The Clinical Map: An Innovative Model

An applied Social-Developmental map for children with body organization, ideation, social and communication issues

The clinical map is an integrated framework that addresses problems in ideation, body organization, social interaction and communication in the home setting as presented by children on the autism spectrum as well as typical children with challenges in learning, communicating, playing and thinking. Integration in this framework means each person working with the child- while focusing on one aspect of the child’s functioning- also addresses other areas of concern. This framework is a map because the child is guided by Top-down and Bottom-up behavioral tools towards two developmental destinations: An Appetitive State or Satiated State.

The Clinical map is integrative framework that assumes that children learn best when they are taught through a combination of top-down and bottom-up behavioral tools. It is a pragmatic social developmental framework with links to the works of Jean Piaget, BF Skinner, Lev Vygotsky, and John Vervaeke and it’s an adaptive strategy for children with developmental challenges.

The Clinical Map is conceptually systematic because it views the formation of child character structure with the entire array of child performance and the application of top-down and bottom-up ABA tools to help children organize their behaviors, develop concept of time and space, problem solve, form relationship with others and build their character.

The elegance of the Clinical Map is it's applied top-down and bottom-up behavior analysis within the 5-character structure of child development in a synchronized fashion across time.

The goal of the Clinical Map is to:

1. Assess the child’s capacity to interact with people and objects, adapt to change, and learn from experience.
2. Build the child’s awareness of his own body as it relates to objects and top-down and bottom-up care systems
3. Guide children from closed, disconnected, scattered ways of being into functional, social and communicative exchanges
4. Provide the necessary transitions from concrete to more abstract symbolic functioning

The Unique Aspect Of The Clinical Map

The Clinical Map’s three major applied strategies:

1. Top-down and bottom-up behavior analysis

The first is an applied of Top-down and bottom-up care system towards an Appetitive State (i.e., developmental gains). The assumption behind this strategy is that all behaviors have the potential to shift from a Satiated State into an Appetitive State. When this is the case, the therapist must know when to apply top-down or bottom-up behavioral tools. For example, atypical behavior repertoire such as ODD, OCD, or perseverative behavior patterns can often be transformed into functional, interactive behaviors by applying bottom-up and top-down care strategies, concurrently.

2. Character Structures

The second major strategy is the introduction of character structures, developmentally relevant behavior patterns, that when assessed and diagnosed can repair developmental lag and restore developmental progression.

Character structures vary in their complexity from simplest one-component structure to more complex, multi-step character structure leading to a particular desire. The simplest one-component character structures are organized, coherent “patterns” of behavior that are initially, quite repetitive. They involve the child acting reflexively with the body on or with some object, event or person in a predictable manner. The latter is referred to an integrative character structure, children who are able to address previously developed character structures in new ways have a basis for problem solving and creative play.

The hallmark of character structures is the investment the child has in maintaining or continuing them. This investment becomes apparent when a particular character structure is interrupted. Interrupted character structures are used to motivate a child. Many children show character structure deviation that interfere with their performance and development. They may be so overinvolved with things and events that they are unable to detach from them, as does the child who perseveratively flicks on and off light switches. Alternatively, these children may be so uninvolved or disconnected from things and people around them, that there is little basis for building or sustaining relationships with either things or people. This means that before such children can progress, careful attention must be given to each character structure.

Which Character Structures?

• The desire for Exploration

• The desire for Sensory Information Flow

• The desire for Play

• The desire for Social Care

• The desire for Elimination of Stimuli

These 5-character structures have one to one mapping with the Big 5 trait theory: Openness to Experience, Conscientiousness, Extraversion, Agreeableness and Neuroticism and Behavioral Neuroscience. This means the 5-character structures are evolutionary tools that help children adapt to their environment as self-maintenance and self-propagation strategies.

Without a clear understanding of how these 5-character structures unfold in the environment, children are more prone to child psychopathologies especially in today’s high technological age.

3. Scientific Narrative Technology

The third major strategy is having the parent and therapist narrate the clinical map, through play, during behavior interventions, with signs and spoken words, what the child is doing while they are doing it. We find that such narration helps children, parents or therapists relate the action, words, signs and stories to their own actions. As this happens, they seem to become more aware of themselves and begin to develop the inner speech so important in communicating both with themselves and with others.