12th International

Congress of
Neuropsychoanalysis
"MINDING THE BODY”

Berlin – June 2011

The P.L.A.Y. (PLAY and Language
for Autistic Youngsters) Project
•Based on the DIR theory of Stanley Greenspan MD
and Serena Wieder, PhD

• Started in 2001, in AA, Mi, under Rick Solomon.

• There are more than 100 agencies in the U.S. and

abroad
 The P.L.A.Y. Project*

The P.L.A.Y. Project is conducting a 3 year

randomized, controlled clinical trial.
The study compares the outcomes of 120
children with autism, making it the largest study
of its kind.

*grants from the National Institute of Mental Health; research-

design guidance from Michigan State University, and community-
outreach support from 5 Easter Seals locations
D.I.R. Model/Floortime (Greenspan)
• Developmental, Individual differences and
Relationship-based
• One-on-one intensive engagement
• Child centered – “meet’em where they’re at”
• DIR is the theory, Floortime the practice
• 6 Functional developmental levels (FDL)
• Emphasis on “affect” at the core of ego
integration.

4
D.I.R. Model/Floortime (Greenspan)
• 6 Functional Developmental Levels (FDL)

1. Attachment & Self regulation (FDL 1)

2. Shared Attention (FDL 2)
3. Two way Communication (FDL 3)
4. Complex two-way Communication (FDL 4)
5. Shared Meanings & Symbolic Play (FDL 5)
6. Emotional Thinking (FDL 6) 5
 Greenspan/Modelo D.I.R.
Seis níveis de desenvolvimento funcional
• Nível 1 – autorregulação e atenção
compartilhada (tipico = 0 – 4 m )
• Nível 2 – engajamento (tipico = 4 – 9 m)
• Nível 3 – comunicação recíproca (t= 9- 15 m)
• Nível 4 – comunicação recíproca complexa
(t= 15m – 2 a)
• Nível 5 – significados compartilhados e
brincadeiras simbólicas (t= 2-3 a)
• Nível 6 – pensamento emocional (t= 3-5 a)
 Evidence for FloorTime/DIR

• Case Study of 200 children

• Clearly diagnosed
• Follow-up > 2 yrs.
• 58% Good to outstanding outcome.
 P.L.A.Y.Project: Clinical Outcomes
Video Brianna
Clip 2
21/2 y FDL I (function as 1 y)
Very visual
Intermittent engagement FDL II
Little reciprocal exchange FDL III
Correlates with Greenspan FDLs I-III
 P.L.A.Y. Project: Clinical Outcomes
• Clip 3 - 6-9 months later
• Less self absorbed (FDL I)
• Longer engagement (FDLII)
• Lots reciprocal exchange (FDLIII e IV)
• IV because we have a game and this involves
higher level cognition.
Relationship between levels of
emotional prossessing
(J. Panksepp)
 3ary

B
Cognitive Top down
regulation 1
2ary

A
Conditioned
responses 1- Top down cognitive regulation.
2 2- Top down conditioned responses.
1ary A- Bottom up learning and
development.
B- Bottom up influences on
rumination and thoughts.
 3ary process
”awareness”
functions
neo-cortical

2ary process
emotional control
learning
basal ganglia
Ucs

1ary process
basic primordial affects
subcortical
Ucs
BIG in early development
 3ary process
social emotions
high cognitive functions
BIG in Maturity
2ary process
emotional control
learning
memory

1ary process
instinctual
emotions
 3ary

Influences on rumination
Cognitive Top down and thoughts
regulation
2ary
Learning and
development

BOTTON UP
Conditioned
responses
1ary
3ary

2ary

FDL 4/5 FDL

1/2/3
1ary
 The P.L.A.Y. Project and
Neuro-psychoanalysis —
Building a Bridge
Maria Sonia Goergen, MD (Brazil)
Richard Solomon, MD (USA)
Laura G. Brust, medical student, UFRGS (Brazil)
Priscila G. Brust, graduate student, Cornell University (USA)

Contact: msonia12@gmail.com
 Bridges
*P.L.A.Y. P uses inhibition/enhancement throughout its
proposition of sensory modulation towards the primitive level out
and up.
*The nested hierarchies of development are a core “bridge”.
P.L.A.Y utiliza inibicao/facilitacao durante toda sua proposicao de
modulacao sensorial de niveis mais primitivos ate os
hierarquicamente mais recentes.
High levels of communication and relationship can only be
established once the primitive emotional systems are constraint
within.
Comunicacao e interacao em niveis mais “superiores” so podem
ser estabelecidos quando os sistemas emocionais mais
primitivos sao contidos e reprimidos nos mesmos.
 Bridges
*Play is build in the nervous system.
*The disruption on the underpinnings of sensory
affect is multifactorial as far as we know, on PDD
DIR (Developmental Individualized-
Difference Relationship-Based) provides a
methodology; levels of control within the
brain are adaptively achieved through
play, from the lower levels up to the
higher representation of affect &
cognitive functions emerging integrated
to mind.
*The overwhelming of sensory input, not being able to be inhibit/modulated keeps the
system perseverating on primitive Ucs leveL.
A sobrecarga de entrada sensorial, incapacitada de ser inibida/modulada, mantem o
sistema PERSEVERANDO em niveis mais primitivos.
*The constraint of primitive levels and the ability to come out of the comfort zone to
higher grounds of feeling their own thoughts is a must.
E ESSENCIAL A “CONTINENCIA” DE NIVEIS MAIS PRIMITIVOS E A HABILIDADE DE PODER
SAIR-SE DA ZONA DE CONFORTO PARA ZONAS MAIS APRIMORADAS, MAIS
MATURADAS – DE SENTIR/APERCEBER-SE/INCORPORAR SEUS PROPRIOS
PENSAMENTOS
P.L.A.Y. through music, body language, different levels of facial expression, rough-
and-tumble-play, different levels of sounds’ intonation etc. conducts the linking from
FDL 1 upwards, to be represented and signified.
P.L.A.Y , ATRAVES DA MUSICA, DA LINGUAGEM CORPORAL, DAS INUMERAS
EXPRESSOES FACIAIS, ETC CONDUZ E FACILITA O EMERGIR LINKADO A PARTIR DO
FDL1 PARA SER REPRESENTADO E SIGNIFICADO DE FORMA MATURATIVA EM NIVEIS
HIERARCHICAMENTE SUPERIORES.
The laws of Affective Consciousness
(J. Panksepp)
1ary processes – are within brain “rewards” and
“punishments” witch are affectively
represented.
2ary processes – brain mechanisms of learning
and memory; deeply Ucs.
3ary processes – thoughts /reflections are
grounded on 2ary processes.
 Developmental Course of Autism

6 yrs old

Typical
Developmental Development Autism: Intensive
Intervention
Age
6
Cognitive Impairment
5
4
3 Autism: Natural Course
2
FDL 1 6 yrs old
Age ©Richard Solomon MD 2004 21
 Conclusion
• P.L.A.Y. Project is a clinical application of the bridges in neuro-
psychoanalysis.
• The pervasiveness that happens to occur NDRC (Neuro-Development
of Relating and Communicating Disorders) is regulated adaptively
from inside out - from the primitive levels, bottom up, and back to
the top down circuitry. A productive positive looping of integrating
the affects entitles the emerging functions on upper levels.
P.L.A.Y. E UMA APLICACAO CLINICA DAS PONTES EM NEURO-PSA.
A INFILTRACAO/INVASAO (PERVASIVENESS) QUE OCORRE EM NDRC
(NEURO-DEVELOPMENT OF RELATING AND COMUNICATING DISORDERS)
E REGULADO ADAPTATIVAMENTE DE DENTRO PRA FOR A – DE NIVEIS
PRIMITIVOS, UCS, BOTTON-UP, E DE VOLTA, TOP-DOWN, EM UMA
CIRCUITARIA.
UM LOOPING POSITIVO DE INTEGRACAO DOS AFETOS PERMITE A
EMERGENCIA DE FUNCOES MENTAIS SUPERIORES.
Thank you!
Obrigada!

Maria Sonia Goergen

msonia12@gmail.com