Just got back from training on Interoception!!!

[PeterPan]

Ok, that was mind-blowing. Any questions? The stress is on the first syllable btw, or at least it is the way Mahler pronounces it. I've had the book for a year and I sorta glossed it, getting the concepts but not really catching on that she spent YEARS working on it with each client and actually made it BETTER. Identified with a lot of what she was describing, especially with things like Zones instruction not making any difference, etc.

Interoception: The Eighth Sensory System  So here's the book, and then she has a curriculum coming out, hopefully in the next month... Should be transformative. That's what the training was doing, laying the foundation and then walking you through teaching the first two phases with videos. There's a 3rd phase she couldn't even get to because it's better as the 2 day course. She's also developing online training.

[Jennifer-72]

That is awesome!  I am so excited about the curriculum she is coming out with.  I first heard about it a couple of months back when I joined her Facebook group, and keep checking to see if it has come out yet.  I would love to go to her training.  I found her book fascinating!  

[PeterPan]

The *order* of the intervention was really fascinating. I had thought of the book as a yes/no (have the skills or don't) and the intervention as brief (6 months, whatever). No she spends YEARS working with these clients, going through a process where they INDUCTIVELY get the terms, inductively start extending the terms to language (if possible, if IQ allows), and then are able to go through the entire process again only this time reapplying it to others! Then she has the team help them develop language supports, if the dc uses AAC at all (even verbal people will when tired as language drops), putting all their body check labels and emotions (hypostatic and affective) into emotions. They extend it to Zones (because logically Intero must be established BEFORE ZONES CAN WORK in this population), so even the color-coded Zones choices are put into the AAC. And they use the data from the body checks to establish, initially to the therapist and later to the persons, what constitutes Feel Good Menu choices.

So think about how backwards we had all this. We teach Zones and say do this to yourself. We teach strategies and say these will make you feel good if you do them. We tell them what they're feeling and tell them to "fix" it by making choices. Everything is out of order, foisted on the dc, because we never developed the *internal* sense of what would make them feel good and constitute a feel good menu, what body things were happening that equaled an emotion, and how to connect body signals to zones. All those lofty goals work better by developing interoception.

Another thing that blew my mind was her hope that there was actually room for progress! Sorry, but I've done mindfulness and you can do it out the wazoo and still have NO CLUE what your emotion is (hypostatic or affective). So your hypostatic emos would be like fatigue, thirst, headache, etc. Your affective would be happy, nervous, sad, etc. So I can do body scans, but I still don't KNOW WHAT I'M FEELING! 

She's saying that if you do the experiences with body feelings enough, really slowing down, focusing on 1-2 parts a week (which, given her list of 15 means an astonishing amount of time, months), their data (redoing the intake questionare) shows that even before they get to the stage of actually trying to connect body check labels to emotions, the clients are already beginning to figure it out!! 

There's a connection between interoception and scoring well on reading one's own body and awareness of *other's* body signals and body language. In phase 3 (so now we're talking very advanced, years into the process), she's going to go through the whole thing again to apply it to others. But they don't just tell the kids. They let it ruminate and develop naturally, almost as induction. The kids figure it out and figure it out deeply and then IDENTIFY with what the other person is feeling or experiencing because they realize they feel it themselves! 

Also that seemed to me to indicate there ought to be a way to harness RDI for this as well. She said there's wind the RDI people are working on it from that angle. But when you ask like ok how does this develop naturally, what is the typical progression of the development of interoception aside from disabilities, etc., THEY HAVE NO DATA. They know infants notice discomfort and that it motivates their behavior. They have enough data to know some level of interception is verbalized by age 3. But when you look at all the categories and aspects of interoception (internal, external, hypostatic/affective, self vs. others, etc.), then no they have no data on that development. She wants people to study it. Apparently it's a wide open thing if anyone needs a project for grad school. 

I would strongly recommend doing the training if possible, just because I think it's a good way to bust through assumptions. She talked about how we use terms that the people don't understand concretely. Like we say "take a break" but we don't define it by the physical change we expect to happen. For that, she does the high-low activities (over a period of MONTHS, not just a couple times), so taking a break means going to do something to get your heart rate down! THAT is something the person who has been practicing that skill and developing a menu for that skill actually could understand and do. And what does "Calm down!" mean? Again, doesn't mean so much to the person and even backfires if they misunderstand it or assume it means something else.

Had kind of an awkward moment when she launched into all this talk on positivity. I'm like that is so NT to think the most valuable emotion is positivity and that we need to help our kids be positive, don't we need to first help them actually acknowledge their emotions and realize what they are, that there's a need to be present even in the negative emotions. And she's like oh no, we have emo equality, we want that. Her trouble was trying to get through 2 days of material in 1, lol. So she was glancing the shocking byproduct that people are finally going to be acknowledging and able to connect with what they're feeling and moving on to the NEXT brilliant thing, which is that then you can finally qualitatively say why something is a good "break" and what a break is for and why you want it. Once the person realizes they have good feelings and can quantify them with body check data, then they might realize they have a whole list of curious, unique things that make them feel good! That then becomes their "Feel Good Menu."

And lest that sound trite or whatever, I'll just say it was revolutionary for me. I had not connected that I do certain things because they make me feel good. These concepts were compartmentalized in my mind. And she's started showing lists individuals had made of all the quirky, unique things that, per the data, made them feel good, things that could go onto Feel Good Menus for breaks! I'm like well that's SO much better than foisted menus and the pre-done lists you find online through OT sites. There's always this assumption like oh an OT or sensory break will make them feel good. Well I guess you could call them sensory, but they were quirky and very specific to the dc. And they weren't being chosen to fix something or because the dc was agitated or yellow zone. It was simply acknowledging hey these things make me feel good. Like for one person it was pacing on a line back and forth 10 times. And they could do body check data and say yes, this actually puts your body in a better place, you feel a certain way as a result, this much will get you there, that would be a great choice. And then you also know it doesn't have to be unending either.

She talked about the need to go from concrete to representational and not to skip concrete for kids who needed concrete. So as far as using a large body tracing vs a diagram in a file folder, that was the line. She explained why the outline, that some kids viewed a body *picture* of themselves as meaning it was only exterior signals, rather than allowing for internal. She sometimes puts facts on the diagrams, sometimes not. She'll do body check and emotions words inside the folder and put Zones checkin on the back or with an adjacent/extension folder. 

I think maybe in some ways Mahler is a lot like me (ok well she's not, but maybe in this). She was like well if you UNDERSTAND all this and the progression, you don't even need the curriculum! To her, she hated to turn it into a curriculum, because to her it's a customized progression. She said some kids she runs the body checks and the application to emos parallel because those kids are ready. For other kids she does it as phases/stages, because doing them together would overload. She said for some kids they run less systems (from the list of 15 parts to develop intero on), because doing more would be overloading. So she was such a hoot with her wishing it didn't have to be a curriculum while people were like please, give us a curriculum! LOL But I think it's because it's hard to get in her head and see that progression and realize how much time she spent and how she expanded each step to fit the dc till each level of awareness clicked. When you read (scan, rabbit on speed read) the main Intero book, it's possible not to grasp that. So the training busts through that, definitely, highly recommend. The curriculum should help too. 

I don't know if she's including any copies of the intake questionaire in the curriculum. It's going to have like 150 pages of downloads, which is wild. She's selling the intake assessment in printed packets, but the reason is that gives the practitioner in the ps on an IEP team something swanky they can score. For our purposes, for my purposes, I'm like ok I need to do this or would like to both for baseline AND because she collected data on where they (the clients) were mixed. I think that step could be really important for self-awareness, because you need to realize ok I'm pretty strong or typical on my intero for x but I'm under-reading for y and I'm over-reading for z. Like a person could be a mix. She talked about the over/under people (absent sense) vs. distorted sensory people who are reading but vague. I don't know, that distinction was less clear to me and seemed somehow radically obvious to her. The main thing to take from that is if you're not doing the pre-questionaire and baselining, then you're not giving that person the data to realize where they're having issues and need to put focus. So we might teach all 15 areas of the body, but we might only target 4-6 to monitor more closely as ones that are affecting our ability to read our systems effectively and make good choices and be safe and happy and healthy.

So yeah, way cool, foundational. She had a nifty quote "Interoception isn't the only thing, but it's the missing piece in everything you're doing." So there you go. The reason Zones isn't congealing for some kids, interoception. The reason the social thinking isn't applying naturally across reading comprehension and life, interoception. On and on. And she can't even say well the way she's doing it is the ONLY way to work on it. It's just a way and a way that is making headway and generating what looks like change in data on the questionaires and what changes function, with enough work (years). I think it's really valid to say ok, how does this develop naturally, or there more paths. But right now, those paths aren't really obvious. This really direct method actually does work, has some evidence behind it, and is easy then to apply to life. 

The irony is. the study data was kind of shocking. It's not like they were doing 3 hours a week and tons of homework 4 times a day and body check-ins and all that, lol. Nope, she took in some students, and the students taught the lessons imperfectly as students would. And then they left body check sheets with busy teachers and hoped for the best. Some teachers put the body check sheets at the bottom of a pile of good intentions, lol. And. shhh, irrespective of whether they did them or not, JUST the fact that they did the lessons and made that nominal amount of effort (30-60 minutes once a week, teaching 1-2 body parts and going through the lesson steps) was enough to make RADICAL bumps on the scores for the intake questionaires. 

So that shows that even our imperfect efforts will be worth a lot. She said her own anecdotal evidence working with adults who could verbalize was that slow was better, giving time for things to click and congeal. And when it comes to being there for the long haul, homeschoolers are it! 

So there you go. You can do it imperfectly, once a week, applying it as you have time, and just keep at it, and you'll actually see life improvement, just by keeping at the progression, nibbling away. I'm crazy excited to see where this could go.

[kbutton]

Very cool information!

 

[PeterPan]

6 minutes ago, kbutton said:

Very cool information!

 

And it was only $25 and we got to eat lunch at Xavier. And they had out cheesecake and desserts. 

It was $125 for professionals but still it was a good price. I was shocked they kept the room so small. Everyone was from Cincy pretty much, and I was wishing they had advertised better and made the room bigger and spread their net farther. RACCA in Cincy is doing amazing stuff. I didn't realize they have a paid coor. Everyone else is volunteer, but that's how they're having such good offerings. 

The fascinating thing for the therapists is that they get to watch these kids unfold and revel in their ability to express what was going on. That was the blossoming you were seeing in the higher IQ kids. She works with all kinds of kids, sure, but some of these kids were like 150 IQ, and you'd give them these interventions and their ability to blossom with it was astonishing.

[kbutton]

What is RACCA? When I search, I get nothing. Do you mean RAAC? I wondered if that was the training you took. There are three trainings offered for families today spread out over town. Those trainings are $10-15, and I think I read they are packed out.

For people local to Cincinnati reading this, you can get on a newsletter through Cincinnati Children's that lists events like this for multiple organizations. 

***ETA: It's a little convoluted, but you can get information about the newsletter under "Classes" on this page: https://www.cincinnatichildrens.org/service/k/autism/patients

Some of the trainings offered will be autism, some DD, some ADHD--all are at least tangentially related to autism in one way or another. Most things for families are quite affordable.

Edited October 4, 2018 by kbutton
Added link

[PeterPan]

Mahler is doing multiple trainings. She did a day with university students, then a full day with professionals (what I went to), and then she's doing multiple 2-hour sessions with parents. I wondered how the parent sessions were going and whether they were going to be well-attended! I felt like since I was driving so far, I was not going to drive for just 2 hours. I plan to do the full curriculum with him, and I want the full training.

So are you going to one of the parent sessions? I'm assuming she'll have found a way to condense it down and make it worthwhile. They'll probably run over with questions, LOL.

Yeah, offerings in Cincy are problematic. The drive is just crazy for me. Yes, must be RAAC. I was too lazy even to look it up. They're using Go to Meeting and streaming some things, so I can participate. I got clued in about their safety series from someone else who has been attending, and the concept has been REVOLUTIONARY for me with ds. Now when I think through situations for ds, we start with safety. With the IEP team and the need for language intervention, it's safety. People really clear out of the way once you point out that we need this to be SAFE.

We also had good chats about police and safety. Not that other people have to deal with this, but in our reality we have to deal with what if we had a situation where we needed the police, how would that go down. They've been doing the trainings, but I hadn't connected to anything or had my ds meet police yet. So the RAAC person was explaining how that would go down, what the police are trained to do. That was sort of epiphanal for me, because I was like oh you mean if I'm overwhelmed and just wishing professionals would help, that the professionals are going to be wondering what to do to? LOL Yup. And she said they train them to ask *What do you want me to do first?" and I was like OH. Total epiphany. Like sometimes the answer is just give me a place to sit, let's get this calmed down. She said their professional training and instinct is to go physical and restrain, and we know that is so not safe with some people, that that escalates it. So they're training the cops to ASK first. And I'm like ok, then if they're going to ask, then I need to be thinking through in situations what I want them to do, what they could do to help. Total mindset shift. What could we change here that would keep everyone safe and allow it to de-escalate and how could they help with that? Epiphany. Little shift, big difference.

It was a good connection to make.

Edited October 4, 2018 by PeterPan

[kbutton]

I have zero time to do anything right now, sigh. 

[PeterPan]

5 minutes ago, kbutton said:

I have zero time to do anything right now, sigh. 

I apparently have more time, because I've been looking at grad schools, lol. But last time I did that, it was 10 years ago and then I was pregnant in three months. 

[Lecka]

For concrete representations, I have seen a ton of boardmaker icons for different things.  

[PeterPan]

She meant concrete as in the outline of the body is the same size as the child, not a smaller diagram. Then for a later stage she sometimes took pics of the body part and had the word bank beside the picture, so a picture of the feet and the words the dc uses to describe how their feet feel, etc.

[Terabith]

Wow!  That sounds amazing!  We don't have major interoception issues here, but I find myself wondering how it would work for anxiety.  Like, for me!  It sounds pretty brilliant.

[PeterPan]

19 minutes ago, Terabith said:

Wow!  That sounds amazing!  We don't have major interoception issues here, but I find myself wondering how it would work for anxiety.  Like, for me!  It sounds pretty brilliant.

Well do they *realize* when they're anxious? Are they noticing the symptoms early and making choices? That would be your interoception piece... 

But you're right, she did say even in the autism community it's not homogenous like ALL people will have this going on. But the stats in autism and a bunch of other areas (trauma, etc. etc. etc.) were pretty high.

[Terabith]

Yeah, we all can tell when we're anxious.  But nobody has really figured out how to alter that really.  It's the changing the state we're not good at.  

[PeterPan]

2 hours ago, Terabith said:

Yeah, we all can tell when we're anxious.  But nobody has really figured out how to alter that really.  It's the changing the state we're not good at.  

If you used the body checks (putting words and descriptions to each area affected) and then had practice altering those things, then you'd have go to choices for altering the issue that caused that state. For instance, when you define "break" as "things I do to lower my heart rate" then you can say ok right now my heart rate is elevated (as part of my anxiety) and so I'm going to go to my list of things I do for that. It could be the feel good menu or organized by zones or whatever. 

I really liked the concept of a Feel Good Menu, even though it seems pretty subtle. It wasn't like the OT sensory lists where they're like oh you just hand him a squeeze ball. It was really specific to the person, like watching animal videos on youtube or doing a particular repetitive thing or... 

I don't know. I mean, look at me. I'm taking enough 5htp, so I must not be in the "you can make your anxiety go away by coloring" camp, lol. 

[sbgrace]

This is fascinating. Interoception is a part of my son's issues. (As an aside, I think Mightier helped him progress in this area).

Would her book have information that would help me work on this (15 areas for example), I would I need to wait on curriculum?

 

[PeterPan]

47 minutes ago, sbgrace said:

This is fascinating. Interoception is a part of my son's issues. (As an aside, I think Mightier helped him progress in this area).

Would her book have information that would help me work on this (15 areas for example), I would I need to wait on curriculum?

 

Well let's see how much they overlap, but I think you'll definitely want the curriculum because she's finally spelling it out so you can how to get there. I'm all about the idiot-proof, really gets done, and the book was much earlier in her work in this, more theoretical. 

Really, I don't think we're talking long. It got hung up a bit, but I think she was saying mid-October. Just as soon, soon as it's available I can post here. Also there's a FB group you could join and follow on. Yes, this awareness is built into Mightier, but it's not as far as it can go. That's just like your first step. You're going to be able to take it so so much farther.

It's not going to be hard to do either. She had grad and even undergrad students doing this, 20-30 minute sessions once a week. The next year they bumped a bit longer sessions, but still they were going into autism schools, really challenging situations, and just teaching once a week. There wasn't necessarily even good followthrough by the teacher. So literally WHATEVER you do will be making progress. 

So what I would say is wait till the curriculum comes out and buy both or just the curriculum. If you want to get a bit wilder, see if you can connect where she's going to be speaking. She's going to be at OCALICON in November. It's a 2 hour session. I don't know if she's doing any of the longer 1 or 2 day trainings while she's there. You could certainly check. It was paradigm shifting to get the big picture. Of course, honestly, I gave you such a good summary here, you may already get it.   I did find her videos and audios helpful, but I think the materials will get us there. 

I think the main thing is that when we get the curriculum it's going to be obvious and idiot-proof. You'll do a pre-inventory and then plunge in, working on one a week. I'm really excited at the potential here. I don't know if I'm more excited for ds or for ME, lol. Seriously, I've done mindfulness and mightier and there's just still this gap. And for ds finally to be able to tell us what he's feeling and what's wrong, it would be amazing, sigh.

 

Edited October 7, 2018 by PeterPan

[BooksandBoys]

I’m going to have to read your post a few times to fully digest it, but this is kind-blowing (and I’ve been guessing it for years...). My DC (who now has an ASD diagnosis after YEARS of doctors shrugging at me or brushing me off as exaggerating his behaviors) has No Idea that he’s anxious. Or that his arm hurts a bit, or that he’s tired, or that he’s thirsty. And any discomfort results in behaviors. I’ve learned to read him pretty well (for someone outside his body), and I can coach with my guesses, but, of course this is why Zones are useless. He can’t identify angry until someone tells him he might be angry (and he has a good vocabulary) even though he’s throwing things, for example. He has no idea what anxiety feels like, even though he’s absolutely drowning in it most of the time. 

Huh 

[PeterPan]

2 hours ago, BooksandBoys said:

I’m going to have to read your post a few times to fully digest it, but this is kind-blowing (and I’ve been guessing it for years...). My DC (who now has an ASD diagnosis after YEARS of doctors shrugging at me or brushing me off as exaggerating his behaviors) has No Idea that he’s anxious. Or that his arm hurts a bit, or that he’s tired, or that he’s thirsty. And any discomfort results in behaviors. I’ve learned to read him pretty well (for someone outside his body), and I can coach with my guesses, but, of course this is why Zones are useless. He can’t identify angry until someone tells him he might be angry (and he has a good vocabulary) even though he’s throwing things, for example. He has no idea what anxiety feels like, even though he’s absolutely drowning in it most of the time.  

Bingo. So as soon as Mahler's new curriculum comes out you can order.  She already has a book on Interoception that has been out for a while. I wish I had picked up the assessment packet, because it would have been awesome for baselining and tracking progress. She's also doing trainings and you might find something on her schedule that you could get to. The full day gig was amazing, but I guess take what you can get. She's also working on an online course and has an active FB group.

The potential is really high for what this can do with the highest IQ kids. She was working with kids with 150 IQ, etc. Lots of potential there to understand and wrangle all these factors and work through it cognitively.