About the P.L.A.Y. Project
The world of autism and developmental delays has grown in the past 2 decades. Prior to the 1990’s, 4-children out of 10,000 had a diagnosis of autism. Recent numbers from the CDC quote numbers as high as 1 out of every 88 children. The National Academy of Sciences brought out a paper in 2001 that the best practices for the treatment of autism would be to begin treatment as early as possible. Treatment should consist of about 25 hours each week and it should be 1 adult to one child or one adult to two children, in other words highly individualized. It also spoke highly of treatment being engaging in nature. There should be a strategic direction to the treatment plan.
Our View on Autism at A Total Approach
We see many beautiful children on very varying and different places on the autism spectrum. We believe in their individual differences, and believe that they are very capable of communicating their needs to us if we would only listen and observe. Children on the autism spectrum are very adept in making decisions about their environment and highly capable of various different emotions. They are very honest and can feel whether you are serious about caring about them. We validate whatever they bring to the table and work from a place where we could join them. If they need to participate in self stimulatory activities, we do not remove their need, but work with them until they choose to use more functional replacement activities. We believe they should own their change and not behave in a certain way only to suit our society without understanding why We believe that just like any other person, they have as much a need, if not more, to find control in their world as we do, yet every day we find adults believing that they know the needs of children better than themselves.
The answer lies in facilitation of the growth process, not over structuring an environment, where the child has to use rote memory with no meaning to get a specific task done. For us it is about the child and his/her profile, not about the diagnosis.
Many parents arrive at our door having completed a myriad of programs, having listened to many people and professionals and some have gone from one treatment process to the other. We have lived through great success with the use of the DIR method, designed by Dr. Stanley Greenspan. These services are clinic based and we were looking for a program closer to the home that would train and empower parents to do this kind of program in their homes. We found Dr.Solomon’s P.L.A.Y. project and decided that this was a good solid structured program making it much easier for parents to follow in their homes.
“The vision of the P.L.A.Y. Project is to be a community based/regional autism training and early intervention center dedicated to empowering the parents and professionals to implement intensive, developmental interventions for young children with autism in the most cost-effective and efficient way.”
The project embraces the DIR model and Functional Emotional Developmental Levels of Dr. Stanley Greenspan:
- Self Regulation and Shared Attention
- Two-Way Communication
- Complex Two-way Communication
- Shared Meanings and Symbolic Play
- Emotional Thinking
Dr. Solomon and his group has trained over 60 agency and school personnel (over 2000 Floortime Practitioners) in various parts of the country and is based out of Ann Arbor Michigan. He officially conducts a training process for the Floortime practitioners that consist of a 4 day weekend training, and a 1-year long supervision and certification. At our center at A Total Approach, our Floortime practitioners will work under the supervision of Maude Le Roux, who has the DIR Certification and also is a Faculty Facilitator for the National DIR Institute.
About Dr. Solomon
Research and Evidence
The PLAY Project is excited to announce that our 3-year NIMH-funded randomized, controlled trial has yielded positive and statistically significant results! For more information about this study, please see the grant summary below. We are in the process of publishing the results and will conduct a formal press release upon publication. To hear Dr. Solomon discuss the details of this study, please listen to his webinar: Session 4 – The PLAY Project: Research Overview.
The PLAY Project Intervention for Autism 2009 – 2012 NIMH Grant Program Summary
A growing number of children (1 in 88) with autism spectrum disorders ASD need intensive intervention (25 hours/week, 1:1 or 1:2 professional to pupil ratio), which most states do not provide because a) there is a national shortage of trained personnel, b) such interventions are very expensive, and c) an evidence-based, cost-effective model has not yet been developed for national dissemination. As a result, there is a very large unmet national need for autism services.
The PLAY (Play and Language for Autistic Youngsters) Project Home Consultation Program, under the direction of developmental and behavioral pediatrician Richard Solomon MD, is an innovative train-the-trainer solution that could potentially address this national need.
Since publication of the pilot study in 2007*, PLAY was awarded a $1.8 million 3 year NIH SBIR (Small Business Innovations Research) grant in 2009 to implement a randomized, multi-site, blinded, controlled effectiveness study. This study compared children in the control group who received Community Standard Services (CSS)—typically special education pre-school—to children in the intervention group who received CSS plus PLAY Home Consulting. The Home Consultation Program is a once a month (3 hour), home-based, parent training program that uses certified masters level pediatric professionals (SLP, OT, MSW MEd., etc) as coaches. PLAY operationalizes Greenspan’s DIR/Floortime framework into a practical, fully manualized approach. Parents are supported to PLAY for a total of two hours per day in ways that are sensitive, responsive, and effective in engaging their hard to engage young children (ages 18 months to 6 years old) with ASD.
With Easter Seals National as our clinical partner and and Michigan State University (Hiram Fitzgerald PhD and Laurie VanEgren PhD) as our evaluation partner, The PLAY Project NIH Grant successfully recruited 112, 3-5 year old children with ASD at 5 Easter Seals sites. Each year a cohort of 30 families received monthly 3-hour PLAY Project home visits for 12 months. Thus about 55 intervention families and 55 control families were recruited.
Data analysis from both cohorts is being finalized to confirm that children in the PLAY intervention group improve when compared to the control group. Our research is focused on whether PLAY children improve in autism severity, language, and interaction; and whether parents learn to PLAY better. We are also hoping to show that PLAY Home Consultants show fidelity to the PLAY model.
With positive results, The PLAY Project would show promise as a replicable developmental model of autism intervention using an efficient train-the-trainer model at relatively low cost to parents and society that can be broadly and quickly disseminated to serve a growing, unmet national need.
* Solomon R, Necheles J, Ferch C, Bruckman D, (2007) Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program. Autism Vol 11(3) 205-224.
Dr. S. Greenspan and Dr. S. Wieder
The 4 truths and relationships
Dr. S. Greenspan and Dr. S. Wieder wrote an article in the professional 0 to 3 Journal titled: “Assessing and treating infants and young children with severe difficulties in relating and communicating”. In this article they note 4 truths that we hold very dearly at our center: P.L.A.Y.
- “Every child has his or her own profile of development and requires an individualized approach.”
- “A child’s symptoms and problem behaviors often stem from underlying problems in sensory modulation and processing, motor planning, and affective integration.”
- “All areas of development are interrelated”
- “The child’s interactions in relationships and family patterns are the primary vehicle for mobilizing development and growth.”
The pyramid model
- Basic services for safety, protection and security (e.g., physical and emotional contact, adequate food, housing, and medical care)
- The formation of ongoing trusting relationships
- The implementation of relationship s geared to the child’s individual differences in sensory reactivity, processing and motor planning
- Techniques to promote development. Interactions matched to the child’s developmental level, which also promote the next developmental level
“Relationships serve many functions in young children”:
- "Fosters warmth, intimace and pleasure"
- "Regulatory aspects of relationships help maintain pleasure in intimacy and a secure, alert state that permits new learning and development to occur"
- "Provides the basis for communication"
- "Are the context for learning which behaivoirs are appropriate and which are inappropriate"
- "Relationships enable a child to learn to symbolize experience"
“Understanding underlying differences provide a basis for tailoring approaches to the child’s individual differences an d underlying processing dysfunctions.”
“Everyone interacting with a child provides another relationship in which to learn.”
“There is emerging evidence that interventions that are intensive and deal with each child as an individual can help significant numbers of children”
Our daughter Sophia, now 4, has recieved therapy through ATA since the age of 2, and has made consistent developmental progress that has surpassed our expectations. One of the key elements in her success has been the support and guidance we have recieved from Janine and Maude via The Play Project. The guidance is so specific to our child's needs and has been wonderfully convenient as it was provided within our own home environment. With clear goals and compassionate support we have experienced through The Play Project, we continue to watch our child blossom to her greatest potential. This is a therapy service I would recommend to any parent.
JoAnne Cooper – March 2008