techniques many of our clients utilize on a daily basis. Brittany works for The Center for Autism and Related Disorders (CARD), one of the worlds largest applied behavioral analysis organizations.

Applied behavior analysis (ABA) refers to a systematic approach to the assessment and evaluation of behavior and the application of interventions that alter behavior. Many of the interventions used in ABA therapy utilize a reward system, largely based around the methodologies of operant conditioning.

During the presentation, Brittany covered topics ranging from reinforcement to scaffolding strategies. One of the favorite things I learned from the presentation was how to use rewards to benefit therapist and client as much as possible. It is important to set up expectations first so the client is aware that if he or she does not complete a challenging task, he or she will not get the reward. At first I thought this was simply bribing the child to do something undesirable, but Brittany emphasized that if the reward is set up before an intervention, it is positive reinforcement, not a bribe.

Since then, I have incorporated the challenge-reward strategy with numerous clients. With one younger client, I began using a two-step “first, then” schedule. I present the client with a list of unfamiliar or challenging interventions he can choose from for the “first” section, then I present him with another set of preferred interventions for the “then” section. This gave us the opportunity to broaden the list of interventions he chose to do in a session and has reduced the clients challenging behaviors throughout difficult interventions.

I have utilized the challenge-reward strategy in other ways, such as: a point system, where the client needed to reach a certain number of points in order to participate in a preferred intervention at the end of the session, and a timed activity, where I challenged the client to participate for a specific amount of time before moving onto a reward activity. Again, the importance of preparation and setting appropriate expectations for the client are incredibly important. Overall, I am grateful that I had the opportunity to observe the presentation and apply some of these techniques to my own work.

 

For more information on CARD and ABA therapy please visit:

https://www.centerforautism.com/

 

Shannon Flaherty

MTCCA Senior Intern