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Clinician's Digest

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Diagnosing Pediatric Bipolar Disorder

Psychotherapy for Infants

By Garry Cooper

Few would argue that without early therapeutic family interventions and psychoeducation, infants with serious developmental disorders like autism will lag further and further behind in developmental growth, but psychiatrist Stanley I. Greenspan insists that the vast majority of "normal" infants and their parents could also use early guidance. The explosion of knowledge about how the earliest parent-child interactions shape neurobiological development and children's social, cognitive, and emotional abilities gives us an unprecedented opportunity to prevent many cases of future distress and full-blown disorders and syndromes, he says.

Greenspan, a clinical professor at the George Washington University Medical School in Washington, D.C., has developed the DIR/ Floortime Approach, which uses parent-child interaction and play for observation, assessment, and intervention. The approach rests upon a comprehensive biopsychosocial model, specifically the Developmental, Individual-Differences, Relationship-Based Approach (DIR), which looks closely at the physical, communication, emotional, and information-processing levels of each child, and at how the parents interact (or don't) to facilitate the child's growth. It also explores family relationships to see how they enhance or constrain the child's progress through six essential stages of early emotional and intellectual development.

"The children lead the way by demonstrating their natural emotional interests," says Greenspan. After watching them interacting with caregivers, therapists assess each child's developmental level, motor and sensory processing differences, and ways of interacting. They then work with caregivers to facilitate the child's healthy development. For example, a DIR/Floortime educator may advise a parent of an overactive, fidgety toddler on how to create an organizing and calming interaction that harnesses the child's energies—for example, enticing her to navigate an exciting obstacle course with the last step being jumping into the parent's arms. A baby who's overly affected by high-pitched sounds may become calm and joyful when mom and dad simply lower the pitch of their voices. The DIR/Floortime goal is to nurture the child's capacity to be calm, focus, engage with others, use social interactions to problem-solve, and think logically.

"Most parents wait until problems emerge before they look for help," says Greenspan, whose book Building Healthy Minds speaks directly to parents. He'd like to educate pediatricians, daycare workers, parents, and early-childhood educators about proactively understanding what each particular child needs to develop optimally, though. "Providing comprehensive preventive and early intervention services for all infants, young children, and their families," says Greenspan, "must be the goal."

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