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Assessment as InterventionDIR® Functional Emotional Developmental Levels 5 & 6

A MENTAL HEALTH PERSPECTIVE

Presentation bySenior Faculty, Profectum Foundation

Diane Selinger, PhD

ContributorsMona Delahooke, PhD, Gil Foley, EdD, Serena Wieder, PhD

Members of the Mental Health Working GroupGriff Doyle PhD, Steve Glazier, MA, Connie Lillas, PhD,Pat Marquart, MFT, Stephanie Pass, PhD,Lori Jeanne Peloquin, Ruby Salazar, LCSW, BCD,Kaja Weeks, BA

Goals and ObjectivesGoal:

To introduce participants to the key aspects of the assessment of Levels V and VI in play.

Objectives:

● Participants will define Levels V and VI, as described by Greenspan and Wieder (2006).

● Participants will understand the difference between these levels.

● Participants will describe challenges in the achievement of Levels V and VI.

● Participants will recognize level of symbolic development in play scenario.

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Assessment Objectives● Has the child achieved Level V?

● What challenges make the attainment of this Level difficult?

● Has the child proceeded from Level V to

Level VI?

● To what extent has Level VI been attained?

● What challenges interfere with the attainment of Level VI?

Level V-Creating Symbols(18-30 months)

● Level V involves the creation, elaboration and sharing of meanings in language and pretend play.

● Representation of images and ideas

● Affect connects to images and ideas

● Children can experience, work through and master the anxieties inherent in development, especially the long process of separation.

● Connection to Levels I-IV and to Level VI

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● Without the development of regulation, engagement, reciprocity, intentionality and two-way communication a child cannot become symbolic.

● With the development of Level V, a child can further master and elaborate on the earlier non-verbal levels.

● Symbolic play develops from the non-verbal interactional play of the earlier levels.

Relationship of Level V toLevels I-IV

Relationship of Level V to Individual Differences

● Challenges in modulation, motor planning and sequencing, visual-spatial processing, auditory processing and language comprehension can impact attainment of this level.

● Motor-planning and sequencing provides the basis for ideation and play.

● Symbolic thought is a visual-spatial capacity that evolves with this development.

● Development of symbolic thought depends on adequate auditory processing and language comprehension.

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Development of Level V from Levels I-IV

● Attuned and contingent responses from caregiver lead to an organized mind in which imagination is even possible. (Level I)

● Play begins in the engaged relationship with the mother—the “first toy”. (Level II)

● Complex emotional signaling allows the child to separate action from perception, and thus hold images in their mind. (Level IV) (Greenspan and Shanker. )

● A complex sense of self (Level IV) allows for symbolization.

Play Precursors to Level V● Pre-Symbolic Games with Caregivers - Peek-a-boo,

chase and reunion games, etc. Games promote differentiation of self from other, and mastery of separation anxiety.

● Pre-Symbolic Play with Objects and Toys Transitional Objects (Winnicott, 1953.) Mother's real objects/Non-mother objects Spontaneous play with objects. Motor spontaneity is required for ideational spontaneity.

● Purposeful play with objects and toys.

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Assessment-Precursors to Level V

● Can the child share attention and engage with care-taker while playing with a toy, or is he self-absorbed in the object?

● Can the child play reciprocally with a toy, such as rolling a car back and forth with caretaker?

● Can the child play spontaneously with a toy by himself, and with caretaker?

● Do the spontaneous games with toys have meaning?

● Are there meaningful spontaneous games with caretaker, such as hide and seek?

Level VRepresentational and Beginning

Symbolic/Role Play● Images are formed, connected to affective experience, and

creatively elaborated.

● Role Play-real life experiences imagined and enacted. Play is affectively embodied.

● Child typically begins to represent through role play. For example, the child may cook, feed baby, pretend to sleep or drive a car.

● Representation of self and other leads to further differentiation and mastery of separation anxiety.

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Role Play and Use of Objects● In typical development, objects are used as part of role play.

For example, the child plays with toy food while representing mother cooking.

● Objects represent the real objects of life.

● In play, a child naturally begins to exchange real objects for not real ones. (i.e. a block becomes a plate.)

● The exchange of an object to signify another develops symbolization.

● Object transformation in play develops into ideational transformation.

Neurodevelopmental Challenges

● Meaningful role-play connects the affect with the body. A child may have difficulty motor-planning, sequencing and imagining this play.

● A child may bypass this meaningful play, and proceed to figures, not connected to body and affect.

● During role-play a child signifies one object for another. A child may not be able to signify or be rigid in this process.

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Representational Versus Symbolic Play

“Representational play involves the replication/enactment of activities and experiences that are apt to be rehearsed and routine patterns of daily life in different contexts and involving a modicum of pretense such as drinking from an empty cup. The Greek root of the word symbol implies a “throw” as in a throw or a leap from the literal. In our research, we then concluded that the leap from representation to symbolic play had to involve: object substitution, imaginative pretense, affect meaning and sociodramatic action. The empty cup drunk out of becomes….

Representation Versus Symbolic Play (continued)

… a symbol when placed on the head and called a hat! An important feature of the definition is the affective meaning. A symbol is often defined as a sign charged with meaning. A stop sign is just that-it sends a message. However, the same stop sign you pass everyday on the way to work becomes a symbol if you had a fender bender at the stop sign so that thereafter that same stop sign would evoke more than just a message, transforming it from sign to symbol”.

Gilbert M. Foley (Sheridan, Foley, Radlinski 1995)

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Assessment of Level V● Does the child role-play?

● What feelings are the child expressing and through what roles?

● What is the meaningful emotional theme expressed, and what anxiety is expressed?

● Has the child been able to develop more than one play scheme or action?

● Are there creative connections between schemes?

● How does the child use objects in play?

Assessment of Level V (continued)

● Is the child capable of using one object to signify another, and is this signification flexible?

● Has the child proceeded from representation to earlier imaginary symbols, such as dinosaurs? (Assess object transformation, imaginative pretense, affect meaning and dramatic action.)

● If figures are used instead of role play, has the child been able to connect affect to play with figures, or is the play a visual imitation or script, without affect connection?(Assess with larger toys, such as puppets, which are easier for motor planning.)

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Assessment of Level V (continued)

● May need to assess other avenues, such as drawing or computer pictures. Determine if child can meaningfully connect affect to representations, when motor-planning challenges are significant.

● When the child does not achieve Level V, he cannot proceed to the ideational level of symbols and representing imaginary ideas.

● Determine why child has not achieved Level V (Assess Levels I-IV, processing systems, history of pre-symbolic games and play with toys.)

VIDEO-FIGURES● Example of non-symbolic play with figures.

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VIDEO-ROLE PLAY● Observe the example of a girl's role play as

mother

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Video-An Octonaut

● Observe a boy attempting to play the imaginary character of a sea creature adventurer.

● Observe his use of object transformation.

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Level VI-Emotional Thinking, Logic, Sense of Reality

(30-42+ months)

● Images are translated into ideas. Child works at level of ideas.

● One idea can signify another idea. Ideational transformation.

● Ideas are logically connected, internally within oneself and externally to another person.

● Level V is not completely overwritten by Level VI, but continues to provide a source of creativity through spontaneous images and non-verbal connections, such as metaphor.

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Symbolization● Develops a more organized experience of self and other,

enabling child to:

distinguish his own feelings from those of others

further share in the rules and interpretation of reality of his world.

● Develops capacity for ambivalence, especially through “good-guy, bad-guy play.”

● Develops modulation of affect. The disguise of symbolization allows affect to be modulated, elaborated, processed and organized.

Assessment of Level VI● A child who has achieved Level VI is able to create a

rich, complex, emotional drama with another person, using figures or dramatic roles, that tells a coherent and complex story embodied in a place.

● The achievement of this involves a long process, even with typical development, but especially when challenges are involved.

● Neurodevelopmental challenges can interfere with this achievement.

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Assessment

● Content What symbols has the child chosen?

● Structure Role play and figures

● Narrative Structure

● Use of space

● Intrusions

Symbols “Not the REAL Thing!”

Earliest Symbols

“Blankie” to Teddy Bears

Barney, Sesame Street, Pooh …

Dora and Steve

Farms, zoos and jungles

Cat

Entry to “good and bad –bad guys”

Earliest Themes

Comfort & Reassurance

Real life learning and feelings

Explore and Think Safety and danger –

a tiger is not a kitty

Dinosaurs and DragonsSerena Wieder (2003)

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Is there a life before and after DISNEY?

Good Guys

Kings and knights

Princesses

Fairy godmother

Wizards

Batman

Superman

Power Rangers

Etc.etc.etc.

Bad Guys

Pirates

Giants

Stepmothers

Witches

Joken

Dracula

(Serena Wieder, 2003)

Typical Anxieties and Solutions

Strangers

Separation

Body Injury

Fears-ghosts and

monsters

Aggression

Good Guy-Bad Guy

Breaking the Rules

Co-regulated Affective

Interactions

Pre-verbal gestural

Magical Thinking

Control

Logical Thinking

Abstraction

(Serena Wieder, 2003)

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Assessment-Symbolic Content

● What Symbols has the child chosen?

● What emotional themes and anxieties are expressed through these symbols?

● Has the child been able to proceed through the hierarchy of symbols, or is he bound by particular symbols?

● Has the child proceeded to magical symbols and solutions, or is he bound by realism?

● Has child proceeded from magic to logic?

● Has the child developed more abstract and complex good and bad guy symbols?

Assessment-Symbolic Content(continued)

● Are symbols partial or whole characteristics?

● Is there a range of affect expressed? Are any emotional themes excluded?

● Is the affect expressed in a constricted or robust manner?

● Does the expression of particular feelings disrupt the play? Does the child disengage, actually leave the scene, or change topics with particular emotional themes?

● Is the child creative in his use of symbols, or are they only borrowed from video?

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Symbolic Structure

● Use of figures, narrative complexity, use of space and intrusions

● Neurodevelopmental challenges can interfere with capacity to use figures, develop a complex narrative, use space and transform intrusions, and thus interfere with the process of symbolization. Challenges with auditory and visual spatial processing, language comprehension and executive function interfere with the development of symbolic structure.

Use of Figures● The child builds boundaries between self and

other and elaborates different emotional aspects of the self.

● It is easier to express feelings connected to the “bad guy” with a figure-a disguised form.

● Allows for integration of various aspects of the self.

● Allows for delineation of fantasy and reality-character versus narrator.

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Assessment-Symbolic Structure

● Does the child use role play and/or figures?

● Does the child speak for the figures or narrate the story?

● Can the caretaker speak for the figures or only observe?

● If the caretaker speaks for a character, is there a back and forth dialogue?

● Can the child integrate the ideas of others, or does he control the story?

Assessment-Symbolic Structure(continued)

● How complex is the story? Are the ideas loosely connected or organized into a story with a beginning, middle and end?

● Does the child incorporate the actual physical space to represent places in the story, or use objects that represent spaces for figures, such as barns and houses?

● How does the child deal with intrusions in play? Is he guided by his ideas and narrative or by the visible objects in the room?

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Content and Structure● The content and structure reveal the level of

symbolic development.

● Does the child display difficulties with the symbolic content, symbolic structure or with both aspects? What challenges interfere with the development of organized play?

● Can the structure contain the content, or do strong affects derail the play in a child who otherwise can organize play?

Working with Parents● Helping parents become symbolic

● Helping parents deal with aggressive themes, and especially playing the “bad guy”

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Reflection● Through symbolic play the child begins the process

of reflection.

● The reflective process ushers in emergent abstract thinking.

● Can ask reflective questions:

What did the child like in the play?

What is the child's favorite part of the play?

How does the child feel?

What are they reminded of? Etc.

VIDEO-PLAYING SEPARATION

● Example of a child with challenges in motor planning and language who is able to use train figures to express various feelings regarding separation.

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VIDEO-RIDING A HORSE

● Observe a 3 ½ year old girl play with the mother figure as her mother plays with the child figure who rides and falls off a horse. Observe how her adequate language and motor planning allows her to play out this pretend scene.

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References● Greenspan, S.I., and Shanker, S. 2004. The

First Idea: How Symbols, Language and Intelligence Evolved From Our Primate Ancestors to Modern Humans. Cambridge, MA. Perseus Books.

● Greenspan, S. I., and Wieder, S. (2006). Infant and Early Childhood Mental Health: A Comprehensive, Developmental Approach. Arlington, VA: American Psychiatric Publishing

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References (continued)

● Sheridan, Margaret K., Foley, Gilbert M., Radlinski, Sara H. (1995). Using the Supportive Play Model: Individualized Intervention in Early Childhood Practice. Early Childhood Education Series. Teachers College Press.

References (continued)

● Wieder, S. (2004). DIR Developmental Pathways to Emotional Challenges. Building a Symbolic World. (Power Point slides). Presented at the Infancy and Early Childhood Training Course, 2004.

● Winnicott, D.W. (1953). Transitional objects and transitional phenomena: a study of the first not-me possession. International Journal of Psychoanalysis. 34: 89-97