(VIDEO – 3min 28sec) In this episode: a video of a teen with Down syndrome asking his girlfriend to homecoming goes viral, researchers are trying to treat PTSD with virtual reality, and more!
An interview with DIR/Floortime provider and autism specialist Dr. Lina Moyano
(25 minutes) Dr. Moyano is specialist in serving children with regulation and communication disorders and their families. She has worked in the field of autism since 2005, and is a DIRFloortime® provider. Dr. Moyano is a Licensed Clinical Social Worker in Florida and received a Doctoral Degree in Special Education with a minor in Autism from Nova Southeastern University. She holds a degree of Master of Social Work from Florida International University and a Bachelor of Arts in Sociology with minors in Psychology and Philosophy from Saint Thomas University.
For more information about Dr. Moyano: crcautism.com
AUDIO PODCAST VERSION:
Or look for us on your favorite podcast provider:
Meeting Dr. Lina Moyano
HACKIE REITMAN (HR): Hi, I’m Dr. Hackie Reitman. Welcome to another episode of Exploring Different Brains. Today, we’re going to learn a lot, cause we are visiting with us the wonderful Dr. Lina Moyano, who’s a DIR floortime provider, a social worker, a PhD, and the list goes on and on and on. And she’s going to tell us how she works with parents and families and children, and those of us who might have some communications and regulation problems. Nina, welcome to Exploring Different Brains.
LINA MOYANO (LM): Thank you! Thank you so much for having me! Really happy to be here sharing with you.
HR: Well, let me tell you such great stuff. How did you get into all this?
LM: So, it’s funny because he was kind of like not planned. Life kind of led me from one thing to another. I started working with kids with autism back in 2005, and I was doing applied behavior analysis. And it was very, like, straight discrete trial. Like, “look at me give you candy” sort of thing. And I did that for a while, and I really enjoyed working with kids, and I really enjoyed having that connection with the child. And it was fun. But after a few years, I wanted more. I wanted more because what I saw is that I really, The interaction that I was having with the child would not generalized to whatever happened at home or even outside of the office. If you didn’t have their little candy or whatever every word the child was working with, it wouldn’t generalize. So I just started researching, and then I found the DIR Floortime Method and I fell in love with it. And I started getting trained on it, and then open about my own practice and started working with the families, which is much more fulfilling for me. And I think it has much more impact than what I was doing before.
The DIR Floortime Method
HR: For those of us who were unfamiliar with the DIR Floortime Method, take us through it. What is it?
LM: Sure, So the DIR floortime approach is a very comprehensive model. So instead of looking at the behavior of the child alone, we really look at a whole thing. Like a much more comprehensive thing of what’s happening with the child. So we look into how is the child developing, and when I say the right thing is really functional emotional development. So, we look at attention, like the basic stages of development that many children are not mastering. We look at attention, we look at engagement, how is the child connected with, look back and two-way back-and-forth communication. Like a whole thing as for how the child is developing. And we meet the child development level, then we look at the individuality of the child. And this is really understanding how is the child experiencing in the world. So it’s how is the child receiving all the input from the environment and then how is the child reacting to this input based on their own profile, which is different for everyone, for all of us. And then the only thing that we look into is the relationship. So it is indeed the individuality of the child and then the relationship. And this is where family comes into play. That is like “how were we relating to a child.” And not only the parents, but any one that is interacting with each child, you have it at the school’s “how is this teacher relating to a child?” And when we talk about relationship it’s like what the child is bringing to the table, based on their profile, based on their personality, all of that. And then what we are bringing to the table. Ao working on that relationship, the whole idea is to nourish the relationship, to address the individuality of the child. So everything that is happening as far as how the child is responding and reacting to the world, and then to use that to help with the development of the child.
HR: And in your method, it’s the opposite of one-size-fits-all.
HR: You go to where the patient is?
Involving the Whole Family in Support
HR: And you connect with the individual and their family?
LM: Absolutely. So, it’s about understanding the child. And again, there is that saying that if you met one person with autism, you’ve met one person with autism. Every, every individual is different. So we need to adjust to that individual. And then also their parents, because working with the families, you’re getting into a whole wider type of understanding. How is the family processing the differences of the child?
HR: Is there a different statistic for divorces within the family’s you treat?
LM: I know it’s higher. I don’t know the exact number, but I know parents struggle a lot and the relationship is not fully there. Then it’s difficult, it’s difficult. It’s a lot of stress, they go through a lot of stress.
HR: In my Aspertools book, I call the single moms the angels with a pitbull mentality, because they have to do everything.
LM: They have to do everything.
HR: They handle the money, they get to fight with the doctor, the school, the teacher, the kid and everything else.
LM: And I think, as a professional, what is important is that you build that alliance with the parents. And I do see that a lot of providers can tend to get into a very judgmental mindset with the parents. Like “they’re not doing this and I told them to this and they’re not following through on the diet.” And really kind of like criticizing what’s happening with how their parents are behaving but I think it’s important to understand that, yes, they’re going through a lot. And that everyone is going through their process of understanding, and grieving in a way. In in their own time. So you cannot rush the process, And so, again, You know, with the parents, you got to build a relationship with the parents and the stay at the level of the parents. So it’s almost like you’re doing everything with the child and then you’re doing it with their parents as well.
HR: Where do you find the biggest roadblock with the parents, or with the child?
LM: It’s usually with the parents. It’s usually with the parents. And that’s why I work with the parents, because I can have a beautiful interaction with the child but if it doesn’t translate to what happens with the parents, it’s challenging. And I think when we talk about the parents, it’s a lot of, I think that of the challenges come from their understanding of what’s happening and their own breathing, and their own expectations, and maybe wanting a quick solution that is just going to be a miracle, and then what? This is going to be a thing of the past that no one is going to know anything about. So it’s also a process of educating the parents and to find ease into their process of like, “Yes, this is where we are, and it’s okay, things are going to get better and just day-by-day, and it’s okay.”
HR: When we talk to parents, whose child is nonverbal, how is the discussion different?
LM: Well, I think with a nonverbal child, what is important to understand is that you gotta build the foundations. So you see a lot of the parents have this idea that if the child would expect things would be different. But, it’s important to understand that before speaking, babies before they speak, they engage and they communicate. So even if the child is nonverbal, we got to work on having that back and forth engagement and that back and forth communication. And if you look at how development happens, babies are very, they really do all these things before the language happens. So when the language happens, it’s basically kind of like putting a label to something they’ve experienced already. So it’s not like “okay, I’m putting the word and then things makes sense,” but it’s based on the experience. So that’s why it’s important that the nonverbal gets to emphasize that that is the experience of sharing that we’re going for. Not just the words, because what happens is that if you concentrate so much on the words, then the interaction slows down. It’s like “say it again.” But if you understand what the child is saying, you move on and you act like, “Oh yeah, that’s what you mean,” and then maybe you say it to model it in a correct way. But you got to just move on, and keep on–what we want is to keep the flow of the back and forth. Even if it’s nonverbal, it doesn’t matter, it doesn’t matter because the child is trying to communicate. So we want to be that, it’s going to be that communicative intent that intention to communicate is more important than the actual words. There are people that are capable of producing words, but if they do not have that desire to communicate, it’s really meaningless in a way.
HR: And in addition to communicating, it’s up to you and the parents and anybody to connect. Because you’re not going to get anywhere until you connect.
Challenges to Connecting
HR: What do you find the biggest barrier is to connecting?
LM: I think it’s preconceptions of how things should be. And I think it’s a lack of understanding of what’s happening with the child and different expectations. So it’s almost like if you want to play with a child, and you want to, let’s say read a book. So you’ll get the book and you’ll start like “Alright, this is how we read the book,” but, if that’s not the idea of the child of how their book should be read–or not even read, maybe the child just wants to look at the pictures or see or hear or hearing the sounds of the pages flapping. You know what, I read the ideas of the child. If you’re not meeting the child on that level, there is not going to be a connection. Because you’re going to have an agenda which is not the same agenda as the child. So if we slow down, and you start to really just first watch and see what’s the intention of the child, what does the child want? Does the child want me to read the book? Okay, we can engage through that but does the child just want to flip pages and then be silly with the vision of it or whatever it is, then we got to join the child in what they’re doing.
HR: And joining is a key word?
HR: When I see certain parents, instead of joining their kid say playing with Legos, instead of joining and getting that connection, in order to go on to other things, it’s “put away those legos, like you’re always playing with those legos.” Like “why aren’t you doing it?” And so you go into the setting and you first connect with the child. And then you get the parents to buy into it?
LM: It’s a two-way thing. First, I have to connect with the parents, and see where they are in their understanding and then connect with the child and then can you just make these little: “Oh! He’s looking into that! Oh! Look at that, Mommy! Oh! That’s what you’re doing! Can I use my own aspect to join the child and to use that for Mom to hook him through my affect to connect with the child.” So yes, maybe we don’t want to play with the toy in the way the toy is supposed to be played with, it doesn’t matter because what we’re going for, is connection. Not how ABC goes in order, it really doesn’t matter. If it’s interesting for the child, then we use that interest to connect and that connection is more important. Even if we’re doing something that is like atypical, or you know, it is it’s that’s not the point, it’s the connection that we’re going for.
HR: And you feel that the earlier the intervention, the better?
LM: Sure. Of course, of course. For their parents and for the child as well. For the parents, because if we get the parent to enjoy that interaction with the child earlier, they’re already kind of associating this time with like: “Oh my gosh! How fun!” And the same thing for the child. You know, if the interaction is like: “Say that again! And what did you say? Use your words.” That’s not fun. “What’s the name of this? What color is this? What animal is this?” That’s squeezing, that’s not that’s not a joyful interaction. So what we want is really help the parents understand this, so they both can have fun. And this is so important, because it has to be on both sides. I remember, one time, I saw a mom and mom was like: “Oh, we played the whole weekend and hours,” and I was like, “Oh! How exciting! So did you guys have fun?” And Mom said, “He was having fun, I wasn’t.” Because the child was repeating and repeating. So that’s when you’re kind of like “wait a second.” So, there is something that needs to be adjusted there, because it needs to be joyful for both of them, and that joy is rewarding on its own. When you’re having a joyful interaction, you want to have it again, and again, and again. So if you’re talking behavioral terms, the joy is the reward. The reinforcement.
The Differences Between Children and Adults with Autism
HR: What’s the biggest difference you find, when you work with children whose brains might be different versus adults?
LM: Yeah, it is, it is different. And I think um, the challenges that they have been often times been misunderstood for a very long time. And often times, they are associating, interacting with people as seen with the stress. You know, having to follow rules. I remember, I was having an interaction with an adult. And he was looking at the blinds, and he was fascinated with it. And it was hard for him to interact with me because his attention was on the blinds. So right away I was like, “Oh! You were looking at that!” And he was like “Oh, no, I’m not!” But it was almost like he’s been conditioned to not do that thing.
LM: That is that is just like, it’s a lot of stress, whereas you been having an interaction since you’re a child to go into: “Oh my gosh! You’re right, Look at those lines! Isn’t that Cool!?” Then it’s almost like in a mental health way, you building a lot of confidence in yourself. And I know like okay, yes, it’s good to be who I am as I am accepted the way that I am, whereas an older person that maybe hasn’t had that type of interaction is going to be much more anxious about interacting in a way, where rules need to be followed in a certain way, so that’s kind of reserved by harder to braid those patterns.
HR: Now, for someone in our audience, who’s may be thinking of going into a career such as yours, what is the recommended pathway for them?
LM: People getting into doing this work of DIR floortime come from different professions. Working particularly with the families, I think having a mental health background is excellent, because you can understand it and because you can connect and because it really requires tools to really build that engagement and that connection with the child in that mental health level. So mental health would be like a good pathway.
HR: And your background was in Social Work initially?
LM: Yeah. Yeah, I started doing sociology in my undergrad and I had no idea what I wanted. And just like one thing led to another, then I did my masters in social work, which is very clinical. It’s mental health title basically. And then, just one thing led to another and then I fell in love with it. I found this and it was just like– it makes sense. When I started learning about DIR floortime, it fits to what I already believed. So, it was like: “Yes!” You know.
HR: I’m home!
LM: Yes! And it’s beautiful, because it’s the experience of a lot of people that really get into the motto of like “Oh my gosh! This has already been set.” You know, there’s a whole bag from behind, this is not me wanting to do things differently with a child, but, that is like there’s already a whole motto that bagged it up.
HR: And your PhD was in Nova Southeastern University?
LM: Yes. It was an Ed. D, education and doctorate in special education with a minor in autism.
HR: And they have quite great facilities over there.
LM: Oh, yeah.
HR: Building the school, and all the other stuff.
HR: Um, who are some of the colleagues that you have over here in Broward County, Florida?
LM: In Broward County, I work closely with Dr. Jennie Trocchio. In fact, we’re going to support group for parents. And really creating a community of people who follow these ideas. Even if they don’t apply DIR floortime, they have therapy on their own, or anything, but, really they see their kids in a different way. In a more developmental way. So, we do a lot of things in the community. It’s a beautiful connection to have.
HR: What are the biggest limiting factors in your practice would you say?
LM: I think that it’s limiting the fact that most people are not aware of this type of intervention. Usually when people go to pediatricians, or neurologies, right away they give them prescriptions or ABA. And they are not aware of other alternatives, all the ways of treating the child. If you live in California, and other places, bigger cities, it’s not a question. Like you’re an adult, this child has this condition, and you can do ABA. These are the providers. You can do DIR Floortime, these are the providers, you choose. Here we don’t have that. So, the challenge, not the challenge, but what I do need to do is educate the families of– “Ok, we’re different.” You know, we’re seeing the child in a different way.
HR: And it’s interesting so, go state-by-state, huh?
HR: And there’s lobbying and stuff that goes around in Florida?
LM: Oh huge, in Florida, we are very behind. In Florida, we’re really behind. And California is a big one. California, I need to follow up on what actually happened, but they were actually passing legislation to allow parents to have choices. You know, so, for insurance companies to cover. To cover floortime. As a formal therapy.
Advice for Parents
HR: So, what type of parents who might be watching this interview, who has a child who is a bit different? What would they be dealing with? Would you say that them may give someone like you a call?
LM: They’d be dealing with frustrations. A lot of the children that I have, it’s really helping them building that regulation. Being stubborn, being rigid, being very disorganized all over the place, and really having a hard time making that connection. There’s different challenges you know. But, along with that, it’s making that connection to the child. So, I want to play with my child, but my child pushes me away, and wants to do something different. So, then we go to the facts and see like–”Alright, let’s see, where does the child interest? Where’s the mommy’s interest?” We can help.
HR: What made you choose treating children rather than adults?
LM: I um, when I was doing my internship, when I was doing my license–not my license, but my masters in clinical social work, I did an internship with adults. And it was very challenging. And when I was doing that internship, it really led me to want to work with children. Because I felt that I was going to have a bigger impact, helping the parents understand the children than working with the adults. So, that’s how kinda, I moved into the side and I like children, I do want to work with children.
HR: And then when your children that you’re working with reach a certain age, is there someone that you hand them off to? Or recommend to the parents? Or, like for instance, here at differentbrains.org, all of our interns are a minimum of 18 years old. And the reason for that is that I feel that we as a society, we have inadvertently discriminated against adults because it’s about the cute little kids.
LM: You’re completely right.
HR: And they grow up.
LM: I know, I’m guilty. I’m part of the problem.
HR: Um, so, where do you recommend the adults go? Like to what age do you follow? Because it’s sounds like, your love, your best affect with the much younger children?
LM: Yeah, I usually don’t have a lot of, a lot of people asking for services for adults. Usually my clientele, like the people who come to me, are usually kids. I haven’t really faced that situation of like “oh, I don’t know.” And teenagers I see, and once in a while, I see a 20, 22 year old. So that’s it’s okay doing that. But yes, my passion is working with the little ones.
HR: And when you work with the little ones, is there a certain amount of time you usually work with them or it’s very variable?
LM: It’s very variable. It really depends on the family, it really depends on the child, it depends on what’s happening. Sometimes, seeing the child once a week, or for a couple of months, might do a huge difference, than that already has an impact on the child. And then maybe later, we see the child in the middle of the week, once a month. It depends on the child. But, then there’s the families that, “alright, let’s do more intensive.” Because, you know, both of you need more. Both of you–and when I say need more, it is like “mommy and child” or “daddy and child” need to spend more time having this connection. Which I know is hard to have it at home. So it’s like we’re practicing here so you can have the tools to do all of that at home.
HR: So, Lina Moyano, it’s been so great talking to you. Thanks so much for coming in.
LM: Thank you so much for having me! I enjoyed this conversation.
HR: How can people learn more about you?
LM: They can go to my web page, www.crcautism.com
HR: And what does the CRC stand for?
LM: The Childrens for Relationship Center. That’s my practice.
HR: The Children’s Relationship Center. Dr. Lina Moyano, thank you so much for being with us here and and another episode of Exploring Different Brains.
LM: Thank you so much for having me.