Developmental

9. Developmental/Emotional Challenges of Toddlerhood Toddlerhood=18-36 months Simultaneous onset of increased mobility and language Capacity for symbolic representation evolves-can now imagine outcomes and anticipate consequences Sudden acquisition of new emotions & emotions differentiating at rapid pace can decide where to go and when on own, and can say “no” to parents can decide where to go and when on own, and can say “no” to parents

10. Challenges of Toddlerhood… Onset of elation, pride, anxiety, self-consciousness, shame, intentional hurting, guilt Quick transitions between carefree marching away and frantic clinging behavior Internal struggle with “can I do it by myself, or do I still need help?”

11. Toddler-Parent Relationship Restructuring of the relationship between attachment & exploration Secure Base Behavior (Balance) Parent struggles with: Protective Behaviors, and Letting Go (parental signals) Social Referencing

12. Toddler-Parent Relationship Toddler seeks to explore, learn, and individuate Parent strives to protect and to socialize Given these different goals, struggles are inevitable

13. “Goal Corrected Partnership” “Where parent and child learn when and how to compromise and rearrange their individual goals for the sake of the relationship, or to accommodate the more urgent priorities of the other” Toddler internalizes parental emotional support and standards of behavior

14. Toddler Referral Concerns Aggression Defiance (temper tantrums) Impulsivity Overactivity Anxiety (separation and fears)

15. Other Referral Concerns Developmental Delays Parent-Child relationship problems Eating and Sleeping Problems Elimination Difficulties-Toilet Training

16. Assessment is Relationship-Based What does the toddler bring to the relationship? What do caregivers and other family members bring to the caregiver-child relationship? How do the contexts of biology, social factors/environment, and cultural factors affect these relationships? Winnicott: no such thing as a baby Toddlers still wholly dependent on parentsWinnicott: no such thing as a baby Toddlers still wholly dependent on parents

17. Goal of Clinical Interview Establish a therapeutic alliance Develop a complete, comprehensive view of the child in context Facilitate a shared understanding of the parent’s perspective of the child’s problem Develop a plan for treatment

18. Assessment as a Collaborative Process Is the first “intervention”, and invites the family to tell their story Is ongoing, never stops Can form the beginning of understanding and hope Parents as primary in “treatment team” Clinicians are hopefully interested in assessing their own impact, continually Stance of “principled, determined ignorance”—knowledge can get in the way of learning from a familyStance of “principled, determined ignorance”—knowledge can get in the way of learning from a family

19. Primary Referral Concerns The therapist follows the client’s lead, in deciding what is important about this initial assessment “Tell me about your concerns.” Each critical area is carefully explored with the parent using open-ended questions Throughout, both strengths and concerns are discussed

20. Areas for Assessment Family Social History Early Developmental History Parent-Child Relationship/Attachment Relationship to Sibling(s) Family/Environmental Stressors (risk and protective factors) Parent-Time Concerns Abuse/Neglect/Domestic Violence Trauma and Loss

21. Areas for Assessment… Behavioral Concerns Emotional Concerns Preschool/Peer Relationships Sensory Integration Regulatory Issues Daily Routine and Schedule Development and Self Help Medical Legal

22. Areas for Assessment… Caregiver’s Attempt to cope with presenting problems Family Psychiatric History Prior Treatment / Current Involvement with other community agencies

23. Behavioral Measures Parenting Stress Index - Summarizes sources of parental stress, arising from attributes of both the parent and child. (Normed only for biological parents). Child Behavior Checklist (1.5 - 5 years) Summarizes normative data for various areas of pathology. ITSEA & BITSEA

24. Infant/Toddler Mental Status Exam Observational Tool with following categories: Appearance Reaction to Situation Self-Regulation Motor Speech and Language Thought Affect and Mood Play Cognition Relatedness

28. Treatment planning Refer for genetic or neurological evaluations if needed Determine interventions for the family, the parent-child relationship and for the child, which is often accomplished through the parent

29. Treatment Interventions Provide practical help for families Take advantage of strengths Provide information, advice, translate infant signals, provide emotional support for families, help with behavioral techniques

30. Treatment Interventions Provide play interventions when needed for the child Provide corrective attachment experiences Open windows when helpful to the parents’ own past and issues