Stanley I. Greenspan

Psychophysiological characteristics of the regulatory disordered infant

Abstract This study examined the psychophysiological responses to sensory and cognitive challenges of 24 normal and 11 regulatory disordered infants (8–11 months). Regulatory disordered infants were defined as being behaviorally difficult and exhibiting disturbances in sleep, feeding, state control, self-calming, and mood regulation. Heart period and cardiac vagal tone were measured during baseline and during sensory and cognitive challenges. The regulatory disordered infants tended to have higher baseline vagal tone. Across groups there was a significant suppression of vagal tone during cognitive processing. Baseline vagal tone was correlated with the suppression of vagal tone during the cognitive task only for the normal infants. In contrast, the responses of the infants with regulatory disorders were heterogeneous. The results provide preliminary support for the hypothesized relationship between vagal tone and the regulatory disorder.

A Functional Developmental Approach to Autism Spectrum Disorders.

Historically, severe developmental disabilities, including autism, have been approached from the point of view of presenting symptoms as well as the overall syndrome. Although individual practitioners, such as speech pathologists, occupational and physical therapists, and educators have worked with the childs individual capacities, a developmentally based functional approach has not been sufficiently articulated and systematized to guide assessment, intervention, and research efforts. In this article, we describe a dynamic, developmental model that conceptualizes the childs functional emotional developmental capacities, individual differences in sensory processing and modulation, motor planning and sequencing, as well as child/caregiver and family interaction patterns. Because each child with developmental challenges is unique, the functional developmental approach will capture the childs special strengths and challenges, as well as provide a more comprehensive and individualized framework for clinical work with a child and his or her family.

Four-year follow-up of a sample of regulatory disordered infants

In this prospective descriptive study, the developmental outcomes of 9 untreated infants with moderate to severe regulatory disorders were examined at 8 to 11 months and again at 4 years of age and compared with 13 normal infants. Regulatory disordered infants were defined as being behaviorally difficult, exhibiting disturbances in sleep, feeding, state control, self-calming, and mood regulation and evidencing poor sensory processing. Eight of the nine regulatory disordered children had developmental, sensorimotor, and/or emotional and behavioral deficits at 4 years. Group differences were found in atten tion and activity level, emotional maturity, motor coordination, and tactile sensitivity at 4 years. For normal infants, ratings of difficultness on the Bates Infant Characteristics Questionnaire and higher baseline cardiac vagal tone were related to better developmental outcomes and behavioral organization respectively at 4 years. In contrast, ratings of difficultness and higher baseline cardiac vagal tone in regulatory disordered infants were associated with poorer developmental outcomes and behavioral difficulties at 4 years. At the time the study was conducted, the clinical significance of regulatory problems was not known, therefore treatment was not considered. The results of this study suggest that untreated regulatory disordered infants may not outgrow behavioral difficulties over time.

Climbing the Symbolic Ladder in the DIR Model Through Floor Time/Interactive Play:

The developmental, individual-difference, relationship-based model (DIR), a theoretical and applied framework for comprehensive intervention, examines the functional developmental capacities of children in the context of their unique biologically based processing profile and their family relationships and interactive patterns. As a functional approach, it uses the complex interactions between biology and experience to understand behavior and articulates the developmental capacities that provide the foundation for higher order symbolic thinking and relating. During spontaneous ‘floor time’ play sessions, adults follow the child’s lead utilizing affectively toned interactions through gestures and words to move the child up the symbolic ladder by first establishing a foundation of shared attention, engagement, simple and complex gestures, and problem solving to usher the child into the world of ideas and abstract thinking. This process is illustrated by a case example of a young boy on the autism spectrum interacting with his father during ‘floor time’ over a 3 year period.

Child Care Research: A Clinical Perspective

Two new studies on day care suggest that young children demonstrate increased aggressive behavior in relationship to time spent in day care and increases in cortisol levels in relationship to full-time, group-oriented, out-of-home care. These observations can be more fully understood in a clinical context that looks at individual differences in children, families, and child care environments. Factors likely to increase risk include sensory processing and modulation challenges; family stress; and lack of sensitive, nurturing interactions associated with less high-quality child care. Because 85% to 90% of current day care is not considered to be of high quality, individual families that can provide high-quality care need to explore carefully their options to see if it is possible to provide direct nurturing care for their infants and young children for at least half of the day.

Guidelines for early identification, screening, and clinical management of children with autism spectrum disorders.

Congratulations to the American Academy of Pediatrics (AAP). Two of their recent clinical reports published in Pediatrics , “Identification and Evaluation of Children With Autism Spectrum Disorders”1 and “Management of Children With Autism Spectrum Disorders,”2 will enable pediatricians to address parent concerns sooner, facilitating the early identification of children with autism spectrum disorders (ASDs). As physicians and developmentalists with decades of accumulated experience in working with children with developmental challenges, we applaud and welcome these publications. However, we would like to expand on these reports. In this commentary we (1) describe a broader functional/developmental framework for screening for ASDs, (2) provide a critique of the current trend toward behavioral treatments as primary intervention strategies, and (3) present research evidence for functional/developmental approaches. A broader and more refined “functional” developmental framework3 looks for compromises in the childs healthy milestones and helps parents and other caregivers work with the child to improve that area of functioning and overall healthy progression.* This approach helps families identify challenges early in the first and second years of life and to begin to help their children before the 18- and 24-month screenings recommended by the AAP.4 An overfocus on specific problem behaviors without a framework for promoting healthy development may prove to be counterproductive.5 Screening that focuses on specific behaviors or symptoms (eg, whether a child responds to his or her name toward the end of the first year) may identify a percentage … Address correspondence to Stanley I. Greenspan, MD, 7201 Glenbrook Road, Bethesda, MD 20814. E-mail: stanleygreenspan{at}gmail.com

Children with Autistic Spectrum Disorders: Individual Differences, Affect, Interaction, and Outcomes

675  Dr. Greenspan is Clinical Professor of Psychiatry, Pediatrics, and Behavioral Sciences at George Washington University Medical School and Chairman of the Interdisciplinary Council for Developmental and Learning Disorders. VER THE PAST 20 YEARS we have formulated a model of early ego Odevelopment that integrates biological differences, developmental stages, interaction patterns, and wishes and affects. Our approach to assessing and intervening with children with autistic spectrum disorders is based on this model, which emerged from work with infants, young children, and their families. Understanding early ego development served as a foundation for a therapeutic program that has enabled a subgroup of children with autistic spectrum diagnoses to become engaging, communicative, verbal, creative, and empathetic (Greenspan and Wieder, 1977, 1998; Greenspan, 1992a). Applying developmental concepts in clinical work has also suggested a core psychological deficit in autistic spectrum disorder and the components of a comprehensive approach to intervention.

Clinical assessment of emotional milestones in infancy and early childhood

It is now possible to monitor, assess, and, where necessary, facilitate emotional development in infants, young children, and their families. The focus on the infant and the family from multiple aspects of development has made it possible to formulate developmental stages that focus on the infants social and emotional functioning. This article includes an outline for the emotional evaluation of infants and young children.

Identifying the multi-risk family prenatally: antecedent psychosocial factors and infant developmental trends

Little is known about the relationship between mother and infant within multiproblem, so-called “hard to reach” families. In an effort to understand factors contributing to problems in caring for the young children of these parents, a group of 47 families was recruited for study by the Clinical Infant Development Program of the National Institute of Mental Health. Serious social pathology was found within 75 percent of families. The lives of mothers in these families was marked by long term disruptions: 64 percent were from families characterized by recurring poverty and psychiatric illness, and 69 percent reported disruptions in parental care prior to age twelve, while more than two-thirds reported a history of being physically and/or sexually abused as children. More than 75 percent of this group of women presently showed psychiatric distress. Many of these women have difficulty in providing adequately for their young children and require innovative intervention programs in order to facilitate parenting.

The Bayley-III Social-Emotional Scale

Publisher Summary Early efforts to address the social-emotional needs of young children often were limited to diagnostic services. However, recent models focused increased attention on early identification, prevention, and intervention services, including attention to the emotional and social development of infants and young children. This attention has spawned increased interest among clinicians and researchers as to the importance of accurately assessing emotional and social development in young children, especially given the unique challenges of assessing children at such young ages. This attention, in turn, has led to the need for standardized norm-referenced measures to assess social and emotional qualities in young children. The Bayley-III Social-Emotional Scale is an outgrowth of this interest. The scale, designed for children from birth to 42 months of age, focuses on the acquisition of functional social- emotional milestones that broadly represent social-emotional patterns and significant accomplishments, not just specific or isolated emotions or social skills. Thus, the scale assesses the attainment of important age-related milestones, including the capacity to engage and use a range of emotions, experiences, and expressions, as well as to comprehend various emotional signals and to elaborate upon a range of feelings through the use of words and other symbols.