Published on January 20, 2014
Play: It’s more than therapy 2014 Lynne Kenney, PsyD www.lynnekenney.com @drlynnekenney
Learning the neurocognitive underpinnings of Play
Where we will travel today Learn why and how play therapy works in light of current neuroscience research Explore how play therapy improves executive function Apply brain research to play therapy techniques Review clinical decision making, goal setting, diagnostic considerations and justification for play therapy treatment Review short-term play therapy techniques to maximize behavior change Clarify the roles of nutrition, sleep, OT, medication and respite in play therapy Explore why and how to engage the family for long-term success
What Is Play Activities that are freely chosen and self-directed arising from intrinsic motivation.
Elements of Play Play is self-chosen and self-directed Play is activity in which means are more valued than ends Play has structure, or rules, which are not dictated by physical necessity but emanate from the minds of the players Play is imaginative, non-literal, mentally removed in some way from ―real‖ or ―serious‖ life Play involves an active, alert, but non-stressed frame of mind. Dr. Peter Gray in Free to Learn
Play Is Evolutionarily Driven The play-as-preparation hypothesis Training for the unexpected Relaxation Developing neuronal connections Self-control and constraint Learning social rules Forming alliances Practicing needed skill sets for success and survival
Stuart Brown's TED Talk- Play is fundamental
Purpose of Play ~ Theory New York Times Magazine ROBIN MARANTZ HENIG February 17, 2008 www.nytimes.com/2008/02/17/magazine/17play.html
Patterns Are Innate A pattern is consistent repetition What does a pattern look like? What might a pattern sound like? Why patterns are important for brain development.
Shape Color Sound
Inhibition + Cognition
Patterns in Play Attunement Body or movement play Object (trucks, dolls) What non-directive play looks & sounds like Social Imaginary or pretend Story telling and narrative I knew a person who (message), Chief up & Down (build rituals), Green Eggs & Ham (rhyme and rhythm) Creative
Leong, Jan 2012 Young Children NAEYC
Play is growing, learning and connecting.
How Critical is Play? Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth (AAP ~ Ginsburg, January 2007, p. 182). Play is so important to children’s development that the United Nations High Commission for Human Rights (1989) recognizes it as a basic right of every child.
Why Play? Build the brain Become a successful social animal Build creativity and imagination Intrapersonal, interpersonal and developmental growth Learn to think and problem solve Learn shapes, size, letters, numbers Learn narrative language
From Neurons To Neighborhoods Human development is shaped by a dynamic and continuous interaction between biology and experience. Culture influences every aspect of human development and is reflected in childrearing beliefs and practices designed to promote healthy adaptation. The growth of self-regulation is a cornerstone of early childhood development that cuts across all domains of behavior. National Academy Press, 2000
Play is Brain Development Emergent literacy and math skills Scribbling, shape formation, letter formation, number concepts Narrative story telling, verbalizing, organization, vocabulary Self-regulation Managing intensity, identifying & managing energy states Problem Solving & Decision Making
What’s In The Way of Play Age progression of academic standards Belief in didactic literacy and math Doubling the burden Larger class size Smaller budgets Curriculum drivers Failure to note that movement improves brain function above all else
Goodbye PE From 1991 to 2003, % of high-school students enrolled in daily PE classes in America plummeted, from 42 percent to 28 percent. 50% of America’s youth meet the current evidence-based guideline ~ at least 60 minutes of vigorous or moderate-intensity physical activity daily. Source: HHS
Hope For Play Playborhoods Cul de Sac Kids Brain Breaks Movement Morsels Role of Exercise in Cognition Emphasis on Nutrition Play Ambassadors
Parents wish to Learn How to PLAY with their children
Cash Rich Time Poor In a 2009 IKEA study 45% of parents internationally felt they wished they had more time to play with their children. What does playing with your children mean? What can you do?
Introduce ―Being Present‖
The Space Between N E E D B E H A V I O R I M P U L S E Practice, relating, skill sets
My Very Own School
At Home Play Schedules Free play (blocks, trains, cars, dolls) Circle Time Story-Time Small manipulatives Writing-Time Snack Math Art Puzzles Lunch Time Reading-Time Cutting Playdoh Sensory Play Outdoor Play
Simple Play Tips Organize your enrichment materials Make time to play throughout the day Play indoors and outdoors Watch and listen, no need to direct Repeat back what you hear Stay with the theme ―I see that‖ ―I hear that‖ ―I wonder about‖
Organization Bookcases Bookshelves Cubbies Hanging Organizers Plastic boxes, labeled Stackable Shelves Storage Bench Toy Bins
Activities Action Figures Age appropriate videos Arts and crafts Board Games Books Building sets Coloring Books Dolls Music Musical Instruments Party Supplies Pretend Play/ Dress Up Puzzles Sporting Goods Stuff Animals Trains/Automobiles
Play and Language Tips Slow down Be Present Get at eye level Experience floor level Listen with your eyes Elaborate only when needed Experience silence www.playingwithwords365.com
Gill Connell & Cheryl McCarthy
A Moving Child A Moving Child Is a Learning Child All learning begins with the body. It has to. Itʼs our point of reference— our own personal, portable True North, so to speak. And for children, itʼs even more because the body is the brainʼs first teacher. And the lesson plan is movement.
A Few Novel Sites www.playingwithwords365.com www.growingajeweledrose.com www.teachpreschool.org www.teacherspayteachers.com www.aahperd.org/headstartbodystart /activityresources www.pinterest.com/kidlutions www.brightring.com
Five characteristics of inviting neighborhood hangouts Fun Variety ~ Features should appeal to children of diverse ages. The Lanza family yard includes a sandbox, fountain, message board, playhouse, and trampoline. Comfort Accessibility Visibility Critical mass
The Rich History Of Play Therapy Melanie Klein, Anna Freud Handbook of Play Therapy, Charles Schaefer Play Therapy, Virginia Axline Parent–Child Interaction Therapy (PCIT) Sheila Eyberg Child Centered Play Therapy, Garry Landreth Liana Lowenstein Eliana Gil
Wendy Young ~ Kidlutions.com
Types of Brain-Based Play Unoccupied (0-3 months) Solitary (3-18 months) Onlooker (toddlers) Parallel (toddler – 3 years) Functional Associative (learning social rules) Social (interactive) Constructive (creating, building) Expressive Pretend Cooperative
Play Skills Pretend/imagine Role play Parallel play Interactive play Self-directed play Other-directed play Maintaining engagement for x amount of time Introducing themes Responding to another in play (other initiated) Repetitive play ~ shifting themes and content
Practical Considerations Referral source Initial contact (The sound is the message) Suitability (Client and clinician characteristics, fees, length of treatment) Referrals after assessment Developmental, behavioral, learning and medical issues Psych-education for care providers Team Work
Short-Term Work ~ I Take a thorough history for an optimal starting position Conduct an assessment Components of Play Assessment Entry into the space Reading the landscape Initiating, maintaining and ending play Choice of materials Use of objects Boundaries Interpersonal relating Sense of self
Short-Term Work ~ II Be mindful of parents/client/school goals Review skill-set domains for goal setting Develop clear, concise, measurable goals Document what you did and why you did it with a camera watching Comment on neurocognitive skills when appropriate When you wrap it up, tie a bow on it
Play Therapy Experience Experience safety and trust You are a person worthy of respect Organize life experiences Metabolize emotions Explore dependence and independence Learn new skills (cognitive, limbic, motor)
The Relationship Is respectful Is reflective Is understanding Is in the present Is in the moment Is safe Directs only when needed What’s your name and how are you feeling? What is your plan to have a good day? I plan to ….
Sand Tray Exploration Description of the process Miniature choice Unconscious background Self-directed exploration Narration Meaning www.childtherapytoys.com www.goodtherapy.org www.creativecounseling101.com
To Build Neurons You Need Whole Real Food Omega-3’s and fatty acids Amino acids Water Exercise or movement Exposure to life experience
7 Senses Tactile or Somatosensory System - sense of touch Visual System - sense of sight Auditory System - sense of hearing Gustatory System - sense of taste Olfactory System - sense of smell Vestibular System - sense of balance Proprioception System - sense of body position
Sensational Play What’s in the bag? Seasonal Sand Tray Do you hear what I hear? Little skittle
www.urbanchildinstitute.org Source: Corel, JL. The postnatal development of the human cerebral cortex. Cambridge, MA: Harvard University Press; 1975
Building A Brain The newborn brain adds neurons over the first few years of life and grows at an amazing rate. It doubles in size in the first year, and by age three it reaches 80 percent of its adult volume.This growth is due mostly to neuron growth and new synapses being made. Connections are formed at a faster rate during these years than at any other time. By age three, the brain has up to twice as many connections as it will have in adulthood.
The Brain Has Priorities Move to learn Connect what is used Prune to be efficient
Pruning In a human fetus, almost a trillion neurons are produced. During the last month, they are produced at the unbelievable rate of 250,000 per second. Eighty-to-hundred billion of these neurons will be utilized by experience and become permanent, while the other 900 billion will be pruned – that is, carefully dismantled with the material recycled by the brain’s unique immune system. jonlieffmd.com
Source: www.urbanchildinstitute.org C.A. Nelson, in Neurons to Neighborhoods, 2000
Brain Facts 100,000,000,000 (100 billion) neurons Neurons multiply at a rate 250,000 neurons/minute during early pregnancy The total surface area of the cerebral cortex (gray matter folds) is about 2.5 ft2 There are 1,000 to 10,000 synapses for a "typical" neuron, 100 trillion in all
Grey and White The CNS has two kinds of tissue: grey matter and white matter, Grey matter, which has a pinkish-grey color in the living brain, contains the cell bodies, dendrites and axon terminals of neurons, so it is where all synapses are. White matter is made of axons connecting different parts of grey matter to each other.
Connections Neurons can connect with up to a hundred thousand other cells. This number of connections is a truly enormous number: 10 thousand trillion. One neuron can have as many as 100,000 dendrites. In a human, there are more than 100 trillion synapses just in the cerebral cortex alone
How do Neurons Connect? The electrical signals (nerve impulses) carried by neurons are passed on to other neurons at junctions called synapses. The signal may be directly transferred at electrical synapses or, if there is no physical link between adjacent neurons, the signal is carried across the gap by chemicals called neurotransmitters. By using neurotransmitters, the nervous system can alter the way a message is passed on. Each neuron communicates with many others and this contributes to the amazing complexity of the brain. www.sciencemuseum.org.uk
What is The Synapse? When a nerve impulse reaches the synapse at the end of a neuron, it cannot pass directly to the next one. Instead, it triggers the neuron to release a chemical neurotransmitter. The neurotransmitter drifts across the gap between the two neurons. On reaching the other side, it fits into a tailor-made receptor on the surface of the target neuron, like a key in a lock. This docking process converts the chemical signal back into an electrical nerve impulse. www.sciencemuseum.org.uk
Your Brain is Like A Placemat Insulted? Don’t be. A placemat is a good thing. Connect the dots.
Neurotransmitters Your brain uses over 50 different neurotransmitter chemicals. Although electrical signaling between neurons is quicker and more energy efficient, chemical signaling is far more versatile. The signals carried by some neurotransmitters excite the target cell while others dampen down their activity, depending on the type of neurotransmitter released at the synapse and the receptors they reach. This is what sharpens the contrast between light and dark in the eye, for example. www.sciencemuseum.org.uk
How Do We Build Brain Connections? Exposure Experience Doing, thinking, mirroring Practice ~ and a lot of it www.unc.edu
Optimal Brain Wiring Receives good daily nutrition Enjoys a variety of positive experiences Has a rich language environment Is provided with adequate amounts of sleep Lives with routines and predictability Has opportunities to develop relationships with nurturing caring adults and other children Learns through lots of time to play and explore Deborah McNelisbraininsights.blogspot.com
We Learn Through Play Planning Decision making Problem solving Inhibition Cognitive Flexibility Attention/Focus/Shift Creativity/Imagination
EF Domains Attention, focus, distractibility Cognitive control, shift and flexibility Memory, input, manipulation, output Emotional regulation and modulation Problem solving, decision making Impulse control and management Organization, planning, and time management Motor management planning, pacing, initiation, maintaining, stopping
Cognitive Domains Cognitive Attention Distraction Focus Shift Rumination Perseveration Hopeful thinking Optimism Negativity Resistance
Thinking Skill Domains Organization Planning Systems and methods Initiation, execution, review Attention to detail Finding the data Problem solving Explaining one’s answer
Self-Regulation Domains Perception ~ sensory Recognizing internal energy state Recognizing escalation or de-escalation Initiating, maintaining and changing energy Labeling, naming or expressing a feeling Utilizing calming skills
Movement and Attention ~ Games The Floating Arm Ping & Pong Let’s Freak-Out
Attention Selective AttentionThe ability to remain focused and on task while being subjected to related and unrelated sensory input (distractions). Sustained AttentionThe ability to remain focused and on task, and the amount of time we can focus. Divided AttentionThe ability to remember information while performing a mental operation and attending to two things at once (multi-tasking). Source learningrx
Processing Speed Speed of Processing Theory: the interference occurs because words are read faster than colors are named. Selective Attention Theory: the interference occurs because naming colors requires more attention than reading words.
Memory Whole brain activity Hippocampus Saliency Novelty Test twice Mental pictures
Improving Memory Pay attention Chunk Visualize and associate Automaticity Move to Think Layer cognition on movement patterns Play thinking games Add rhythm and timing
Problem Solving ~ Understanding Can you state the problem in your own words? What are you trying to find or do? Read the data, environment or clues What is working or not working? What do you know? What don’t you know?
Problem Solving ~ Plan and execute Read the landscape Know where you need to end up Make a plan on how to get there Look for patterns Solve what you do know first Guess then test Review and revise
EF and Behavioral Change Visualizing and verbalizing Role Play Social Stories The Beginning, Middle & End Going Full Circle See, say, play, touch, build Mentoring others Motor movement
Generalizing Does the intervention generalize? What do you measure? How do you know? Sustainable change
Creativity Play with abandon. A constant focus on work without play dulls creativity. Draw, doodle, sculpt, paint Use a visual inspiration Make the time Create opportunity
Creative Play The Ruby Books Ladybugs & Lollipops Who’s in my corner
Domains of Creative Arts Music engagement Visual arts therapy Movement-based creative expression Expressive writing Planning Organization Cognitive intention Inhibition Focus/attention Rhythm/timing
Creative Arts Non-stressful Expressive Attached Present Mindful Moving away from defensive brain
Creative Arts Activities
Yes, Virginia, There Is Some Art Therapy Research Art Art Art Art therapy therapy therapy therapy in healthcare in trauma in cancer and cognition www.cathymalchiodi.com
Music Daniel Levitin and post-doctoral researcher Mona Lisa Chanda, McGill University, reviewed 400 published scientific papers Effects on brain chemistry and associated mental and physical health benefits Management of mood Stress reduction Boosting immunity As an aid to social bonding Trends in Cognitive Sciences, Volume 17, Issue 4, 179-193, 1 April 2013
Audition The Listening Program Integrated Listening Therapeutic Listening In Time Healing at the Speed of Sound (Campbell & Doman)
Play To Learn
Math Skills K-5 Number recognition (receptive and expressive) Counting objects with 1:1 correspondence Counting out objects from a group Patterns/sorting Estimation/guessin g/comparison Addition Subtraction Multiplication Division Fractions Factors
Play Math is a corticocerebellar math program that alternates fine and gross motor movement to teach children ages 6-12 fact families, factors and fractions (Kenney 2012)
The Method Mirror or Skip Count (Balls) Slide and Glide (Blocks) Over and Up (Blocks) How do numbers fit together? What makes a family? Advanced techniques
Three things children taught me about how they learn math. We build brain connections with: a. Rhythm b. Fine and Gross Motor Movement c. Mentoring
We Calm Down To Think Teach relaxation breathing and self-talk Allow for a break (including a physical place to calm down) when child encounters a change Provide warnings (signals) prior to transitions – they can be visual, touch, or verbal @stressfreekids Lori Lite
Calming Resources SEL www.kimochis.com Physical Movement www.sparkpe.org Repetitive Movement balavisx.com Rhythmic Breathing Take Five Music/Stories Listening www.stressfreekids.com Art Drawing Mandalas Listen to a Raisin – Meditate Vision Therapy
Meditation and Mindfulness
Self-Regulation Recognizing escalation Asking for help (I feel revved up, angry, annoyed) Stopping escalation Making a choice to use a calming skill De-escalating Initiating calm Maintaining calm Using calming skills (breathing, music, motor movement, yoga, meditation Using energy release skills (jump ropes, trampoline, jumping jacks)
Bloom: Helping children blossom
Managing Body Space Kinesthetic awareness (where are you in relationship to people and objects) Proximity Use of materials that can hurt others Balance Coordination Posturing
Communication Communication Messaging Meaning For Understanding Non-verbal Verbal Gestural Facial Observing Reaching Turning away Facial expressions Gestures Pointing Body movements
Language Receptive Expressive/Labeling Intraverbal (asking and answering ―Wh‖ questions, commenting, etc.) We’re going on a field trip. Who, what, when, where, how narrative exploration of an experience. Interverbal (knowing what you are saying outloud) Vocabulary (generalization and discrimination of new words)
Pragmatics Greeting Informing Requesting Talking turns in conversation If this, then what Staying on topic Informing the uninformed listener Asking for help when not understanding Rephrasing when misunderstood Telling a story or experience in a clear sequence
Phonemic Awareness Phonemes are small units of sound. Phonemes are heard, not read. Phonics is symbol-sound relationships. A grapheme is the smallest semantically distinguishing unit in a written language. Vocabulary is the set of words that allow for meaningful oral and written expression.
Early Reading Skills ~ I Identifies front, back, title, and author of a book Demonstrates top to bottom, left to right progression Distinguishes letters from words and words from sentences Identifies all uppercase and lowercase letters Demonstrates knowledge of beginning sounds by printing correct letter symbols with corresponding pictures
Early Reading Skills ~ II Orally tells what sound is heard at the beginning and ending of words Blends CVC sounds aloud to make a word Rhymes Count the number of sounds in a syllable and the number of syllables in a word Reads one syllable and common words by sight such as "the", "I", "is‖ Orally states the names of the days of the week and months of the year Identifies the eight basic colors and reads the corresponding color words
Later Reading Skills ~ III Understands temporal relationships Makes predictions Identifies characters, setting, and main idea of a story Demonstrates comprehension of stories by orally retelling or acting out Can say what they learned and where they learned it
Writing Uppercase letter formation Lowercase letter formation Number formation Staying in the lines Writing words Spelling Writing sentences Writing paragraphs Writing for meaning Write me a message
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