Marion Blank, Ph.D. Columbia University msb5@columbia.edu

1. Marion Blank, Ph.D. Columbia University msb5@columbia.edu Suzanne Goh, M.D. Pediatric Neurology Therapeutics sgoh@gohmd.com Website www.spectacularbond.com Email info@spectacularbond.com Susan Deland delands@optonline.net

2. OVERVIEW • creating the social and behavioral foundation for learning Dr. Marion Blank • the neuroscience behind Spectacular Bond Dr. Suzanne Goh • a family’s experience Susan Deland

3. The Starting Point • in contrast to the common focus on what the child needs to learn, our starting point is seeing the world through the child’s eyes • the “everyday world” is not getting in – WHY?

4. The Child’s View • via reports • via observations the child finds the world to be overwhelming, confusing, & painful • Much of that pain and confusion is caused by the very stimulation that NT children find appealing and irresistible – the social realm.

5. The Social World • newborn is primed to attend to, focus on, and interact with the adult • one-day-old infant with her mother

6. Diane Deland age 2 (prior to starting the Spectacular Bond program)

7. Implications • The social world is the basis for communication. • Communication is the basis of all interaction, including INTERVENTION. • When a child avoids the social world, adult-directed teaching will rarely, if ever, be truly effective. • The “accommodations” made for children are often counterproductive.

8. The First Element Simplify the World • simplifying the world is the opposite of providing stimulation • key points for the two worlds: • the non-social world • the social world

9. Simplification is not Enough • well-established defenses are in play • child will not readily give them up • one key defense is “stimming” • keeps the outside world from intruding • provides stimulation

10. Comment from a “Nonverbal” Teenager with ASD “I treat stims like a welcomed friend….I am so needy to escape reality and stims take me to another world.” (Ido in Autismland)

11. The Second Element Self Control of Stimming and Other Unproductive Behaviors (in the presence of adults)

12. The Third Element Managing Meltdowns • temper tantrums • overloads

13. The Fourth Element Sitting Quietly

14. Key Elements • focus is on developing inhibition and inner calm • all are done at home – prior to moving to the outside world • goal is 10 to 15 minutes of carefully structured, effective interaction every hour (child is “free” the rest of the time) • child’s room becomes a “haven”

15. OVERVIEW • creating the social and behavioral foundation for learning Dr. Marion Blank • the neuroscience behind Spectacular Bond Dr. Suzanne Goh • a family’s experience Susan Deland

16. The Neuroscience Behind Spectacular Bond • Knowledge about how the brain works has not been factored into most intervention programs • Yet, all intervention programs represent efforts to reshape brain networks

17. The Brain in Autism CAN Change • With early intervention, electrical patterns of brain activity begin to resemble that of neurotypical children* • Before these changes can take place, children need to be receptive to intervention *Dawson, G. et al. (2012) “Early behavioral intervention is associated with normalized brain activity in young children with autism.” Journal of the American Academy of Child and Adolescent Psychiatry. 51(11):1150–1159.

18. The Effects of “Training” on Brain Networks • If unproductive behaviors aren’t addressed in a treatment program • stronger neural networks are created in areas of the brain that should NOT be growing • new, productive patterns can’t be established

19. How to Reshape Neural Networks • Change is possible if we • Diminish those repetitive behaviors that are working against positive brain growth • Expand neural networks for the skills that will allow the children to live full and productive lives

20. Calm the Brain before Stimulating It • Reduce the stressful stimulation that the child must face • Simplify the child’s world

21. Intervention Must Begin in the Social Domain • Social brain is intimately tied to emotional centers of the brain that control feelings of fear and anxiety • The “Social Brain” • Amygdala • Prefrontal cortices • Temporal cortices

22. OVERVIEW • creating the social and behavioral foundation for learning Dr. Marion Blank • the neuroscience behind Spectacular Bond Dr. Suzanne Goh • a family’s experience Susan Deland

23. Diane Deland – a case study • Diagnosed at 3 years of age, Diane began the Spectacular Bond program right away. • We will see the program in action in her particular case.

24. Element 1 – simplify the world • changing the physical and interpersonal environment • Diane would no longer eat meals in the playroom

25. Element 2 – build self control • targeting unproductive behaviors • Diane would stop running and shrieking in our playroom. She would stop pulling clothes out of drawers.

26. Element 3 – manage meltdowns • distinguishing between tantrums and overloads • bypassing rewards • learning to say “not now” • Diane would get the things she desired, but at the times that we decided, not at her request

27. Element 4 – sit quietly • calming the mind • reshaping my relationship with Diane • Diane would sit quietly with her hands on her lap for a short period of time

28. Element 5 – organize the day • Creating a clear plan for how each day would be structured • There would be time for adult-led exchange, child-led exchange, minimal exchange, and no exchange.

29. Element 6 – simple actions • Teaching her to follow simple commands under an adult’s direction • Diane would imitate simple actions with me or Dr. Blank

30. Marion Blank, Ph.D. Columbia University msb5@columbia.edu Suzanne Goh, M.D. Pediatric Neurology Therapeutics sgoh@gohmd.com Website www.spectacularbond.com Email info@spectacularbond.com Susan Deland delands@optonline.net