11/9/2011

1

Translating Concepts from

Neurobiology into Therapeutic

Interventions for Young Children

Melbourne, Victoria, Australia Tuesday, 11-15-11 • Dr. Kristie Brandt

● Be able to describe the enriching & therapeutic value of common activities in a child’s life.

● Have an improved ability to examine neuro-relational concepts and translate these into strategies to optimize a child’s health and well-being.

LEARNING OBJECTIVES FOR THE SESSION:

A Mobius Care Model

Mobius: • HAS NO BEGINNING POINT AND NO ENDING POINT

• CONTINUOUS FROM ANY POINT OF ENTRY

Caring for an infant is Mobius Care:

It is fluid and continuous, without a start or

end point to the day or week. Optimally, the baby is always being looked after by an adult who understands and can

support the baby’s developmental needs.

The

Tile & Grout Approach

ADAM’S MOTHER (CAROLINE)

• 38 year old with 16 years of education; Medical Records manager at a local hospital – very successful

• Uneventful childhood; 2 older siblings; many moves with father’s employment; says mother was very shy & quiet “probably depressed”

• Married Jesse at age 28 after 15 months of dating & co-habitation

• Shortly after marriage, Jesse perpetrated severe DV witnessed by neighbors – arrested; sentenced to Anger Management classes, 1 week in jail & probation

• Unexpected pregnancy with Adam 9 months after marriage; DV escalated through pregnancy and after Adam’s birth

• Very difficult pregnancy with nausea, miscarriage threat, pre-term labor, hypertension, gestational diabetes & bed rest 30wks to delivery at 36 weeks; loss of her income significant; high social stress

• Diagnosed with depression in pregnancy and treatment with SSRIs “on and off” ever since; lived in fear of Jesse’s violence

11/9/2011

2

Caroline & Adam

• Adam born at 36 wks gestation; weighed 6#14 oz; vaginal birth after a very challenging pregnancy - high stress, DV/IPV, hypertension, gestational diabetes

• Starting at 2 weeks of age, father yelled and swore at Adam frequently; forbid mom to go to him if he was crying; per mom, both mom & baby were “virtual prisoners in their own rooms”

• Mom was afraid to spend much time with Adam and stopped breastfeeding at 5 weeks postpartum

• Mom reports that Adam’s father hit him violently at 10 wks of age leaving bruises on his legs & torso; mom was being subjected to emotional, sexual & physical abuse (not reported)

• Mom isolated first 4 mos until returning to work 20 hrs/week due to several financial problems; Adam stayed with father or MGM when mom worked; while she felt glad to be away from Jesse, mom wondered what was happening to Adam when in Jesse’s care

Adam…Age 8

• Adam is at the 55% percentile for weight & 50th for height for age 8

• He is in a special education classroom 8a-2p each day, rides the bus for 50 minutes each direction to and from school, and is cared for after school in his home by a 15yo female neighbor

• He spends most of his non-school hours on the couch watching television or playing video games. He does this until 12m-1am when he falls asleep on the couch.

• Adam sleeps 5-6 hours/night with the television on and mom wakes him around 6am to get ready for the school bus at 7:10a

• Adam’s breakfast is usually an orange flavored soda and a poptart. He has lunch at school and eats cookies, hot dogs, chips, sodas, pizza, or chicken nuggets. His dinner is usually cereal and milk.

• Adam does not engage in any sports or physical activity. He occasionally goes into the backyard and digs, kicks around a soccer ball, or rides a mini-ATV his grandparents gave him

Adam & Caroline

• By all reports, Adam’s 1st year was in a sad, fearful environment

• Adam (10 mos) & mother severally beaten by father while intoxicated; did not report this

• Adam (22 mos) & mom brutally beaten, hospitalized with head injuries and broken bones; Adam 1 surgery (fx femur)/mom 2 surgeries for massive head, pelvic & abdominal injuries (father was sentenced to prison)

• Mom was hospitalized for a month and Adam went to live with his MGM during that time

• Mom was severally depressed and sad, had physical therapy and psychotherapy; home on disability for 13 months after assault; MGM & PGF provided some care for mom and Adam

Adam & Caroline

• Adam’s mom is called to the school about once a week to deal with some classroom issue

• Caroline spends most of her evenings watching television in her room, completing work projects at home, reading, on the internet doing a variety of things, and sometimes she watches TV with Adam in the living room

• On Saturday, she goes to the gym and has time for errands (hair styling, manicures, etc.), while the 15yo neighbor babysits Adam

• Adam’s behavior in public is so stressful to her that she only takes him to school, the 2 therapy appointments each week, and out for a fast-food dinner once a week

• She says she never thought her “life would turn out like this”

• Relationship between Caroline and her parents is strained since she decided to marry Jesse (Adam’s father); they did not like him and begged Caroline not to go through with the wedding

Adam & Caroline

• Adam has several unusual behaviors/tics including slight muscle contractions of his left cheek, drumming his fingers, and forcefully blowing air through his nose several times a minute

• Adam’s resting heart rate is 114 and he was diagnosed with mild hypertension at age 7 for which no treatment other than recommended exercise and sodium reduction have been given

• According to mom, he is “constantly sick” with “sniffles, diarrhea, stomach pains, headaches, colds, and body aches;” he is seen regularly by his pediatrician

• At school, he moves between being completely detached (about 55% of the time) to aggressive with teachers and peers if they try to interact with him (about 15% of the time) to happy, interactive, and funny (about 30% of the time), but they never know when his mood will change (according to his teachers)

• Adam does not like to eat with others and will either take his food to eat alone or not eat

ADAM’S FATHER (JESSE)

• Initially uneventful relationship while dating Caroline

• Daily 1-2 drink alcohol use with heavy social setting binges

• First hit Adam at age 10 weeks while intoxicated; severely beat both Caroline & Adam when Adam was 22 months old and was arrested

• Convicted of DV & Child Abuse – served 4 years in prison

• Died in drunk driving accident when Adam was 6yr 5mo

• College football scholarship, quit senior year of college; salesman for sporting goods line prior to prison , but lost his job shortly after Caroline became pregnant; (unemployed at death)

11/9/2011

3

• PDD-NOS

• ADHD

• Oppositional Defiant Disorder

• Complex Rapidly Cycling Bipolar Disorder of Childhood

Adam’s Diagnosis

Medications Risperdal Strattera

Children that exhibit externalizing behaviors are usually categorized into specific DSM-IV diagnostic categories: Hyperactive/Hypervigilant/Distracted/ Impulsive:

ADHD Aggressive Behaviors:

Oppositional Defiant Disorder Delinquent Behaviors:

Conduct Disorder

Creating

“Mobius Therapy”

for Adam

BASIC CONTEXT FOR CHILD THERAPY

The child’s ability to achieve optimal social-emotional, cognitive, and physical development is dependent upon:

• Play

• Exploration

• Interaction with others

• “Falling in Love” &

“Being in Love” with a

safe and nurturing adult

Dr. Kristie Brandt © 2007

Primary Principle of

IPMH Therapy:

“Therapy is not about

erasing the old stuff…

it is about creating new,

positive experiences.”

Bruce Perry

Dr. Kristie Brandt © 2007

HEALING:

“It is not what has

happened to you, but how

you make sense of what

has happened to you.”

Dan Siegel

11/9/2011

4

ADAM’S CURRENT THERAPY

Portion of Adam’s week that is

“Therapeutic”

NMT Informed Developmentally Appropriate Therapy (DAT):

1. Specific and identified therapeutic intent

2. Therapeutic goals

3. An identified and qualified (or informed) therapist

Following in color are the portions of Adam’s 168 hour week that were NMT DAT…

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES SPEC ED STUDIES INDEPENDENT

STUDY SPEC ED STUDIES SPEC ED STUDIES

9a-10a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

10a-11a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

11a-12n SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

12n-1p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

1p-2p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES

2p-3p BUS BUS BUS BUS BUS

3p-4p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

4p-5p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR CBT WATCHED BY

15YO NEIGHBOR WATCHED BY

15YO NEIGHBOR

5p-6p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

WATCHED BY 15YO NEIGHBOR

6p-7p WATCHED BY 15YO NEIGHBOR

7p-8p WATCHED BY 15YO NEIGHBOR

8p-9p

9p-10p

10p-11p

27 hours of Therapy

16% of Adam’s week

The Special Education goals for Adam are for him to:

1. Be able to listen attentively in class and follow simple classroom instructions

2. Refrain from hitting or being aggressive with teachers & peers

3. Use his classroom time constructively

4. Spend less time in class being silent, staring, or wandering

5. Be able to work with classroom peers in a cooperative way

6. Develop independent study skills

7. Reduce refusals to participate in classroom discussions

8. Reduce or eliminate episodes of being expelled from class due to behavioral challenges

9. Support cognitive/academic advancement to at least grade level

ADAM IS IN A 3RD SPECIAL EDUCATION GRADE CLASSROOM (8YO), BUT PERFORMS AT A KINDERGARTEN OR FIRST GRADE LEVEL (5-6 YO).

• Teaching children and their non-offending caregivers adaptive coping skills

• Assisting children to emotionally and cognitively process their traumatic experiences

• Reducing emotional and behavioral reactions exhibited by children

• Facilitating children's adjustment to placement when needed

• Assisting non-offending caregivers in responding to their child's reactions and helping them cope with their own feelings related to the trauma(s)

• Working with caregivers and children in joint sessions to improve interaction, enhance communication and practice personal safety skills to help reduce the risk of future victimization

Retrieved from http://www.caresinstitute.net/services_trauma.php on 10-10-11

Goal for Trauma Focused

Cognitive Behavioral Therapy (TF-CogB) FAMILY PSYCHOTHERAPY GOALS • Enhance how Adam and his mother relate and function as

a family group

• Support mother and son in understanding and modifying problematic or dysfunctional patterns of interaction

• Help mother and son to communicate and interact more effectively

• Identify coping strategies for each individual and the dyad, and support them in appreciating where these can be useful and where they can create conflict

• Support mother and son in non-violent conflict management

• Reduce Adam’s externalizing behaviors (Goals came directly from the psychotherapist)

Therapist: PhD/Clinical Psychologist Therapy type: Interpersonal Psychotherapy

11/9/2011

5

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES SPEC ED STUDIES INDEPENDENT

STUDY SPEC ED STUDIES SPEC ED STUDIES

9a-10a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

10a-11a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

11a-12n SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

12n-1p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

1p-2p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES

2p-3p BUS BUS BUS BUS BUS

3p-4p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

4p-5p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR CBT WATCHED BY

15YO NEIGHBOR WATCHED BY

15YO NEIGHBOR

5p-6p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

WATCHED BY 15YO NEIGHBOR

6p-7p WATCHED BY 15YO NEIGHBOR

7p-8p WATCHED BY 15YO NEIGHBOR

8p-9p

9p-10p

10p-11p

27 hours of Therapy

16% of Adam’s week

Goal:

Increase the portion of

Adam’s week that is

“Therapeutic”

Much of what Adam needs to construct or

re-construct will best be accomplished in

the context of his primary attachment

relationship.

MOM’S CURRENT WORK SCHEDULE

• Monday: 7:30a-5:30p (9 hrs)

• Tuesday: 7:30a-5:30p (9 hrs)

• Wednesday: 7:30a- 3:00p (6.5 hrs)

• Thursday: 7:30a-4:00p (7.5 hrs)

• Friday: 7:30a-4:30p (8 hrs)

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES SPEC ED STUDIES INDEPENDENT

STUDY SPEC ED STUDIES SPEC ED STUDIES

9a-10a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

10a-11a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

11a-12n SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

12n-1p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

1p-2p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES

2p-3p BUS BUS BUS BUS BUS

3p-4p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

4p-5p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR CBT WATCHED BY

15YO NEIGHBOR WATCHED BY

15YO NEIGHBOR

5p-6p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

WATCHED BY 15YO NEIGHBOR

6p-7p WATCHED BY 15YO NEIGHBOR

7p-8p WATCHED BY 15YO NEIGHBOR

8p-9p

9p-10p

10p-11p

“In order to develop normally, a child requires

progressively more complex joint activity

with one or more adults who have an

irrational emotional relationship

with the child. Somebody’s got

to be crazy about that kid.

That’s number one. First, last and always.”

Urie Bronfenbrenner

11/9/2011

6

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES SPEC ED STUDIES INDEPENDENT

STUDY SPEC ED STUDIES SPEC ED STUDIES

9a-10a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

10a-11a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

11a-12n SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

12n-1p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

1p-2p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES

2p-3p BUS BUS BUS BUS BUS

3p-4p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

4p-5p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR CBT WATCHED BY

15YO NEIGHBOR WATCHED BY

15YO NEIGHBOR

5p-6p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

WATCHED BY 15YO NEIGHBOR

6p-7p WATCHED BY 15YO NEIGHBOR

7p-8p WATCHED BY 15YO NEIGHBOR

8p-9p

9p-10p

10p-11p

27 hours of Therapy

16% of Adam’s week

First Target 1. Reduced stress levels

(Nielsen & Hansen, 2007)

2. Positive neuroendocrine & affect support, decreased cortisol (Van Den Berg & Custers, 2011)

3. Physical fitness/exercise

4. Better nutrition (increase the amount and variety of vegetables eaten) (Ratcliffe, et al., 2011)

5. Sunlight exposure + impact on mood

6. Develop “parallel play” capacities

7. Interface with safe & nurturing adults

Goals of Student Farm Therapy

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES SPEC ED STUDIES INDEPENDENT

STUDY SPEC ED STUDIES SPEC ED STUDIES

9a-10a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

10a-11a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

11a-12n SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

12n-1p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

1p-2p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES

2p-3p BUS BUS BUS BUS BUS

3p-4p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

4p-5p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR CBT WATCHED BY

15YO NEIGHBOR WATCHED BY

15YO NEIGHBOR

5p-6p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

WATCHED BY 15YO NEIGHBOR

6p-7p WATCHED BY 15YO NEIGHBOR

7p-8p WATCHED BY 15YO NEIGHBOR

8p-9p

9p-10p

10p-11p

27 hours of Therapy

16% of Adam’s week

“The presence of

animals, and interaction

with animals, decreases

physiological indices

such as heart rate and

blood pressure, and

improves psychosocial

variables (e.g., reduces

anxiety) in both patients

and healthy persons.”

Cole, Gawlinski, Steers & Kotlerman. 2007. American Journal of Critical Care. 2007;16: 575-585

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

IN LIBRARY ALONE

SPEC ED STUDIES

SPEC ED STUDIES

2p-3p BUS

3p-4p WATCHED BY 15YO NEIGHBOR

4p-5p CBT

5p-6p DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

6p-7p

7p-8p

8p-9p

9p-10p

10p-11p

32 hours of Therapy

19% of Adam’s week

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

IN LIBRARY ALONE

SPEC ED STUDIES

SPEC ED STUDIES

2p-3p GRANDFATHER PICK-UP

BUS

3p-4p WITH GRANDPARENTS

WATCHED BY 15YO NEIGHBOR

4p-5p DINNER WITH GRANDPARENTS CBT

5p-6p WITH GRANDPARENTS

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

6p-7p GAMES W/MOM & G-PARENTS

7p-8p

8p-9p

9p-10p

10p-11p

11/9/2011

7

Therapeutic Goals for Time with Grandparents

1. Support Adam in forming a stronger connection with safe and nurturing adults, and strengthen kinship ties

2. Develop or strengthen the foundational capacities for: (1) Turn-Taking; (2) Sustained Attention; (3) Mutual Responsiveness; (4) Match/Mis-Match & Repair; (5) Clear Cue Giving & Receiving; and, (6) Co-creation of dyadic states of consciousness

3. Experience the attention of another

4. Provide variety and expand tolerance for different social setting, shared activities, conversation, triadic engagement, and joint attention

5. Enhance nutrition

6. Support socialization and play

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

IN LIBRARY ALONE

SPEC ED STUDIES

SPEC ED STUDIES

2p-3p GRANDFATHER PICK-UP

BUS

3p-4p WITH GRANDPARENTS

WATCHED BY 15YO NEIGHBOR

4p-5p DINNER WITH GRANDPARENTS CBT

5p-6p WITH GRANDPARENTS

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

6p-7p

7p-8p

8p-9p

9p-10p

10p-11p

36 hours of Therapy/Wk

21.5% of Adam’s week

Search for After School Therapeutic Activities

Boys & Girls Club of America (BCGA) offering “latch key” program from 2p-5p each day with school pick-up.

BGCA staff very enthusiastic about getting training to work with children who have histories and therapeutic needs like Adam’s.

Solid and promising schedule developed that was both predictable and flexible.

Therapeutic Goals for Time at BGCA

1. Increase physical activity to support proprioceptive feedback for core regulation and promote good health

2. Enhance neuro-functioning through novel activities that require navigational skills, visual/spatial skills, cross-midline coordination, motor planning & agility

3. Enhance self-regulatory capacities (martial arts, music, art)

4. Reduce anxiety through repetitive activities and expressive arts

5. Increase reading skills to enhance confidence in school

6. Increase range of social contexts and contact with safe and nurturing adults

7. Support socialization and play

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

IN LIBRARY ALONE

SPEC ED STUDIES

SPEC ED STUDIES

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY BUS BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

WATCHED BY 15YO NEIGHBOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

6p-7p

7p-8p

8p-9p

9p-10p

10p-11p

45 hours of Therapy/Week

26.75% of Adam’s week

Discussed with mother the economic feasibility of

specialized tutoring with someone willing to be trained

on NMT, cue giving, TPs & other core concepts.

GOALS FOR SPECIALIZED TUTORING TIME:

1. Experience close and regular contact with a safe and nurturing person

2. Be exposed to a regular quasi-peer relationship

3. Enhance social skills, co-regulation and conversational rhythmicity in an ongoing and predictable relationship

4. Experience one-to-one engagement with a “therapeutic other” that actively manages aspects of the experience in response to Adam’s neurobiological cues

5. Identify and expand interests and learning style

11/9/2011

8

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

2p-3p GRANDFATHER PICK-UP

B&G CLUB OF AM

FREE PLAY TECH

TUTORING B&G CLUB OF AM

FREE PLAY B&G CLUB OF AM

FREE PLAY

3p-4p WITH GRANDPARENTS

BGCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BGCA MARTIAL ARTS

BGCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BGCA ART “THERAPY” CBT BGCA

MUSIC JAM BGCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

6p-7p

7p-8p

8p-9p

9p-10p

10p-11p

48 hours of Therapy/Week

28.5% of Adam’s week

Building Time

with Mom

Therapeutic Goals for

Dedicated Time with Mother

1. Help mother and son “fall in love” and stay in love

2. Achieve moments of “Mutual Delight”

3. Support rhythmicity, predictability, and organization of each day

4. Enhance current mother-child contact that is reminiscent of the common contact point in the early relationship of feeding/eating to support positive associations with engagement and interaction around eating

Why didn’t we start with

focusing on more

organized and predictable

mother-son time?

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p

9p-10p

10p-11p

59 hours of Therapy/Week

35.1% of Adam’s week

Time with mom engaged in activities with

her parents (Adam’s grandparents)

added with the goals of:

1. Strengthening family connections & support

system

2. Assisting Adam in developing skills for transitioning

3. Support Adam in expanding his regulatory capacities

11/9/2011

9

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

WATCHED BY 15YO NEIGHBOR

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p

9p-10p

10p-11p

60 hours of Therapy/Week

35.75% of Adam’s week

ADAM’S BEHAVIOR AND ENGAGEMENT IMPROVED…

Director of School Farm had forged relationship with

Adam and invited him to join 4-H group that meets and

tends the School Farm on Saturday mornings.

GOALS: 1. Similar to “School Farm” earlier

2. Expand social contexts with a non-school related peer group

3. Expand opportunity to engage with safe and nurturing adults

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p

9p-10p

10p-11p

64 hours of Therapy/Week

38% of Adam’s week

At this point, mom enrolled Adam in

Big Brothers of America MOM’s goals for this contact:

1.Socialization and play

2.Role Modeling

3.New social context and expanded opportunity for building his capacities to interact

4.Chance for Adam to experience both a shared agenda and negotiation in a relationship

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p

9p-10p

10p-11p

66 hours of Therapy/Week

39.25% of Adam’s week

Therapeutic Goals for Portion of Day for Media & “Down Time Alone”

1. Organize and provide limits or guidelines for electronic media; this begins the reconstruction of limit setting and boundaries established by mom, and helps Adam learn self control

2. Provide support for state regulation and state transition for sleep

3. Cultivate tolerance of “choice” and thwarting

4. Support development of skills for “time in” with self (e.g. reading, drawing, day dreaming, thinking, solitary games, etc.)

11/9/2011

10

Why didn’t we

start here?

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p

80 hours of Therapy/Week 47.6% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

7a-8a BUS BUS BUS BUS BUS

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

92 hours of Therapy/Week 54.75% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

7a-8a BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

8a-9a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

11/9/2011

11

97 hours of Therapy/Week 57.7% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a RESTORATIVE SLEEP

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

MORNING ROUTINE

8a-9a MORNING ROUTINE

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

9a-10a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

100 hours of Therapy/Week 59.5% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a RESTORATIVE SLEEP

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

MORNING ROUTINE

8a-9a MORNING ROUTINE

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

BREAKFAST WITH MOM

9a-10a BREAKFAST WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

104 hours of Therapy/Week 62% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a RESTORATIVE SLEEP

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

MORNING ROUTINE

8a-9a MORNING ROUTINE

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

BREAKFAST WITH MOM

9a-10a BREAKFAST WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

11/9/2011

12

107 hours of Therapy/Week 66% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a RESTORATIVE SLEEP

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

MORNING ROUTINE

8a-9a MORNING ROUTINE

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

BREAKFAST WITH MOM

9a-10a BREAKFAST WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p OUTDOORS WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p OUTDOORS WITH MOM

GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p OUTDOORS WITH MOM

WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p OUTDOORS WITH MOM

DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

7p-8p HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

Multiple benefits,

including exposure to

“circannual rhythms”

as part of constructing

meta regulatory

templates…

…play…learning in context…imitation… enrichment of relationships...etc.

Geocaching & Remote Control Planes

111 hours of Therapy/Week 62.5% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a RESTORATIVE SLEEP

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

MORNING ROUTINE

8a-9a MORNING ROUTINE

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

BREAKFAST WITH MOM

9a-10a BREAKFAST WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p OUTDOORS WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p OUTDOORS WITH MOM

GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p OUTDOORS WITH MOM

WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

4p-5p OUTDOORS WITH MOM

DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

7p-8p DOWN TIME WITH MOM

HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DOWN TIME WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

11/9/2011

13

115 hours of Therapy/Week 68.5% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a RESTORATIVE SLEEP

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

MORNING ROUTINE

8a-9a MORNING ROUTINE

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

BREAKFAST WITH MOM

9a-10a BREAKFAST WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p OUTDOORS WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p OUTDOORS WITH MOM

GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p OUTDOORS WITH MOM

WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

STAINED GLASS WORK W/MOM

4p-5p OUTDOORS WITH MOM

DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE STAINED GLASS WORK W/MOM

5p-6p WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

PREP & DINNER WITH MOM

6p-7p GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

7p-8p DOWN TIME WITH MOM

HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DOWN TIME WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

117 hours of Therapy/Week 69.6% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Sun Mon Tue Wed Thu Fri Sat

6a-7a RESTORATIVE SLEEP

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

MORNING ROUTINE

8a-9a MORNING ROUTINE

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

BREAKFAST WITH MOM

9a-10a BREAKFAST WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p OUTDOORS WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING

SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p OUTDOORS WITH MOM

GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p OUTDOORS WITH MOM

WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

STAINED GLASS WORK W/MOM

4p-5p OUTDOORS WITH MOM

DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE STAINED GLASS WORK W/MOM

5p-6p DINNER WITH FRIENDS/FAMILY

WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

PREP & DINNER WITH MOM

6p-7p DINNER WITH FRIENDS/FAMILY

GAMES W/MOM

& G-PARENTS HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

7p-8p DOWN TIME WITH MOM

HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DOWN TIME WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

119 hours of Therapy/Week 70.8% of Adam’s week

Portion of Adam’s week that is

“Therapeutic”

Enhancing Deep, Restorative Sleep

• Sleep routine • Sleep music • Air Filter with white noise • Comfortable bed & bedding • Window covering for privacy • Window covering to darken • Secure locked windows • Reassurance (attachment-based)

11/9/2011

14

THE BODY’S CLOCK: SUPRACHIASMATIC NUCLEUS (SCN)

• The SCN is 2 pinhead-sized brain structures each having about 10,000 neurons in the hypothalamus, just above the point where the optic nerves cross

• Light on the retina is received by photoreceptors in the retina and moved along the optic nerve to the SCN

• Signals from the SCN travel to the pineal gland, that responds to light by switching off production of the hormone melatonin that usually begins to rise at dusk

• The body's level of melatonin normally increases after darkness falls, making people feel drowsy

• SCN influences sleep/wake cycles, body temperature, hormone secretion, blood pressure changes, and more

ALL NINDS-PREPARED INFORMATION IS IN THE PUBLIC DOMAIN AND MAY BE FREELY COPIED; NIH PUBLICATION NO.06-3440-C; MAY 21, 2007

Sun Mon Tue Wed Thu Fri Sat

11p-12m RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

12m-1a RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

1a-2a RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

2a-3a RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

3a-4a RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

4a-5a RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

5a-6a RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

RESTORATIVE SLEEP

6a-7a RESTORATIVE SLEEP

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

7 7 7 7 7 8 9+

About 52 hours of sleep per week now (Previous total about 40 per week before)

Weekly Sleep Average

Adam’s life

before…

Sun Mon Tue Wed Thu Fri Sat

6a-7a

7a-8a

8a-9a SPEC ED STUDIES SPEC ED STUDIES INDEPENDENT

STUDY SPEC ED STUDIES SPEC ED STUDIES

9a-10a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

10a-11a SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

11a-12n SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

12n-1p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES WATCHED BY

15YO NEIGHBOR

1p-2p SPEC ED STUDIES SPEC ED STUDIES IN LIBRARY

ALONE SPEC ED STUDIES SPEC ED STUDIES

2p-3p BUS BUS BUS BUS BUS

3p-4p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

4p-5p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR CBT WATCHED BY

15YO NEIGHBOR WATCHED BY

15YO NEIGHBOR

5p-6p WATCHED BY 15YO NEIGHBOR

WATCHED BY 15YO NEIGHBOR

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

WATCHED BY 15YO NEIGHBOR

6p-7p WATCHED BY 15YO NEIGHBOR

7p-8p WATCHED BY 15YO NEIGHBOR

8p-9p

9p-10p

10p-11p

27 hours of Therapy

16% of Adam’s week

Adam’s life

now…

11/9/2011

15

Sun Mon Tue Wed Thu Fri Sat

6a-7a RESTORATIVE SLEEP

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

MORNING ROUTINE

RESTORATIVE SLEEP

7a-8a RESTORATIVE SLEEP

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

BUS/NUTRITIOUS BRKF & ART JOURNAL

MORNING ROUTINE

8a-9a MORNING ROUTINE

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

BREAKFAST WITH MOM

9a-10a BREAKFAST WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

10a-11a SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

11a-12n SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

12n-1p SUNDAY SCHOOL SOCIAL SKILLS

SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM SPEC ED STUDIES

SPEC ED STUDIES

STUDENT FARM

1p-2p OUTDOORS WITH MOM

SPEC ED STUDIES

SPEC ED STUDIES

TECH TUTORING SPEC ED STUDIES

SPEC ED STUDIES

BIG BROTHER

2p-3p OUTDOORS WITH MOM

GRANDFATHER PICK-UP

BOYS CLUB OF AM

FREE PLAY TECH

TUTORING BOYS CLUB OF AM

FREE PLAY BOYS CLUB OF AM

FREE PLAY BIG BROTHER

3p-4p OUTDOORS WITH MOM

WITH GRANDPARENTS

BCA MARTIAL ARTS

HOMEWORK WITH TUTOR

BCA MARTIAL ARTS

BCA READING SKILLS

STAINED GLASS WORK W/MOM

4p-5p OUTDOORS WITH MOM

DINNER WITH GRANDPARENTS

BCA ART “THERAPY” CBT BCA

MUSIC JAM BCA OBSTACLE

COURSE STAINED GLASS WORK W/MOM

5p-6p DINNER WITH FRIENDS/FAMILY

WITH GRANDPARENTS

PREP & DINNER WITH MOM

DINNER OUT WITH MOM

FAMILY PSYCHOTHERAPY

PREP & DINNER WITH MOM

PREP & DINNER WITH MOM

6p-7p DINNER WITH FRIENDS/FAMILY

GAMES W/MOM & G-PARENTS

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

ACTIVITIES WITH MOM

DINNER WITH MOM

7p-8p DOWN TIME WITH MOM

HOMEWORK WITH MOM

DOWN TIME WITH MOM

ACTIVITIES WITH MOM

HOMEWORK WITH MOM

ACTIVITIES WITH MOM

DOWN TIME WITH MOM

8p-9p MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

MEDIA CHOICE

9p-10p DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

DOWN TIME ALONE

10p-11p BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

BEDTIME ROUTINE

Adam now has “MOBIUS THERAPY”

The NMT is being used to

guide and provide

Developmentally Appropriate

Therapy (DAT)

HIS THERAPY IS FLUID AND CONTINUOUS, WITHOUT A START OR

END POINT TO THE DAY OR WEEK.

He is always being looked after by

an adult who understands and can

therapeutically support his

developmental needs.

● Be able to describe the enriching & therapeutic value of common activities in a child’s life.

● Have an improved ability to examine neuro-relational concepts and translate these into strategies to optimize a child’s health and well-being.

LEARNING OBJECTIVES FOR THE SESSION:

The

Tile & Grout Approach