FASD Reflections

FASD the preventable disability. Working with people with FASD can be extremely challenging. Not only do they have neurological deficits but social and learning difficulites as well.

Compromised executive functioning D
Difficulty planning, predicting, organizing, prioritizing, sequencing, initiating, and following through. Difficulty setting goals, complying with contractual
expectations, being on time, or adhering to a schedule.

➤ Difficulty with memory
Information input, integration, forming associations, retrieval, and output. Difficulty learning from past experiences. Often repeat the same mistake over and over again in spite of increasingly severe punishment. Inconsistent memory or performance; may remember on Monday, forget by Tuesday.

➤ Difficulty with abstract concepts
Such as time, math, or money.

➤ Impaired judgment
Often unable to make decisions. Difficulty understanding safety and danger, friend and stranger, or differentiating fantasy from reality.

➤ Inability to generalize information
Difficulty forming links and associations, unable to apply a learned rule in a new setting; learns to not take Johnny’s bike, but then takes Mary’s bike.

➤ Communication challenges
Appears to understand instructions, nod and agree, but is unable to comprehend. Often repeats rules verbatim, then fails to apply the rules — “talks the talk” but doesn’t “walk the walk.”

➤ Language problems
Difficulty comprehending the meanings of language and accurately answering questions. May agree or confabulate — comply or fill in the blanks. Many talk
excessively, yet are unable to engage in a meaningful exchange. The sheer volume of words creates the impression of competence.

➤ Slow cognitive pace
May think more slowly, say “I don’t know,” shut down, or require minutes to generate an answer rather than seconds. Those with fasd are “Ten‑second people in a one second world.”

➤ Slow auditory pace
Central auditory delays means language is processed more slowly, requiring more time to comprehend. Many only grasp every third word of normally paced speech.

➤ Preservation
May be rigid, get stuck, have difficulty switching gears, stopping an activity, or transforming to a new activity. Often react strongly to changes in setting, program or personnel.

➤ Dysmaturity
Often function socially, emotionally, and cognitively at a much younger level developmentally than their chronological age. A 5-year old may be developmentally more like a 2-year old, a 12-year old more like a 6-year old; and a 25-year old more like a 13-year old.

➤ Impulsivity
Coupled with inability to abstract and predict outcomes; acts first and then is able to see the problem after the fact.

➤ Sensory systems dysfunctions
May be over-reactive to stimuli — e.g. tactile defensiveness. May be easily overwhelmed by sensory input, may be unable to filter out extraneous stimuli; symptoms include increased agitation, irritability, and aggression. May under-react to pain — may not complain of earaches, broken bones, and be unable to experience painful stimuli.

Secondary Behaviours

Secondary behaviours are defensive behaviours that develop over time when there is a chronic “poor fit” between the person and his environment. Defensive behaviors are normal protective reactions to frustration and are helpful cues for identifying points of intervention.

By definition, these are preventable when a good fit is provided. Again, these are not exclusive of fasd.

• Inappropriate humor — the “class clown.”
• Pseudo-sophistication; may echo words, phrases, manners, and dress in order to “pass” as competent beyond their actual ability, often to their detriment.
• Fatigued, irritable, resistant, argumentative.
• Anxious, fearful, chronically overwhelmed.
• Frustrated, angry, aggressive, destructive.
• Poor self-concept, often masked by unrealistic goals or self-aggrandizement.
• Isolated, few friends, picked on.
• Family or school problems including fighting, suspension, or expulsion.
• May run away, have other forms of avoidance.
• Trouble with the law, addictions.
• Depressed, may be self-destructive, suicidal.

Secondary behaviors often develop in early childhood, frequently becoming patterns of behavior by adolescence. Secondary conditions come at a high cost to the individual, their family, and the community. Early identification of both primary symptoms and secondary behaviors is necessary in order to develop appropriate
interventions, or “accommodations” that prevent or resolve secondary behaviors.
Section 4 of this document (“Reason”) provides a useful table outlining primary and secondary behaviours and the kinds of interventions or “accommodations”
that work and don’t work in coping with them

(This breakdown of primary and secondary behaviours has been adapted from a presentation by Diane Malbin at the 2005 FASD National

Special Class An example of a school that has special classrooms for students with fasd is the David Livingstone Community School in Winnipeg, Manitoba.

“This is an Early Childhood Behavioural Treatment Program … designed for students who display severe behaviour resulting from fas/fae or other neurological difficulties. A description of the program is as follows:
low stimulus environment,low enrolment classroom, focus on social skills, behaviour and academics, strong consistent classroom agenda, individual education plans, predictable routines and expectations, behaviour plan consistently reinforced by Teacher Assistants and Support personnel, consistent consequencing, speech therapy on site two times a week, occupational therapy on site once a week.”

This program has had demonstrated success with students seriously affected with fasd.
Conference, “Equality of Access: Rights and the Right Thing to Do.”

INCREASING SUCCESS IN SCHOOL THROUGH PRIMING

Research has shown that for some students a method that could be more beneficial is to provide information that is to be presented in the near future rather than continually focusing on what has already been presented. Some students may engage in behaviours to escape or avoid due to the anxiety they experience when faced with new material. The important feature of priming is to target pivotal behaviours such as motivation, interest and attention.

Koegal et al. (1997) defines priming as an intervention which previews material or activities that a child is likely to have difficulties with. The goal of priming is to increase the child’s competence in a given learning field before inappropriate behaviour can surface. Material is presented as closely as possible to the way it will be presented the following day. The child is then prompted to respond to questions or evoke responses that they have already been prepared for.

Specific session lengths have not currently been assessed systematically but short, meaningful sessions tend to be more effective than lengthy sessions. The more pleasant the experience the more likely it is that the child will retain the information and be motivated to continue the learning. When the information is more challenging for the individual, specific sections should be targeted in order to prevent anxiety from escalating. If the child has difficulty with complex sentences or words the point than is to familiarize the student with words or names that they can easily recall and prompt them the following day for that information. The child can then experience success without having to fully comprehend all the information being presented. Priming becomes about participation in learning not getting “it right”.

There are four general steps used in the priming program:

1. Collaboration – Who will be responsible giving assignments to primer? Conducting the sessions?
2. Communication – How often? Where will the materials be left? Where will the materials be returned?
3. Priming – Place, Time, Duration, Mood
4. Feedback – Is priming working? From teachers, parents, child’s perspective
The main component of the priming method is to understand that it is not necessarily about teaching the new information but the importance is to introduce new material. The child does not need to grasp the entire concept of what is being presented. Priming is about involving the child in positive interactions around their learning to hopefully encourage motivation for further learning experiences.
When to do the priming may cause some concern. Certain information can be delivered just hours before they need to utilize it but other time priming may have to occur the night before. Setting up a specific routine initially may help to alleviate some of the confusion around when priming should occur.

Helping Children With Autism Learn

When deciding a treatment program for an child with autism it can become very distressing and confusing. Lacking is the research in relation to long term treatment outcomes for the various treatments.. Don't get me wrong there is research in relation to treatment programs like ABA, drug therapies, Floortime, Dietary Modifications, Play Therapy, Behaviour Modification Programs, but not conclusive for all children with Autism. The point I am trying to make is that not one particular method may be the most beneficial for children with Autism. However it seems fairly clear that early intervention in key areas may be the most beneficial.

The core skill deficits for children with Autism may be referred to as "Autism Specific Learning Disablities"(Seigal, 2003). It is necessary to treat the individual symptoms not the diagnosis.
When preparing a treatment intervention it is vital to consider the following areas to determine the child's individual deficits or "learning styles" and to identify the child's strengths/ weaknesses:

1. Cognitive: How is the brain functioning?
2. Developmental: Social, communication, engagement, emotional functioning
3. Educational: Plans, Learning, Assessments
4. Medical: What are the child's physiological differences?

When a holistic assessment has been completed the planning process can be developed. The underlying philosophy of any treatment/program or individual/agency/professional must also be examined prior to commencement of intervention. Motivation to learn is enhanced by providing enriching experiences for the child. Encouraging the child to seek out pleasurable experiences and continue seeking those experiences should be a main goal of those providing learning environments for children with special needs.

It may also be important to consider providing activites for the child to move from a situation of forced responding to active responding. Providing time for activities that are self-initiated encourage the development of problem solving skills which enhances higher level learning capapbilities. Forcing children to respond to stimuli may acheive the desired outcome but does it actually show that the child has learned a new skill or can transfer that learning to different environments?

BEST PRACTICE EDUCATIONAL STRATEGIES:

The three "P"'s may be helpful for children with Autism Specific Learning Disabilities:

1. Priming: Pre-practice is an excellent way to introduce material to children before they have to activley engage in learning the material. Priming may also be beneficial to encourage peer or social interactions, initiation of social interactions or becoming familiar with a story from a social situation before it given to the entire class.

2. Prompting: The teacher can use prompting strategies for the child with autism while also including "neurotypical" peers in the process. Prompt the "neurotypical" child who then in turn prompts the child with Autism. Prompts can also be used directly with the child with autism.

Research has also been conducted on using a tactile prompt like a device in the student's pocket that vibrates when the child should intiate a social / verbal interaction.

3. Pictures: Picture schedules increase predictability and is an alternative to verbal or written communication. Can serve as effective cues for children with autism to commence or deter them from a certain behaviour. Is also helpful in transitions and times that may cause increased stress or frustration.

4. Delayed or Contingent Reinforcement: Research has shown that students with disabilities are less likely to engage in inappropriate behaviour while being supervised by an adult. The removal of the adult also removes the positive reinforcement that is given to the student. Research has been completed that uses unpredictable schedules of supervision and found an increase in appropriate behaviours as the student was unaware of when supervision would be occuring. This may conclude that "thinning" supervision may be required to increase on task behaviour without supervision. (See Dunlap, Pilienis, and Williams 1987)

5. Self-Management Strategies: These strategies are requried to encourage independence and self responsibility from the student. Self monitoring forms or sheets to encourage self-analysis on inappropriate/appropriate behaviours can be utilized. Students with disabilities were taught ot use a wrist counter to record their correct responsed to questions and rewarded.

6. Peer Tutoring: Classwide Peer Tutoring (CPT) involves pairing of children and who then work together to complete a project.

7. Peer Support: Training specific children to interact with children with Autism on a regular basis. Increased the probability that children will engage and interact.

8. Cooperative Learning: Teaching academic and social skills to both children with autism and their "neurotypical" peers.

MULTICOMPONENT INTERVENTION:

Educators have utilized a multicomponent intervention to target increased inclusion for the child with autism.

Hunt, Alwell, Farron-Davis and Goetz (1996) evalualted a multicomponent intervention that comprised of the following:

a. weekly club meetings to discuss interactions between peers and students with autism
b. various media used for communicative purposes
c. rotating buddy system

Dramatically increseased reciprocal interaction between peers and students with disabilities.

PRETASK SEQUENCING:

Precede a difficult task with a series of smaller tasks and reinforcing compliance with these easy requests.

Pivotal Response Training and Naturalistic Teaching Strategies:

Increasing motivation to learn by incorporating choices, reinforcing attempts, using adequate modeling, natural consequences, and natural language teaching interactions.

Research in relation to outcomes of these strategies and new innovative strategies need to become priorities as children with ASD, ADHD, and oppositional behaviour are entering our classrooms at staggering rates. Full inclusion requires appropriate resourcing and funding to allow children with disabilities to meet their full potential.

Dr. Amen and ADHD

Dr. Amen is a well known child and adult psychologist specializing in brain imaging science. He believes there are currently 6 types of ADHD not the 3 stated in the Diagnostic Manual.

The brain imaging that he works with is referred to as SPECT imaging (single photon emission computerized tomography). SPECT is a sophisticated nuclear medicine study that looks directly at cerebral blood flow and indirectly at brain activity (or metabolism). In this study, a radioactive isotope (which, as we will see, is akin to a myriad of beacons of energy or light) is bound to a substance that is readily taken up by the cells in the brain.

One kind is a 3D surface brain image, looking at the blood flow of the brain’s cortical surface. These images are helpful for picking up cortical surface areas of good activity as well as underactive areas. They are helpful to look at strokes, brain trauma, the effects from drug abuse, etc. A normal 3D surface scan shows good, full, symmetrical activity across the brain’s cortical surface.

The other kind is a 3D active brain image comparing average brain activity to the hottest 15% of activity. These images are helpful for picking up areas of overactivity, as seen in active seizures, obsessive compulsive disorder, anxiety problems, certain forms of depression, etc. A normal 3D active scan shows increased activity (seen by the light color) in the back of the brain (the cerebellum and visual or occipital cortex) and average activity everywhere else (shown by the background grid).

Physicians are usually alerted that something is wrong in one of three ways: (a) they see too much activity in a certain area; (b) they see too little activity in a certain area; or (c) they see asymmetrical areas of activity, which ought to be symmetrical.

These are "neurotypical" images of the brain.

1. Classic ADHD: Sufferers are inattentive, distractable, disorganized, hyperactive, restless and impulsive SPECT Brain imaging typically shows decreased activity in the basal ganglia and prefrontal cortex during a concentration task. Dr. Amen notes that this subtype of ADD typically responds best to psychostimulant medication.

2. AD/HD, primarily inattentive ADD subtype with symptoms of inattention and also chronic boredom, decreased motivation, internal preoccupation and low energy. Brain SPECT imaging typically shows decreased activity in the basal ganglia and dorsal lateral prefrontal cortex during a concentration task. This subtype of Inattentive ADD also typically responds best to psychostimulant medication.

3. Overfocused ADD, with symptoms of trouble shifting attention, cognitive inflexibility, difficulty with transitions, excessive worrying, and oppositional and argumentative behavior. There are often also symptoms of inattention and hyperactivity-impulsivity. Brain SPECT imaging typically shows increased activity in the anterior cingulate gyrus and decreased prefrontal cortex activity. This subtype of Overfocused ADD typically responds best to medications that enhance both serotonin and dopamine availability in the brain, such as venlafaxine or a combination of an SSRI (such as fluoxetine or sertraline) and a psychostimulant.

5. Limbic ADD, with symptoms of inattention and/or hyperactivity-impulsivity and negativity, depression, sleep problems, low energy, low self-esteem, social isolation, decreased motivation and irritability. Brain SPECT imaging typically shows increased central limbic system activity and decreased prefrontal cortex activity. This Limbic ADD subtype typically responds best to stimulating antidepressants such as buprion or imipramine, or venlafaxine if obsessive symptoms are present.

6. Ring of Fire ADD – many of the children and teenagers who present with symptoms of ADD have the "ring of fire" pattern on SPECT. They often do not respond to psychostimulant medication and in many cases are made worse by them. They tend to improve with either anticonvulsant medications, like Depakote or Neurontin, or the new, novel antipsychotic medications such as Risperdal or Zyprexa. The symptoms of this pattern tend to be severe oppositional behavior, distractibility, irritability and temper problems and mood swings. We think it may represent an early bipolar pattern.

The important thing to remember is that each individual should have a full diagnostic assessment of their condition. Interventions could include:

1. Diet

2. Exercise

3. Medication

4. Supplements

5. Behavioural Interventions - for person with ADHD and family (Neurofeedback)

If medication is given it is important to make sure that there is proper supervision, followthrough and evaluation of the child. You also need to find the right doctor who will spend time with the family to explain the use of the medication and alternatives.

THE BRAIN AND EARLY CHILDHOOD

The brain weighs approximately 3 pounds and has been the topic of many a research article. The amount of information in relation to how the brain functions is vast but has not even scraped the surface of understanding. There is so much more to learn but there have been many insights that researchers have uncovered that help us when it comes to teaching the young brain to respond to learning.

During the early years 0-10 the brain is at its most vulnerable stage to change. Parents and educators share a desire to maximise the growth and development of children to ensure a strong foundation as they continue to mature. Providing children optimal learning opportunities and engaging environments can encourage the process of acquiring knowledge and the ability to apply that knowledge. Certain methods of learning can be used to help acheive this goal.

Play and the Brain: Play is a complex, lifelong activity. Play usually involves both mental and social skills that promote learning. Here are some things to think about when initiating play activities with your children:

1. Active, Meaningful Learning: Hands on activity, pleasurable, symbolic, practice, exploration, embedded and integrated.

2. Safe Non-Threatening Environments: Encourage risk taking, persistance, ownership, and activities that are intrinsically motivating.

3. Stimulating, Varied Input: Challenging, Varied materials, choice, interaction with peers, sensory input, complex materials

4. Accurate, Timely Feedback: Rewarding, pleasurable, interaction with both peers and adults

Remember at birth a child's brain is not fully functional. As the child experiences their environment(through sensory and tactile modes) along with their genetic inheritance, the brain's neurons and dendrites explode along pathways setting down information neccessary for the child to function. The brain is not static so it is constantly changing and modifying according to the experiences in the environment.

Enriching the Environment: (Diamond & Hopson, 1998)

1. Includes a steady source of positive emotional support
2. Provides a nutritious diet with enough protein, vitamins, minerals and calories
3. Stimulates all senses (not necessarily all at once)
4. Has an atmosphere free of undue pressure and stress but suffused with a degree
of pleasurable intensity
5. Presents a series of novel challenges that are neither too easy or too hard for
the child at his/her stage of development
6. Allows social interaction for a significant percentage of activities
7. Promotes the development of a broad range of skills and interests that are
mental, physical, aesthetic, social, and emotional
8. Gives the child the opportunity to choose many of his or her efforts and to
modify them.
9. Provides and enjoyable atmosphere that promotes exploration and the fun of
learning
10. Allows the child to be an active participant rather than a passive observer.

** An enriched environment gives the child an opportunity to make sense out of what they are learning rather than just taking in meaningless data.
** The brain develops in an integrated fashion. An enriched environment addresses multiple aspects of development simulateously.
** The brain is naturally curious. It constantly seeks connections between the new and the known. Learning is a process of active construction by the learner.
** The brain is innately social and collaborative. Learning is enhanced when the environment provides them with an opportunity to discuss their thinking out loud, to talk with peers and to produce collaborative work.

IQ is not fixed at birth. Intervention programs for impoverished children could prevent children having low IQ's (Ramey & Ramey, 1996).

There are sensitive "windows of opportunity" where some abilities are acquired more easily. Vision and language development seem to have very "tight windows" If sight is not restored by age 3, if the child has had cataracts or blindness the cells in the brain designed to interpret vision to atrophy or be diverted by other tasks (Bruer).

**When we are able to add emotional input into learning experiences to make them more meaningful and exciting, the brain deems the information more important and retention is increased. However extreme emotional experiences may actually do the opposite and cause memory loss rather than retention.

A child's brain moving from pre-school to kindergarten to grade one does not automatically change from an experience or play based learning brain to a "sit down" higher order advanced thinking brain. Therefore many researchers still agree that up untill the end of grade 2 or even grade 3 children still learn best through projects, learning centers and playful activities.

Suggestions for grade primary classrooms:

* Child initiated learning, centers for construction, sand, water play, socio-dramatic play, woodworking, puppet center, cooking center, library center, science/math center, block building/manipulative center, etc....

Strengthen each child's natural curiousity to investigate, hypothesis, and look for cause and effect. These as well as play activities present for the child many different opportunities to engage and interact within their environment. Encourage each child's individual ability and tailor the learning to their needs. Building on the child's interests and strengths will lead to pleasurable learning experiences and continued motivation for life long learning.

A FEW THOUGHTS ON TEACHING!

I became a teacher because I had excellent relationships with those that taught me in both primary school and high school. Their ability to engage and connect with me made me realize that teaching was what I wanted to do as a career when I had the opportunity to do so. Teachers guided me and counselled me when I was experiencing the typical adolescent dilemmas. They encouraged me to excel and find my passions and interests as I became a young adult. I remember them not for the curriculum they taught me but for the life lessons that they helped me learn.

My philosophy is very much centered on these experiences I had with my teachers as a child. I believe that children continually go through developmental stages in their lives where they need discipline, guidance and support. Teaching is not all about delivering curriculum or information but connecting to engage them to make personal decisions that encourage their own growth and development.

I have learned that initially my methods were authoritarian and controlling. I needed to feel that I was in control of the classroom and all those within it. I did not recognize the complexity of the situation in relation to the different way students responded to my style of teaching. It was my classroom and they would do as I told them. I did achieve outcomes using this style of teaching but was very concerned with those students who were not managing to keep up with the level of information that they were required to learn. I remember a deputy principal saying to me “ Don’t worry about her we’ll just pass her and move her on to the next grade.” This child was having difficulty reading and writing in grade 9. I realized at that point that the outcomes that I was getting were superficial. Was I actually teaching these kids to learn or was I imparting information that they needed only to pass the tests?

My style of teaching began to change as I started to work with high risk children. Using this authoritarian style was not as effective as using it with those children whose behaviour was compliant and socially acceptable. The high risk children needed different methods and it took a few years to figure out that maybe I needed to change my approach rather than expecting them to do all the changing. Evaluating children’s needs using a holistic perspective was required from me so I could understand the underlying motivation and function of their behaviour in relation to their learning.

The number of damaged children that I have encountered has encouraged me to look beyond their “academic marks” and find the things that help them create their own peace in their lives. Fixing them is not my responsibility. The only person that I have the power to fix or change is me. I do not control anyone else but myself. I am still working towards this understanding as I know there are some days and some people who I would love to control to get them to do what I want them to. I now know that this will only increase my stress levels and make me unhealthy.

Teaching our children that they have the power to make their own decisions and solve their own problems, I believe, will create children who feel powerful within themselves and hopefully not have to feel powerful over others. Those that feel powerful within tend to help others because they want to share their positive feelings. People who are negative and unhappy want you to feel the same way as well so they try to get you in the same frame of mind as them. (Power over you) Children that are able to understand that they control themselves and can make decisions in relation to others will be far better off as they encounter situations where others are trying to take power from them in negative and hurtful ways.

People who try to be powerful over others are seeking this feeling of happiness and satisfaction but may only receive short term gratification. They may feel happiness and satisfaction as an immediate feeling but will have to continually seek it out from others as they can never retain it (a bit like taking drugs - you need more to maintain the high but never reach the ultimate feeling as you need to keep taking more and more which will ultimately destroy yourself.) We can only retain this feeling if we make the decision within to seek happiness and satisfaction through our own behaviour and interactions with our environment and that others do not have control over how we react. Wouldn't it be great if everyone made the decision to be happy, help and understand others (powerful within) rather than try to be powerful over others.

I know, I know, naive and wishful thinking but I can dream can't I...... I can also teach.....

Sensory Motor Regulatory Patterns

THESE WONDERFUL ACTIVITIES WERE SENT TO ME BY: Author: Bill Nason,LLP

Sensory Motor Regulatory Patterns

Purpose: Calm and organize nervous system

Promote emotional attunement

Establish “facial gazing” and “emotion sharing”

Establish adult as soothing support when distressed.

Use very simple interactive activities, such as peek-a boo, “I am going get you”, rocking back and forth, sandwiching/squishing with bean bag, etc. that provides repetitive, rhythmic interaction patterns.

Sit (stand) face to face, at eye level, with close physical contact. This allows you to regulate activity, keep child focused, and encourages facial gazing.

Add rhythmic singsong or chatting (like “row, row, row your boat”) to the rhythmic pattern. This uses your voice, touch, and facial expression to engage the child.

Use exaggerated gestures, animated facial expressions, and exciting vocal noises to engage the child, establish facial gazing, and share enjoyment.

Your primary objective is to establish facial gazing so that the child can reference your emotions. Start the rhythmic pattern and establish facial gazing. If child averts his gaze (turns away), hesitate and pause the interaction until child returns gaze, than immediately restart pattern. If needed you can stutter or exaggerate the movement, slow it down or speed it up, or raise or lower your voice to draw child’s gaze back to you.

You can greatly enhance the emotion sharing by spotlighting the exciting part of the pattern. Hesitating, pause, exaggerate, or draw out the moment just before the climax (just before dropping, tickling, etc.). For example, in peek-a-boo, just before showing your animated face, draw out the words “peek, aaaaaaaaaaa, boo!”. This creates anticipation and excitement.

Stay with same pattern for a while to create sense of predictability and familiarity. As the child becomes comfortable with the pattern, you can add simple variations to the pattern. Keep it very simple at first and add small variations to provide novelty and excitement. If child seems too anxious by the change, back up to previous pattern.

Try to pick only a few patterns to start out with. Keep them simple and do them the same way at first so that they become familiar and predictable for the child.

Eventually you we feel the child start to help regulate the activity. As you hesitate, child may actively attempt to regulate the pattern.

It is important that you lead the activity, and don’t let the child control or direct the interaction. You want the child to learn to follow your lead and allow you to regulate interaction.

Remember what your objectives are. You are focusing on establishing “facial gazing”, “emotion sharing”, and “engagement”.

Most importantly, engage the child and have fun!

1. Rocking, swaying, or dancing together. Standing or sitting, hold child’s hands or arms, and rock, sway, or dance in a simple rhythmic movement. Chant or sing.
2. “1,2,3…bop!” Gently clap hands and tap cheeks. Take her hands in yours, clap them softly together to the count of “1..2..3” and “bop!” tap her hands to your cheeks. Than, repeat to her cheeks.
3. Peek-a-boo, using child’s hands or feet. Animate your facial expressions and voice.
4. Leg presses. Lie child down. Knell in front of him and bend his knees so they are up in the air, with your face between them. While counting to three bounce his knees slightly. Chant “1..2..3…pause/hesitate…PRESS!” and press his knees down and in toward his chest. Allow your face to follow so it comes into close to his gaze.
5. Blowing up balloon. Adult blows up balloon with animated expressions. Gently let air out on child’s hand or neck, make squeaky noises while letting air out, or let go of balloon to fly around the room. Variation: have child press against your cheeks as you blow. . In addition, tie the balloon and gently tap it back and forth.
6. Blowing bubbles, face to face, while child touches, claps, or tries to catch them. Get close, wait to child references your face before blowing the bubble.
7. “Up..up..up…drop!” With child lying down, hold her arms and gradually lift her upper body with stuttering pauses (“up..up..up”). Hesitate, than let child drop back down with animated excitement.
8. “I am going to get you, get you, get you!”….than tickle, poke or kiss the child.
9. Rocking/rowing back and forth. Sit facing each other, holding each others arms. Slowly rock back and forth (to “row your boat”), or pull each other (stretch) back and forth.
10. Crash, fall, or jump together into bean bags. Stand side by side, count to three…pause.. and fall together. Lie there a moment and tickle each other.
11. Push child backward into bean bags. With child’s back to bean bags, count 1,2,,3 and push child to fall backwards into bean bags. Cuddle and tickle together on bags.
12. Pillow press with bean bag or large pillow. With child lying down, chat, “I am going to get you!” and squish him with a beanbag. Keep your face close to his for emotion sharing.
13. Friendly pillow fights. Use animated faces and excited vocals to create anticipation.
14. Sit and bounce together on therapy balls. Hold hands and bounce or sway together. Add excitement by creating a chant and falling off!
15. Toss a ball back and forth, or try to hit each other with a soft ball.
16. Clapping hands or drumming to music. Get face to face, take her hands and clap them to a simple beat, with animated singing.
17. Swinging. With child in a swing. Stand in front of her, take her legs and swing her back and forth. On the way up, hold and pause to elicit anticipation, than let her drop and swing back. Variation: As she swings, grab feet each time she comes back. Variation: Pretend to be kicked each time child comes back at you.
18. “This is the way the cowboy rides!”. Sit child on your knees, facing you. Take her arms and gently bounce her on your knees. Start with “this is the way the lady rides”, than “gentleman rides”, than “cowboy rides” as you increase the intensity of bouncing.
19. Making a sandwich. Make a sandwich with the child as meat. Lie child on a large pillow or couch cushion. Child pretends to be their favorite meat. Pretend to spread mustard, catsup, pickles, etc. on her in tickling fashion. Next place another large pillow on top of child and pretend to eat her.

20. Rolling prone on ball: Lie child prone on a ball. Holding his hands, roll him back and forth to “Row, row, row your boat”. Pause and go faster for “merrily, merrily, merrily, merrily, life is but a DREAM” and roll child off ball into your arms.
21. Bounce and fall off ball. Knee in front of child. Hold child and bounce him on a ball to Humpty Dumpty. Pause and draw out “h...a..d….a…g..r..e..a..t…..” and bounce child off onto a bean bag to “FALL!”
22. Rolling ball on child: With child lying down, roll therapy ball over body and sing (to rhythm of “Mary had a little lamb”) “Were rolling out the cookie dough, cookie dough, cookie dough, repeat, …pause/hesitate….and bouncing it to pieces (bounce ball on child)”.
23. Swinging. Hold child’s legs and swing back and forth while chanting. After a few swings, swing child up and hold…pausing (sharing excited facial expressions) and letting him drop.
24. Making a hot dog roll: Lie child on one end of a roll out blanket. Pretend to make a hot dog roll. Put on mustard, catsup, relish, etc and than roll him tight in the blanket…and pretend to eat him.
25. Sit child on top of the back of a couch, that is up against a wall. To “Humpty Dumpty”, when you get to “had a great….pause/hesitate….FALL” pull the child so he slides down the couch to the cushion.
26. “Wheels on the bus”: Sit child on your lap. Hold arms and rotate to “Wheel on the bus go round and round”, then back and forth to “Wipers go swish, swish, swish”, then bounce to “people on the bus go up and down”.
27. Using face paint, sit face to face and paint each others’ faces.
28. Sit with your child in front of you. Let the child brush and “do you hair” with ribbons, curlers, barrettes. Make funny faces and excited statements.
29. Sit side by side in front of a mirror. Take turns tracing each other’s face on the mirror.
30. Sit face to face and feed each other ice cream out of a bowl. Use animated face and excited vocal to “emotion share”.

These are only the beginning! Use your creativity and improvise as you go along. Any simple interactive games can be adapted for facial gazing, social referencing, and emotion sharing.