“Holistic Approach to Improving Children with Developmental Delay” 7Th – 31St May 2019 at Rajanagarindra Institute of Child Development, Chiang Mai, Thailand

Lessons Learned from the Training Program

“Holistic Approach to Improving Children with Developmental Delay” 7th – 31st May 2019 at Rajanagarindra Institute of Child Development, Chiang Mai, Thailand

Rajanagarindra Institute of Child Development Department of Mental Health, Ministry of Public Health, Thailand 2019

Contents

Chapter I Introduction Purpose of the Training Course 3 Course Objectives 3 Course Outcome 4 Procedure 4 Participants 5 Training materials 5 Statistical Tools for Quantitative Analysis 5 Duration 5 Evaluation of Course Competencies: 6 Chapter II Result of Training Evaluation 1. Quantitative Data 7 1.1 General Information 7 1.2 Evaluation results of trainees’ scores 8 1.3 The result of the quality of the training program 9 1.3.1 Utility 9 1.3.2 Feasibility 10 1.3.3 Propriety 11 1.3.4 Accuracy 13 1.4 The Results of the Trainees’ satisfaction 15 2. Qualitative Data 2.1 Trainees 16 2.2 Speakers’ suggestions 34 3. Corse Content Summary 3.1 Topic: Thai Child Developmental System Model 35 3.2 Topic: Introduction to RICD and Field Visit 37 3.3 Topic: Guide to Living in Chiang Mai 39 3.4 Topic: Children with Developmental Delay and NDD 40 3.5 Topic: DSPM 43 3.6 Topic: DAIM 46 3.7 Topic: TEDA4I 48 3.8 Topic: Early Stage Development and Postural Support Devices 52 3.9 Topics: Thai Massage Therapy for Children with CP and ASD 57 3.10 Topic: Sensory Integration and Snoezelen 59 3.11 Topic: Applied Speech Therapy for Children with ASD 62 3.12 Topic: Picture Exchange Communication System, PECS 63 3.13 Topic: AAC for children with complex communication needs 66 3.14 Topic: Social Skills Training 69 3.15 Topic: Applied Behavioral Analysis 72 3.16 Topic: Shared Action model for treating children with ADHD 73 3.17 Topic: Neurofeedback 75 3.18 Topic: Applied Eastern Psychology for Children with ADHD 76 3.19 Field Visits 77 3.20 Elective Courses (Field-based observation) 80 3.21 Project Proposal Presentation 87 Chapter III Improvement of the Training Program 89 Appendix 91

Chapter I Introduction

Rajanagarindra Institute of Child Development (RICD) is a specialized hospital providing medical services to children with developmental delay and mental health problems such as Autism spectrum disorder (ASD), Attention deficit hyperactivity disorder (ADHD), Cerebral palsy (CP), Learning disorder (LD) and Intellectual development disorder (IDD). Moreover, RICD provides and promotes support of academic and technological research and development to related agencies in order to improve child development and mental health. This year, RICD conducted a training course “Holistic Approach to Improving Children with Developmental Delay” for international participants to gain a better understanding of children with developmental delay, to know how to assess children with developmental delay, provide appropriate intervention and be able to make suitable referrals for further intervention. The training program “Holistic Approach to Improving Children with Developmental Delay” was conducted at Rajanagarindra Institute of Child Development, Chiang Mai, Thailand from 7th to 31st May 2019. The course duration was 98 hours/around 3 weeks, and was divided into 3 parts including the 56 hour core course consisting of 2 modules, a 30 hour elective course for field-based observation, and a 12 hour course outline, presentation and examination. This training course had 24 participants, consisting of 4 psychiatrists, a pediatrician, 3 psychologists, 4 physiotherapists, 2 nurses, a social worker, and 9 teachers from 13 organizations. The 24 participants were from different agencies in Cambodia, Vietnam, Singapore and Myanmar, namely Provincial Referral Hospital, Preah Kossamak Hospital, Kantha Bopha Children’s Hospital, EMDR Association Cambodia, Hanoi Medical University, National Pediatric Hospital, Basic Needs Vietnam, Danang Social Work Center, Parami General Hospital, 500 Bedded Mandalay Children’s Hospital, Mental Health Hospital, Little Aces Pre-School and Special Education Center, Smart Kids College, Future Light Special Education Learning Center, and New Hope Association. During the program, participants were trained on a Holistic Approach to Improving Children with Developmental Delay. As the 24 participants had different educational backgrounds, they were divided into three groups: Medical Doctors, Medical Multidisciplinary Team and Teachers. The three groups trained together in the core course and separately for electives. However, during the last week, there were four groups, because of numbers, in order to present project proposals on child development, and on the last day there was an examination. All training materials and information were provided to the trainees before the training program started, to help trainees understand more about the details, assignments, and evaluation criteria before they came to this training program.

Purpose of the Training Course The purpose of this course is to increase participants' understanding of children with developmental delay, to give appropriate intervention and to make effective referrals.

Course Objectives The trainees will: 1. acquire assessment skills of the development process of children 2. identify children at risk/developmental delay and provide effective early intervention

Course Outcome 1. Gain a better understanding of the development process of children with developmental delay 2. Gain an understanding of how to assess children with developmental delay, give appropriate intervention and make effective referrals.

Procedure The training process was as follows: Phase I 1. Development of the international training course (Feb - April 2018) 1.1 Analyze organizational expertise “Developmental Delay” 1.2 Integrate the RICD training experience for Thai medical residents and Myanmarese health personnel 1.3 Development of the training course syllabus and manual 1.4 Development of the training materials 2. Enhancing the developing of teaching skills for speakers (May 2018). 3. The first pilot-testing of the training program by conducting a practice run by speakers and the project manager (Jan - Feb 2019). 4. Improvements from the first trial of the training program (March – April 2019) 5. Development of additional training materials and an evaluation form (March – April 2019). Phase II 1. Conduct a full pilot test of the training program with a group of available participants Pre-training (March - April 2019) 1. The project manager studied the information in the manual for the training organizers. 2. The project manager announced the application for qualified trainees through online social media. 3. Before training, the project manager informed the purposes, objectives, learning plans, assignments, evaluation process and the roles of the trainees. 4. Before training, the project manager distributed the training manual and materials for the trainees to study before trialing the training program and to use during training. 5. Before training, the project manager distributed the manual for the speakers to prepare themselves, to understand the learning process of trainees, and to evaluate the trainees. 6. Before training, the project manager prepared the materials and equipment according to the learning plans of the speakers. 7. Before training, the speakers provided the project manager with materials for trialing the training program.

Training Implementation (May 2019) 1. Ran the training trial program according to the schedule from 9.00-16.00 for 17 days. 2. The evaluation for knowledge and skills of the trainees were as follows: 2.1 Pre-evaluation of trainees’ knowledge was held on the 7th of May. It was provided to assess trainees’ knowledge in accordance with the manual. 2.2 Trainee assignments were held on the 7th of May by assigning trainees to write an experience report and make a project proposal plan. The due date for project presentation was the 27th of May, and before the 31st of May for the summary report. 2.3 The post-evaluation of trainees’ knowledge was held on the 31st of the training program. 2.4 Evaluation of the quality of the training program in aspects of utility, feasibility, propriety and accuracy was held on the 31st of May. 2.5 The trainees completed a feedback questionnaire on the 31st of May. Phase III Post-Training (June 2019) 1. Adjustments were made to the training program. 2. Synthesizing of lessons learned.

Participants 1. Trainees: this training course had 24 participants, consisting of 4 psychiatrists, a pediatrician, 3 psychologists, 4 physiotherapists, 2 nurses, a social worker, and 9 teachers from 13 organizations, from Myanmar, Cambodia, and Vietnam. 2. Speakers: the training course had 29 speakers from 7 organizations, from the Department of Mental Health, Rajanagarindra Institute of Child Development, Rajanukul Institute, Yuwaprasat Vithayoprathum Hospital, Chiang Mai University, Suanprung Psychiatric Hospital, and The Center for Bioethics and Social Medicine, Taiwan 3. Project manager team: this training course had 3 staff, consisting of a training organizer and 2 general managers

Training materials 1 .The training program manual 2. The evaluation form 3. The DSPM 4. The DAIM 5. The TEDA4I

Statistical Tools for Quantitative Analysis 1. Frequency, percentage, mean, standard deviation 2. Kruskal Wallis Test 3. Mann-Whitney U 4. Wilcoxon’s Signed Rank test 5. P-value less than 0.05 was considered to confirm significant difference and association.

Duration 7th – 31st May 2019

Evaluation of Course Competencies: 1. Regular class attendance 5 points 2. Participation in class discussion and activities 5 points 3. Assignments (40 points) 3.1 Experience Summary Report – 20 points 3.2 Project Proposal 20 points 4. Exam – 50 points (Minimum passing score of 25 points) 5. Minimum score to pass for medical doctors was 80%, while the medical multidisciplinary team was 75%, and teachers was 70%

Chapter II Result of Training Evaluation

1. Quantitative Data 1.1 General Information

Table 1: Numbers and percentages of trainees’ general information

General Information Number Percentage Gender 1. Male 4 16.67 2. Female 20 83.33 Total 24 100 Age 1. 20-29 years old 7 29.17 2. 30-39 years old 13 54.17 3. 40-49 years old 3 12.50 4. 50-59 years old 1 4.17 Total 24 100 Nationality 1. Myanmarese 14 58.33 2. Cambodian 6 25.00 3. Vietnamese 3 12.50 4. Singaporean 1 4.17 Total 24 100 Professional Medical Doctors # 5 (20.84%) 1. Psychiatrist 4 16.67 2. Pediatrician 1 4.17 Medical Multidisciplinary Team # 10 (41.67%) 1. Psychologist 3 12.50 2. Nurse 2 8.33 3. Social Worker 1 4.17 4. Physiotherapist 4 16.67 Teachers # 9 (37.50%) Teacher 9 37.50 Total 24 100

From table 1, the largest group of trainees consisted of 9 teachers (37.50 %) 20 were females (83.33 %) mostly in the age range of 30-39. The largest ethnic group of trainees (15 people) was from Myanmar (16.50 %). The biggest professional group was the medical multidisciplinary team (10 people, 41.67%). The details are shown in Table 1.

1.2 Evaluation results of trainees’ scores Trainees’ scores consisted of the following: regular class attendance (5 points), participation in class discussion and activities (5 points), assignments for project proposal (20 points) and an experience summary report (20 points), and examination (50 points). The exam evaluation of trainees’ knowledge was evaluated from 7 questions. From Table 2, it can be considered that the evaluation of knowledge of trainees was from a total of 100 points and the criteria to pass for medical doctors was a minimum of 80%, 75% for the medical multidisciplinary team, and 70% for teachers.

Table 2 The conclusion of the evaluation of trainees’ scores, shown as professional groups No. Participation Assignments Examination Total Evaluation Class attendance Project Experience (50 points) Score criteria & participation Proposal Summary (100 points) (10 points) (20 points) Report (20 points) Medical doctors (criteria to pass was a minimum of 80%) 1 10 20 17 36 83 Pass 2 10 20 17 36 83 Pass 3 10 20 17 39 88 Pass 4 10 20 17 36 83 Pass 5 10 20 17 36 83 Pass Min = 83, Max = 88, Mean = 84 Medical multidisciplinary team (criteria to pass was a minimum of 75%) 6 10 20 17 35 82 Pass 7 10 20 20 50 100 Pass 8 10 20 18 39 87 Pass 9 10 20 20 45 95 Pass 10 10 20 20 43 93 Pass 11 10 20 20 43 93 Pass 12 10 20 20 44 94 Pass 13 10 20 18 40 88 Pass 14 10 20 18 43 91 Pass 15 10 20 18 40 88 Pass Min = 82, Max = 100, Mean = 91.1 Teachers (criteria to pass was a minimum of 70%) 16 10 20 18 44 92 Pass 17 10 20 18 43 91 Pass 18 10 20 18 42 90 Pass 19 10 20 18 20 68 Fail 20 10 20 20 43 93 Pass 21 10 20 18 20 68 Fail 22 10 20 18 20 68 Fail 23 10 20 18 20 68 Fail 24 10 20 18 20 68 Fail Min = 68, Max = 93, Mean = 78.4

From Table 2 it can be seen that most participants in the training had knowledge of a holistic approach to improving children with developmental delay, with medical doctors and

8 multidisciplinary team’s knowledge being higher than the minimum scores. But the knowledge scores of 5 teachers were lower than the minimum. 1.3 The result of the quality of the training program To verify the quality of the training program, the scale consists of 3 levels, 1= Agree, 0 = Not sure, and -1 = Disagree, these criteria interpretations were employed by class interval An average between 0.36 – 1.00 means Agree, An average between -0.32 – 0.35 means Not sure, An average between -1.00 - -0.33 mean Disagree

1.3.1 Utility

Table 3: Mean and Standard Deviation (SD) of the level of the trainees’ opinion towards the training program in the aspect of utility

Aspect of Utility Medical Interpretation Medical Interpretation Teachers Interpretation of the training Doctors Multidisciplinary program Team Mean SD Mean SD Mean SD 1. The program is 0.80 0.45 Agree 1.00 0.00 Agree 1.00 0.00 Agree beneficial for improving knowledge and skills for enabling the trainees to improve children with developmental delay (U1) 2. The program is 1.00 0.00 Agree 0.70 0.68 Agree 0.44 0.88 Agree beneficial for improving children with developmental delay. (U2) 3. The program 0.60 0.55 Agree 0.90 0.32 Agree 1.00 0.00 Agree responds to the training needs of the trainees and is beneficial for trainees to improve children with developmental delay. (U3) 4. The program can 0.80 0.45 Agree 1.00 0.00 Agree 1.00 0.00 Agree apply to the development of trainees to improve children with developmental delay (U4) Total 0.80 0.41 Agree 0.90 0.38 Agree 0.86 0.49 Agree

Table 3 reveals that the participants involved in the training program agreed that the quality of the training program in the aspect of utility was entirely in the “Agree”. They positively agreed that the training program is most beneficial for improving knowledge and skills for enabling the trainees to improve children with developmental delay; and can apply to the development of trainees to improve children with developmental delay respectively.

Table 4: Comparison of the median difference between trainees’ professional group towards the training program in the aspect of utility Test Statisticsa,b U1 U2 U3 U4 Chi-Square 3.800 2.121 4.600 3.800 Df 2 2 2 2 Asymp .Sig. 0.150 0.346 0.100 0.150 a .Kruskal Wallis Test b .Grouping Variable :Group

Table 4, presents the results of comparison of median difference between trainees’ professional group towards the training program in the aspect of utility. The median of opinion level in all items of utility is not difference (p>0.05).

1.3.2 Feasibility

Table 5: Mean and Standard Deviation (SD) of the level of the trainees’ opinion towards the training program in the aspect of feasibility

Aspect of Feasibility of Medical Interpretation Medical Interpretation Teachers Interpretation the training program Doctors Multidisciplinary Team Mean SD Mean SD Mean SD 1. The program can be 0.80 0.45 Agree 0.90 0.32 Agree 0.78 0.44 Agree practical in the centers specializing in children with developmental delay. (F1) 2. The program is easy -0.20 0.84 Not sure 0.50 0.53 Agree 0.56 0.53 Agree to understand, easy and not too complicated to use/apply. (F2) 3. The use of the 0.60 0.89 Agree 0.90 0.32 Agree 1.00 0.00 Agree program helps the trainees to gain knowledge, skills and apply to children with developmental delay effectively. (F3) 4. It is feasible for 0.80 0.45 Agree 0.80 0.63 Agree 0.33 0.87 Not sure participants to cooperate in the training operation. (F4) 5. Results of the 0.20 0.45 Not sure 0.70 0.48 Agree 0.78 0.44 Agree program use are worth when comparing to duration of the operation. (F5) 6. The program is 0.40 0.55 Agree 0.70 0.68 Agree 0.44 0.88 Agree feasible in additional resource allocation. (F6) Total 0.43 0.68 Agree 0.75 0.51 Agree 0.65 0.62 Agree

Table 5 reveals that the participants involved in the training program agreed that the quality of the training program in the aspect of feasibility was entirely in the “Agree”. They positively agreed that training program is most use of the program helps the trainees to gain knowledge, skills and apply to children with developmental delay effectively. Following by

can be practical in the centers specializing in children with developmental delay; feasible for participants to cooperate in the training operation respectively. Table 6: Comparison of the median difference between trainees’ professional group towards the training program in the aspect of feasibility Test Statisticsa,b F1 F2 F3 F4 F5 F6 Chi-Square .537 3.796 1.780 2.791 4.782 1.450 Df 2 2 2 2 2 2 Asymp . 0.765 0.150 0.411 0.248 0.092 0.484 Sig. a .Kruskal Wallis Test b .Grouping Variable :Group

Table 6 presents the results of comparison of median difference between trainees’ professional group towards the training program in the aspect of feasibility. The median of opinion level in all items of utility is not difference (p>0.05).

1.3.3 Propriety

Table 7: Mean and Standard Deviation (SD) of the level of the trainees’ opinion towards the training program in the aspect of propriety

Aspect of Propriety of Medical Interpretation Medical Interpretation Teachers Interpretation the training program Doctors Multidisciplinary Team Mean SD Mean SD Mean SD 1. The program is proper 1.00 0.00 Agree 0.90 0.32 Agree 1.00 0.00 Agree for the context of the centers specializing in children with developmental delay. (P1) 2. The program has 1.00 0.00 Agree 0.90 0.32 Agree 0.67 0.50 Agree propriety in developing children with developmental delay. (P2) 3. The program has 0.80 0.45 Agree 0.90 0.32 Agree 0.22 0.44 Not sure propriety for development of the trainees. (P3) 4. Duration of the -0.40 0.89 Disagree 0.60 0.70 Agree 0.89 0.33 Agree operation in the program has propriety. (P4) 5. An evaluation of the 0.80 0.45 Agree 0.80 0.42 Agree 1.00 0.00 Agree program has propriety. (P5) Total 0.64 0.70 Agree 0.82 0.44 Agree 0.76 0.43 Agree

Table 7 shows that the participants involved in the training program agreed that the quality of the training program in the aspect of propriety was entirely in the “Agree”. They positively agreed that the training program is most proper for the context of the centers specializing in children with developmental delay. Apart from that, they had agreed that an evaluation of the program has propriety; the program has propriety in developing children with developmental delay respectively. While, the medical doctors negatively agreed that duration of the operation in the program has propriety.

Table 8: Comparison of median difference between trainees’ professional group towards the training program in the aspect of propriety Test Statisticsa,b P1 P2 P3 P4 P5 Chi-Square 1.400 2.990 9.688 8.151 1.971 Df 2 2 2 2 2 Asymp .Sig. 0.497 0.224 0.008 0.017 0.373 a .Kruskal Wallis Test b .Grouping Variable :Group

Table 9: Pairwise-comparison of median difference between trainees’ professional group regarding the training program in the aspect of propriety Test Statisticsa Group 1 VS Group 2 Group 1 VS Group 3 Group 2 VS Group 3 P3 P4 P3 P4 P3 P4 Mann-Whitney U 9.500 5.500 22.500 10.000 14.500 36.000 Wilcoxon W 54.500 20.500 37.500 25.000 59.500 91.000 Z -2.017 -2.662 .-519 -2.023 -2.908 -1.034 Asymp .Sig) .2-tailed( 0.044 0.008 0.604 0.043 0.004 0.301 a. Grouping Variable :Group Group 1: Medical Doctor Group 2: Teacher Group 3: Medical Multidisciplinary Team

Table 8 presents the results of comparison of median difference between trainees’ professional group towards the training program in the aspect of propriety. The median of opinion level in items 3 and 4 of propriety is significantly difference (p<0.05). From Table 9, the result of the Wilcoxon-Mann-Whitney test in item 3 shows there is a significantly difference opinion between teachers and medical doctors (p=0.044) and the medical multidisciplinary team (p=0.004), and item 4 shows there is a significant difference opinion between medical doctors and teachers (p=0.008) and medical the multidisciplinary team (p=0.043).

1.3.4 Accuracy

Table 10: Mean and Standard Deviation (SD) of the level of the trainees’ opinion towards the training program in the aspect of accuracy

Aspect of Accuracy of Medical Interpretation Medical Interpretation Teachers Interpretation the training program Doctors Multidisciplinary Team Mean SD Mean SD Mean SD 1. Concepts and 0.80 0.45 Agree 0.90 0.32 Agree 0.67 0.50 Agree principles in each contents are clear and accurate. (A1) 2. The objectives is clear 1.00 0.00 Agree 1.00 0.00 Agree 1.00 0.00 Agree and accurate. (A2) 3. The contents is 0.40 0.89 Agree 1.00 0.00 Agree 0.89 0.33 Agree accurate for developing knowledge and skills for the trainees. (A3) 4. Methods of the 0.60 0.55 Agree 0.80 0.42 Agree 0.89 0.33 Agree operation is systematic and accurate. (A4) 5. The evaluation of the 0.60 0.55 Agree 0.90 0.32 Agree 0.89 0.33 Agree program is accurate, systematic and reliable. (A5) 6. The content of 0.40 0.55 Agree 1.00 0.00 Agree 0.89 0.33 Agree improving knowledge and skills of the trainees are accurate. (A6) 7. Stages of the 1.00 0.00 Agree 0.80 0.42 Agree 0.44 0.53 Agree operation can improve knowledge and skills of the trainees. (A7) 8. Evaluation of the 0.60 0.55 Agree 0.90 0.32 Agree 1.00 0.00 Agree program shows that the trainees gain knowledge and skills to improving children with developmental delay. (A8) Total 0.68 0.53 Agree 0.91 0.28 Agree 0.83 0.38 Agree

Table 10 reveals that the participants involved in the training program agreed that the quality of the training program in the aspect of accuracy was entirely in the “Agree”. They positively agreed that the training program is most of the objectives is clear and accurate. Then, they agreed that the contents is accurate for developing knowledge and skills for the trainees; Evaluation of the program shows that the trainees gain knowledge and skills to improving children with developmental delay respectively.

Table 11: Comparison of median difference between trainees’ professional group towards the training program in the aspect of accuracy Test Statisticsa,b A1 A2 A3 A4 A5 A6 A7 A8 Chi-Square 1.501 0.000 4.894 1.566 2.377 8.587 5.270 4.600 Df 2 2 2 2 2 2 2 2 Asymp .Sig. 0.472 1.000 0.087 0.457 0.305 0.014 0.072 0.100

a .Kruskal Wallis Test b .Grouping Variable :Group Table12: Pairwise-comparison of median difference between trainee professional group regarding the training program in the aspect of accuracy Test Statisticsa Group 1 VS Group 2 Group 1 VS Group 3 Group 2 VS Group 3 Mann-Whitney U 11.500 10.000 40.000 Wilcoxon W 26.500 25.000 85.000 Z -1.870 -2.646 -1.054 Asymp .Sig) .2-tailed( 0.062 0.008 0.292 a .Grouping Variable :Group Group 1: Medical Doctor Group 2: Teacher Group 3: Medical Multidisciplinary Team

Table 11 presents the results of comparison of median difference between trainees’ professional group towards the training program in the aspect of accuracy. The median of opinion level in items 6 of accuracy is significantly difference (p<0.05). From Table 12, the result of the Wilcoxon-Mann-Whitney test in the item 6 shows there is significantly difference opinion between medical doctor and medical multidisciplinary team (p=0.008).

1.4 The Results of the Trainees’ satisfaction In satisfaction questions, there is a scale of satisfaction consists of 4 level, 4 = Strongly Agree, 3 = Agree, 2 = Disagree and 1 = Strongly Disagree Criteria for classified satisfaction level by class interval 1. An average between 3.26 – 4.00 = Strongly Agree 2. An average between 2.51 – 3.25 = Agree 3. An average between 1.76 – 2.50 = Disagree 4. An average between 1.00 – 1.75 = Strongly Disagree

Table 13: Mean and the level of the trainees’ opinion towards the training program satisfaction

Item Amount Min Max Mean Level Score Score 1. The objectives of the training were met 24 3 4 3.50 Strongly Agree 2. The speakers were engaging 23 2 4 3.39 Strongly Agree 3. The presentation materials were 24 3 4 3.33 Strongly Agree relevant 4. The content of the course was 24 2 4 3.29 Strongly Agree organized and easy to follow 5. The speakers were well prepared and 24 2 4 3.17 Agree able to answer any questions 6. The course length was appropriate 24 1 4 2.88 Agree 7. The pace of the course was appropriate 24 2 4 3.21 Agree to the content and attendees 8. The venue was appropriate for the 24 2 4 3.21 Agree event

Table 13 show that mean for trainees’ satisfaction, based on the item 1-4 was strong agree level, and the item 5-8 was agree level.

z 2. Qualitative Data 2.1 Trainees 2.1.1 Knowledge and skills 1) Knowledge acquired: this is a narrative report based on our reflection about the course at Rajanagarindra Institute of Child Development (RICD) which lasted from 7th to 31st May 2019. Overall, this was a very interesting and helpful training course. We understand that this work required a lot of dedication, focus, planning and time management. We learned many different things and different types of services that RICD offered to patients, which in turn, provided us more insight into the variety of roles and responsibilities of mental health professionals. We understood the Thai child development system model, the reasons to develop the common program to detect problem early and offered appropriate intervention for the children with developmental delays. Moreover, we also learned the way you expanded to use the instruments all over the country. Furthermore, we had the knowledge to distinguish developmental delay and developmental disability, screening and surveillance as well as other common neurodevelopmental disorders. We got the knowledge about physical therapy, occupational therapy, picture exchange communication system (PECS), Augmentative and Alternative Communication (AAC), social skills training, Thai traditional medicine, Taiwanese model for ADHD, neurodevelopmental feedback, eastern psychology and speech therapy for special needs children. We also found that each clinic in RICD had several people with different strengths and experiences. These people worked together as a team and created such a good environment at the workplace to complete their work effectively and serve the best services to patients. We understand about connection between multi-sectors to provide services for child with developmental delay in Thailand as follows:

Health care system

Diagnosis, Early intervention

Disability Vocational Child Vocational NGO Foundation training developmental training (for small children) (for adult) delay

Free Specialized specialize education. education Pension

Education Social welfare system (for system small children)

2) Skills learned: this was an amazing course that provided us not only the knowledge that related to children with developmental delay but also the skills throughout practicing in class. This course gave us an incredibly valuable opportunity to learn about the tools to screen and implement interventions for children with developmental delays. We had the chance to practice every item in the Development Surveillance and Promotion Manual, developmental assessment for Intervention manual as well as Thai early developmental assessment for intervention. Therefore, we understood clearly about these tools we got skills for using them. This is very important with us to share these tools with colleagues at our workplace. The class with Mr. Joey Tell about Postural support devices gave us a deep impression. We tried out some of the postural devices such as cushions, a wheelchair with head and lateral support, lap belt and butterfly harness, and standing frame and we were showed how to use those devices. Moreover, we had a chance to practice on some case studies to decide what appropriate postural device we should prescribe for the therapeutic setting. Throughout this lecture, we got the skill to assess the people who need the postural support and select the proper devices for them. Thai massage was an interesting experience that we had during the class about traditional medicine. We were able to do the basic Thai massage. We got the clear instruction from the lecturers to mutual practice at the different part of the body. In particular, we practiced leg massage, back massage, shoulder massage, arm massage, facial massage, and stomach massage. We played a role both as the practitioner and the client. When we were the client, we can get obvious benefits, the feeling is incredible. It helped us to relieve the stress and tension in joint and muscles. It also very good when we felt stiff especially during 3 hours in the classroom. Moreover, the massage stimulated blood flow and other systems to work better. Therefore, we felt extremely relaxed, no stress. Inversely, when we were the practitioner, we felt that we were proud of ourselves and we felt happy when we can provide such as incredible skills to the clients. We also got the new skill about PECS when we attended the PECS class. In particular, we were play a role with our classmate to practice PECS phase 1. One of our friends played as the child with disability very well and throughout this activity, we analyzed and discussed a lot to find out the best way to deal with child. The class about Augmentative and Alternative Communication (AAC) also gave us a lot of experiences. We can see different types of visual supports. It can be light tech like schedules, finished box, analyze the tasks into step by step, timer, first-then, contingency map, behavior cue cards. It also can be mid-tech devices like voice output communication aids or Speech generating devices or high-tech devices like tablet applications. The teacher in the class also had an amazing activity for us, she required us to write down 16 words that we could use to communicate in case that we cannot talk and throughout this activity, we can understand that how important vocabulary selection can help for the child. We also experienced some games that only used symbol languages. The main idea that we got from this activity as it does not matter about the things that we use but about how we use it and the way or the ability to apply to our situation. We were very excited about the social skills class. The important skill that we learned from the teacher is the way to teach social skills. In particular, we can play different games and throughout those games, we can teach the children many different skills such as listening skills, conversation skills, turn-taking, and sharing skills and so on. One more interesting skill that we have learned from this class was about teaching empathy for children. As you know, empathy

is very difficult to teach, especially for children with autism. Empathy includes cognitive empathy and affective empathy. We can teach the children about cognitive empathy first and through the time by time the children practice and they can get effective empathy later on. The cognitive empathy is something related to appropriate social behavior, even though they not feel like “I really care about you” Other skills that we had learned from this training course as follows: 1. Training organization skills: prepare the list of participants with pictures and summary their expectation and send it over to the participants in advance 2. Materials ready before hand 3. Organize pick up at the airport: send clear instruction with illustration (picture of pick up person) 4. Arrange car, buy Sim cards to help participants connect home easily, so that they can focus on the training 5. Good orientation: learn some basic language and Thai cultures 6. Use app in mobile phone to update information and send presentation to participants quickly 7. Care about physical activity for those who want to do exercise 8. Communication skills: Speak slowly, shortly to get people understand 9. Facilitation skills: Using participatory approach, involve participants in planning and practice screening and evaluation tools, using video, coaching, mentoring (DSPM, DAIM, PECS). 10. Tips to have more motivation when practice: at the beginning, should not choose the severe/complicated case to practice, choose case that you can success 11. How to manage behavior when practice “disability simulation” activity. 12. Skills to facilitate social skills training: observation, ask a question, listening... All in all, we were not only got the knowledge on a holistic care approach for child developmental delay but also had the opportunity to experience, practice and observe the services delivery process. At the same time, practical activities, field visits to various facilities have provided us with an overview of the appropriate and effective approach to support the children with developmental delays.

2.1.2 Observed attitudes and gained values: the first value that we gained from this course was the enthusiasm of staffs. This is true to any profession especially working with disabled people. We have to love what we do, if not, we could not provide the good service to the patient or inspire patient to overcome their disabilities. The second value was teamwork. In this course we worked in a group to practice the exercises on the class, we also established teamwork to fulfill the course’s assignment. We recognized that each person has unique strength and if we can maximize the strengths or synergistic way of working, where the sum is greater than the parts, the results will be beyond expectation. The third value that we gained is networking. This course allowed us to work with other friends from different backgrounds. This gave us the chance to get to know and created relationships with them. These friends can also be important networking for us later on in terms of collaborative working. Other attitudes and values that we gained: 1. Sincerely: sincerely with ourselves, sincerely with our colleagues and especially with patients who we work with. 2. Respectful: Be respectful with others come from different backgrounds. Be respectful with patients. 3. Slow but seriously: We have to be serious in work to make sure we understand theory and practice correctly, avoid the side effects of the intervention. 4. Be focus: focus on what we are doing, especially when working with patients 5. Be patience: we need to understand that positive changes cannot happen in one day, it needs time and energy of not only an individual but also of a team. 6. Being positive: when working with children who have developmental delay issue, we should look at positive things to provide complement to children who has problems 7. Be grateful with what we have now: aware that we are luckier than a lot of people in community, hence please take care of yourself then give something (your time, your efforts...) back to community. 8. Never stop practicing: practicing will enhance skills. We need practice ourselves and transfer this message to parents, care givers of the child.

2.1.3 The most challenging task performed: Theoretically application and practical application is vastly different. For example it’s easy to read a developmental test, but there are so many more complex components to actually doing a developmental test. Trainings like these sharpen our skills as professionals, and keeps us up to date on what the best model is currently to treat children with developmental delays. It helps us to recognizing the importance of focusing on child development, child education to maximize children potential, the purpose of work is to improve quality of life of children and their family, because it helps: 1) to improve the children IQ and EQ, 2) to improve children communication ability, as a result improve the quality of relationships in family, 3) to help children with disability improve their functioning, that leads to improve quality of daily life, 4) it also improved health care system capacity; improve the collaboration between multi-sectors; strengthen our believe that people with disability has potential to change, if you find the right way, the right time you can make changes. The more important is to help us relied how lucky we are and be grateful with what we have now. The most challenging mission for us was about making the project. Firstly, we were so confused and do not know how to do it. Therefore, one day we had the meeting together to share our opinions and we decided the topic that we will do. Fortunately, the organizer gave us the project structures so that we can follow this template to write. After that, we work independently on searching for the references related to the background of the project. This part is the most difficult task since the database is hard to assess. So, we spent time for literature review and we had the group meeting again to synthesize all the ideas and references. Finally, the project was done with agreements of all the members in the group.

2.1.4 Did any academic concepts become apparent during this experience? Yes, actually many academic concepts were apparent during the experience. However we will only talk about two that I thought were stand outs. The first was “individualized” approach. Having and individualized program is always talked about in theory, but very difficult to develop in practice, especially in government settings. Here at RICD, we can see that every treatment approach is individualized, from the assessments to interventions. Individualized interventions are often very resource intensive, and RICD is able to accomplish this in a high quality way. Another term that I saw come into reality was the “multidisciplinary” approach. The collaboration and coordination between professional at RICD is simply phenomenal. Part of the success of the program is due to the central database and computer based records of patients. However there is a great culture of collaboration and coordination among professionals here at RICD. The concept “Holistic approach” became more clearly during this course which includes early detection of the problem and comprehensive intervention with using the multiple methods and combination with children families. The concept “surveillance” was used for parents to observe, monitor closely to the child to see the child development. The concept “screening” means the health care personnel used the tools to detect abnormal in the child’s development. The concept “evaluation” means to assess all the aspects of development which include gross motor skill, fine motor and cognitive skill, receptive language, expressive language and personal self-help to identify child develop problem. Developmental delay means the child can delay in one of the areas such as gross or fine motor, language, social or thinking skill but early intervention can help the child to catch up. Development disabilities mean that kids do not outgrow or catch up though they can make the progress etc.

2.1.5 Did this experience differ from your initial expectations? Yes. I expected that I got knowledge but I didn’t think a lot. However, I got a lot of knowledge than I expected from multi sides. As a physiotherapist, I want to learn more about techniques and guidelines for physiotherapy. For this Topic, I got only some new experiences. As a psychologist, this experience was way beyond my expectations. This is because I have attended other courses at RICD before, and they were not near the quality, detail and organization as this course. Every course was well developed, detailed, and filled with valuable hands on information, taught be experts. This course gave us lots of experiences over our initial expectations. In particular, the topics about postural support devices and AAC. These topics provided us different styles of learning which we learned through lectures, observations, and experiences. The main reason was those topics had time for practice and the trainers’ enthusiasm inspired us. Therefore, we applied the academic knowledge in real practice.

2.1.6 How does your experience and academic knowledge inform your understanding of the holistic approach to improving children with developmental delay? Holistic means to address the whole child, including their physical, emotional, mental as well as social factors. The holistic approach refers to holistic treatment which is used a variety of methods and may be very creative and empowers their parents to take charge of their own children. Holistic treatment also includes evidence-based treatments and alternative treatments. There are some evidence-based treatments such as applied behavior analysis (ABA), speech therapy (SP), occupational therapy (OT), physical therapy (PT), augmentative alternative communication (AAC), picture exchange communication system (PECS)….and some complementary and alternative treatments such as dietary intervention, vitamin supplements, herbal remedies, art therapy, drama, hippo therapy and neurodevelopmental feedback. Moreover, the holistic approach also means that using the surveillance and screening tools to detect the problem as early as possible. Right after detecting any delay in child development, giving intensive intervention is necessary. In order to do this, the health care personnel and the family need to have good collaboration to increase time for children intervention each day and both sides have the same objective. All in all, the holistic approach is early detection the problem, early intervention, and comprehensive intervention. This course helped us conceptualize children holistically. First we saw the “bio-psychosocial” approach, were there may be “biological” treatments (such as medications), different therapies and special schools for the “psychological” component, and “social” for the treatment of parents. In this way it is holistic. Also the programs are holistic in the way that the treatment is multidimensional. For example all areas of development are targeted: Fine motor, Gross motor, Personal-social, expressive language, receptive language. Finally there is a multidisciplinary team all working together to determine the best outcomes for him.

2.1.7 What was the goal you were trying to accomplish? The goal that we were trying to accomplish is to become a “better” clinician. We were also aiming to get a certificate from this workshop, in child development. Our first reason is that in our country I have very few colleagues to learn from, and true experts in fields are hard to find. We wanted to learn about the newest technologies and methods, as well as practice our clinical assessment skills of both humans and adults. Another goal was to successful design and start a child development project that is easily feasible and low cost, with the goal of publishing a paper in the next available CDMH. The goal that we were trying to achieve was a

“holistic approach” to improving children with Developmental Delay as well as the other neurodevelopmental disorders.

2.1.8 Were you able to effectively achieve your goal? We think we were all able to meet our goals. We were able to increase our skills as clinicians in conducting assessments and interventions. We knew that Thailand had a great child development system. Also the topics listed in this workshop were interesting, and were conducted by skilled clinicians. We were also interested in learning about the tools. Overall becoming better professionals in our fields was our goal. We were able to achieve our goal of becoming better professionals because the prior level of training for us as a group was good. We had just enough prior knowledge for not all the material to be a challenge, but still had the opportunity to learn. We were also able to complete our project through teamwork, and our multidisciplinary knowledge. This course provided us lots of chances to observe and experienced different methods in treatment for children with a special need. We saw a holistic treatment that was used the variety of approaches and affected the whole body of the child. In particular, the child got treatments based on evidence such as ABA, SP, PECS, OT, PT. The interesting thing that this system also brought different alternative methods which were very creative like music therapy, art therapy, drama, hippo therapy. This combination created a comprehensive intervention for the child. This system also had a parent training program to help the parents keep teaching and take care of the child at home. Normally, the child got 3 hours of treatment in the clinic, the child also got the treatment at home, without the combination from the parents, the child difficult to get the expected results. The good combination between the clinic and family can create an intensive intervention for the child. Thai child developmental system can screen and surveillance the child developmental from birth. By using this model, the child with developmental delay can get the intervention as soon as possible and right after the detection of any problems. In conclusion, this course gave us all the knowledge and experiences to achieve our goal.

2.1.9 Which skills did you bring to the experience that helped you meet your goal? We were all hungry for knowledge. Our special education system is under developed in our countries, so we rarely get opportunity to learn new, up to date concepts. Which is why we made the commitment to come to Chiang Mai to learn. We also had prior knowledge and experience working with children with special needs before we came to Thailand, which was valuable during this training because we were able to compare to our countries, and think about how we can improve it over there. Listening skill, observational learning and teamwork skill, critical thinking, analytical problem skill, adaptability skill are important skills that help us to meet with the goal. About listening skill, we not only listen to the content of the lectures, we also active listening by pay attention on the lectures and keep asking the question to make more clarification, we also use reflective listening which means use our own words to repeat the speaker’s idea to clear all the content and the emotional under the speaker’s information. By using effective listening skill, we understood well all the knowledge from this course. Relation to observational learning skills, it not the same as a pure imitation of the other behavior. For example, after observing the people test the tools for screening and assessing the child development such as DSPM, DAIM, TEDA4I, we were able to do it, moreover, we observed and gave the comments to the other friends whether they did it right or wrong and we tried to avoid the wrong behavior. Teamwork skill is an important skill. During this course, we used this skill for both the activities in the class and the assignments. This skill helps us to organize and synthesize ideas from all the members to create the best product. Critical thinking skills

helped us analyzing information objectively, compare what we learned here and our prior knowledge. We also can evaluate the resources such as data, facts, observable phenomenon and new concepts that we learned. After that, we have comprehensive knowledge to develop ourselves and develop this topic in our country. Analytical problem skills helped us know how to use manuals, step by step, to understand children's developmental problems from all angles before giving the summary or decision what we will do with children and make decisions what we can support children. Adaptability skills helped us to approach with other therapies and models to process screening, assessment, surveillance children development delays more suitable and more effective. We observed, monitored and compared the same and different of the social context and willing to learn from specialists.

2.1.10 Did you acquire any new skills by having to work to achieve this goal? We acquired many different new skills. We learned “academic” knowledge, such as clinical skills like child assessment techniques, therapeutic tools such as AAC, PECS, ABA, we learned in depth about the different therapies and how to apply them. We also learned a lot of “non-academic” skills, such as soft skills, like attitudes and values. The Thai approach is very calm, well-mannered, and is different from the chaotic environment in our country. This probably has a lot to do with skill and training. We learned about maintaining a positive attitude, being hopeful, teaching parents to make their own decisions (empowering the family), always working in the interest of the child, and empowering families to do their own therapies. Much of the workshop was designed in way to teach us skills, and not just give us theories. The workshop was designed to teach us how to think and solve our own problems. This course provided us many new skills to achieve the holistic approach a child. Firstly, we were able to do screening, surveillance tools to detect early child developmental delays. Secondly, the class with Mr. Joey Tell about Postural support devices gave us a chance to try out some of the postural devices such as cushions, a wheelchair with head and lateral support, lap belt and butterfly harness, and standing frame, we got the skill to assess the people who need the postural support and select the proper devices for them. Thirdly, we learned Thai massage during the class about traditional medicine. We were able to do the basic Thai massage which includes leg massage, back massage, shoulder massage, arm massage, facial massage, and stomach massage. Fourthly, we did PECS phase 1 when we attended the PECS class. Fifthly, in speech therapy class we got the skill of how to teach children to vocalize. Sixthly, the class about Augmentative and Alternative Communication (AAC) also gave us a lot of new skills. In particular, we got the skill of how to use different devices which are low- tech, mid-tech and high tech to teach the children with complex communication needs. We also had the skill to select vocabulary to help children who cannot speak at all. Seventhly, the important skill that we learned from the teacher in social class was the way to teach social skills throughout different games to achieve effective teaching in listening skills, conversation skills, turn-taking, and sharing skills and so on.

2.1.11 Was this an easy or a difficult task to undertake? Overall this project was not easy. First the workshop is long so many preparations had to be made before we could come to Thailand. Secondly the work load is intense, with both the project, reflection, and exams were all big and challenging tasks. Learning new things was the easy part. However we can see that if someone was new to this field this would be overwhelming to learn everything. However even though this workshop was difficult, it is also very satisfying, because it was a challenge. Of course, there are bound to be easy and difficult to undertake at any given course. We had some basic knowledge about children with developmental delays and we worked with them so this helped us to understand professional concepts and know-how to practice after guided.

However, we also need to analyze a lot of information and used many methods to understand the relevant knowledge and put that knowledge in the context of our society to see which things can be applied to develop a model of child developmental delay services in our countries.

2.1.12 Were any academic concepts utilized to reach the goal you were trying to accomplish? We learned and used many academic concepts during our stay. For example all the academic concepts we learned in our studies we had to apply in our project. Our project goal was to be individualized, child and family centered, parent focused, culturally appropriate, comprehensive, and a complimentary system to early intervention. These were all concepts that we utilized in our project. We reached the “holistic approach” by using the following different concepts: “Holistic approach” became more clearly during this course which includes early detection of the problem and comprehensive intervention with using the multiple methods and combination with children families.

2.1.13 What do the differences between your textbook and your experience in the training program? We already heard about most of the topics before. However, after the training program we noticed that some have differences. For music therapy, we only know that treating the child with music. I don’t know how to do music therapy, using optimusic with activities and creating the activities depend upon the child’s need. Also, we learned about DSPM, DAIM, TEDA4I for assessing the child. Firstly, we read the instructions from the book and practice. After practicing we saw that we understand more some difficulties to do like the instructions. In some cases, we need to change a little bit to be suitable for that situation. The theory and experience are always different. Since the technology transformation, the information can assess easily, and the textbook is sometimes vague and general at which not all that knowledge can apply in real working. In this course, we were taught by speakers who have many experiences in clinical teaching. Those experiences were the dearest possession that helped us to deal with the real situation. Moreover, the speakers’ enthusiasm inspired us to continue striving for mastery to help disabled children. Our textbook helped us more understanding of key concepts and when we have the experience that made those concepts integrated easily into practice. In addition, we can learn both the knowledge and experiences of other people in the discussions of training.

2.1.14 What might/should be done in the future? In our countries, research on mental health is limited, mainly focus on studying mental disorder prevalence in the community. In addition, data on children developmental delay is under the management of both systems: health and social protection. However, each system uses different condition categories hence it is very difficult to have accurate numbers related to child developmental delay in our countries. Moreover, lack of services on child mental health, children with development delay usually be discovered lately. What’s more, the stigma issue and underestimation of mental health services make parents don’t want to share their child information with public institutions. Therefore, to fill the gap about the child developmental delay services in our countries. We will take the knowledge we learned in Thailand, and bring it back to our countries. We will continue the project developed here in our countries. Our goal is to develop policy/systems in our countries so that the future of child development in our countries can be like Thailand. Dr. Samai is an inspiration to us all, and we all want to do the things that he has done for Thailand. We will continue to collaborate and work with Thailand/RICD to learn and grow. Follow up after the training: we hope to have

continue support even the training end. In the future, may we have some kind of refresh training on this topic, it will be wonderful.

2.1.15 How did your skills contribute to the diversity of the people with whom you worked? We had to use patience, understanding, positive thinking, and maintain a teamwork attitude in working together with diverse cultures. We got the opportunity to learn from new cultures and also develop friendships with others. Over the 3 weeks, we became brothers and sister. We were also able to compare our country knowledge and skills to those of Thailand and other countries. In the training course, each people held the diversity about age, ethnicity, skill sets, responsibilities and different education levels. In other words, the difference about the language, cultures, and experiences allowed us to use proper communication skills to support and learn from each other. We also shared our knowledge, experience, and background for all the people in the group. Moreover, analytical, critical thinking skills and teamwork have helped us to discuss and share our personal opinion. Therefore, the learning environment became more interesting, and the knowledge that we got more specific and clearer. In conclusion, the diversity of the group contributed greatly to the success of the training course

2.1.16 What personal knowledge and skills did you discover or acquire during this experience that will assist you in your future endeavors in this area? A lot of what personal skills we learned is written in our reflection. But we learned clinical skills as well as attitudes and values. 1. We learned the importance of having a positive attitude. 2. We learned the importance of being patient (like finding the right wheelchair for a patient). 3. We enhanced our perceptions, meaning we were able to have empathy and understand disability so we were able to better help patients. 4. We learned many clinical skills. 5. We learned the importance of sharing our skills with others. We got knowledge about holistic approach and intervention methods includes both evidence base methods and alternative methods. This knowledge is very important to help us providing such comprehensive services for children with special need. We also got new skills on how to use those tools for screening and surveillance the child’s development, how to approach the person holistically and teamwork. These skills support us a lot in our future career.

2.1.17 Did this experience inspire you to continue a commitment to work with children with developmental delay? Of course. Actually, when we finished our university, we have some experiences in adults than children. We didn’t have confidence to work with the children because children aren’t like the adult. For example, we cannot do the intervention as we expected. During intervention time, the child may cry, feel sleepy and etc. We have a chance to work with developmental delay children. Since we have been working with children, we decided to continue to work with children more than adults. This training course has given us many knowledge and experiences and inspired us to continue striving for mastery to help as much as possible for children with developmental delays in our country. We understand there are a lot of things need to be done in order to develop such well-functioning model as Thailand. But we will try our best to process. Hopefully we will continue to get support from Thailand as well as other international experts in this field.

2.1.18 What steps have you taken - or do you plan to take - to implement this plan of continued commitment? We designed the project to apply those tools for early detection the children with developmental delays. We will translate, validate and adapt the tools into our countries which will benefits children and parents. Children will be monitored closely by their parents and will be screened for the risk of developmental delay by health personal. Moreover, the parent will know about child development and clear guidance to support their children in achieving milestones as expected.

2.1.19 Strength, Weakness, Opportunities, Threats (SWOT) of the training program

Strength Weakness Management Language 1. The trainees got all the materials and training Language barriers between schedule before the beginning of the course. This participants helped us to arrange appropriate timetable 2. The program was very well organized. Beginning Participants from the airport, to all the activities, transportation, The diversity of the programming, and logistics were all very well participants in the class organized. might cause difficult in 3. The organizer and logistic group managed the classes collaborating the activities very effective after the course. 4. Organizing an almost one month program is a difficult task, and during the three weeks there were Facilities little to no problems. 1. Training room should be bigger for activities Motivation 2. Lunch box is good but Motivate participants to go further after the training coffee, tea, snack is very limited Relationship 3. Wi-Fi connection does The program allowed us to make new friends. Being not work well together, and working together for 3 weeks allowed us to become good friends.

Strength Weakness Training Program Training Program 1. The course integrated the variety of learning styles such 1. High workload – while as lectures, observations and experiences the workload benefited us 2. This course provided the diversity of new knowledge in the way that it made sure 3. The learning environment was convenient in combining we were going to study, a the activities of training little less work load would 4. The learner can choose options in selective course have been nice, such as a 5. Different kinds of training materials are available 6. The program was comprehensive in the fact that it smaller reflection paper, or included a multidisciplinary approach in teaching child more time to study for the development. Truly there is no other program like the one exam. here at RICD, where in one place you can truly develop a 2. The intensity of the comprehensive skill set. Having attended many continued course may scare away professional development programs, nothing compares to interested participants. the volume and detail of this program. All aspects of child 3. Assignments/projects/ development were covered. The program material was exams are all very intensive very, very, very well thought out. and may not suit everyone. 7. There are few programs that teach theoretical background, 4. The schedule was tight. and practical experience in a comprehensive manner. Meaning there were more Including child development assessments tools, therapies, and as well as the teaching of many interesting tools. break days in the beginning 8. The majority of the programs were packed with valuable and less at the end. Ideally information. it would have been nice to 9. The programs that included practicum were extremely have more breaks later on valuable, such as the all the Thai child development tools, than earlier. AAC, social skills groups, Thai massage etc. 5. All lessons are well 10. Including field visits and observations were valuable – organized and we hope that such as getting to see the vocational center in practice. we could get more special Also the field observation of the seeing the TDSI was education information for extremely interesting. the teaching professional. 11. Up to date – the program is good for any professional in 6. Suggest to have more the field that wishes to be up to date on the cutting edge of technology for child development (such as practicum and case neurofeedback). As a professional it gave me perspective discussion on what therapies and techniques are available currently. 12. Diversity of participants and speakers. 13. High quality, high expectation of trainees. The assignments and projects forced us to do our work and pay attention. 14. The main strength of the workshop was that all the classes were designed to teach us how to think and solve our own problems and not just simple teach theories. For example by learning how to conceptualize AAC, we are able to do our own AAC back home because we understand the thinking process behind it. 15. Method: student-centered, good time management 16. Materials enough: Speaker, handout, PPP, video, TIDA4I tool kit 17. Training methods are good.

Strength Weakness Speakers 1. The program was taught by true experts in the field. This is an important point – our speakers during this course were true experts in the field, who have had many experiences. 2. Not only were they experts in their field, we had good teachers with good teaching styles. Our teachers were truly invested and interested in sharing their knowledge, and we could see they were passionate about their program. For example our teachers of the assessment tools DSPM, DAIM, TEDA were truly excellent. Other teachers like Dr. Kulwadee, Joey, Nicole, Our ABA teachers, were all excellent teachers. We would have liked to have more time with Dr. Kulwadee.

Opportunities Threats Training Program Pre-training 1. This program can be further expanded into a more A threat to the program is detailed program. If there are enough people that the need for screening of attend the course, there may be enough interest for a the participants. For follow-up course. For example as a professional in example some of the the field I am very interested in learning to use the participants who have no TDSI, and the TDAS. prior experience at all will 2. There is opportunities for further expansion of have great difficulty with courses, or allow for follow up courses. For example, the detail of the program. I a 1-week, or 2-week specific training course on think knowing the occupational therapy/speech therapy/physiotherapy experience/ability level of etc. the participant is extremely important as this is a long Network and intense course. Same Develop the network between the people in this field. on the other hand, if the person is already too Knowledge, skills and attitude experienced, he maybe 1. Develop knowledge and skill of the trainees should look for other 2. Improve the quality of services for delay development topics. children 3. Foster the positive changes from each country. Post-training 1. Surveillance and screening quality assurance after the training 2. To ensure the other people use the copyright materials exactly.

2.1.20 Suggestions/comments

I. Medical Doctors 1. The most useful of the training program 1.1 Assessment tools 1.2 Referral system from bottom to up level 1.3 Speech therapy 1.4 Behavioral modification 1.5 Eastern psychology 1.6 AAC 2. The least useful of the training program 2.1 The content of PowerPoint presentation 3. The topics that the trainees would like to learn more for the training program 3.1 Speech therapy 3.2 AAC 3.3 OPD 3.4 Occupational therapy 3. Other topics that the trainees would like to be offered training course in 3.1 Clinical practice 3.2 TDAS 4. Suggestions/comments 4.1 Real hand-on practice more with children and supervision, and follow by case Discussion 4.2 Should have one way mirror room to observe activity 4.4 Length of training course should be 1-2 weeks 4.5 Should divide into small group and rotation 4.6 Support for airfare, room accommodation, food, and assessment tools

II. Medical Multidisciplinary Team 1. The most useful of the training program 1.1 Assessment tools 1.2 Social skills 1.3 Shared action model for ADHD 1.4 Neurofeedback 1.5 Speech therapy 1.6 Occupational therapy 1.7 Hydrotherapy 1.8 Opti-music 1.9 Thai traditional medicine 1.10 Eastern psychology 1.11 AAC 1.12 Wheelchair 1.13 Field visit 1.14 NDD 1.15 Behavior modification 2. The least useful of the training program 2.1 Shared action model for ADHD

2.2 Speech therapy 2.3 Physiotherapy

3. The topics that the trainees would like to learn more for the training program 3.1 Physiotherapy 3.2 Speech therapy and practice 3.3 Occupational therapy 3.4 Social skills 3.5 How to calculate the result for DSPM, DAIM, TEDA4I 3.6 Vocational training 4. Other topics that the trainees would like to be offered training course in 4.1 TDSI 4.2 TDAS 4.3 A specific course on assessment tools such as ADHD, CP, ID 5. Suggestions 5.1 More practice than lecture 5.2 Need supervision after the training 5.3 Set up an alumni network after the training to continuous exchange knowledge 5.4 Specific professional training program such as training program for Physiotherapist 5.5 Have level of training course 5.6 Have more free time before exam 5.7 Duration of training course too long

III. Teachers 1. The most useful of the training program 1.1 Assessment tools 1.2 Materials 1.3 Field-Based Observation 2. The least useful of the training program Basic Pediatric Physical Therapy 3. The topics that the trainees would like to learn more for the training program 4.1 Speech therapy 4.2 Psychology 4.3 Children with special needs 4. Other topics that the trainees would like to be offered training course in 1.4 TDAS 1.5 TDSI 5. Suggestions 5.1 Short course training less than 3 weeks 5.2 Speakers from special needs teachers 5.3 Training course for special education 5.4 Short course training for medical doctor should be 1 week per month for 4 times

2.1.21 Expression to the training program

Dr. Kim Sophea Initially, I would like to thank to RICD which provide this training course on the Holistic Approach to Improve Child development Delay. It is a best chance for me for joining this training and I have learnt many things from this training. Through the training, I can enlarge my knowledge and enhance my capacity to work with child who has neurodevelopment problems. I hope that what I have learnt from here, RICD, I can partly apply at my current workplace as possible. Moreover, during the training time, I make connection with others trainee who come from various organization (in Myanmar and Vietnam). Furthermore, I really appreciated for RICD that works so hard in order to facilitate us and provide warm welcome to all trainees. At the least not last, I wish that RICD will provide more and more training in the next future.

Dr. Ka Mikazer Before the training, I hoped I will get more knowledge on child problem as I’ve never known before. Also, we really need it to help our patients even there is no child development service in our hospital yet but so far there are many people coming to us for this problem. This course is new to me and I don’t think it is easy to do it so it likes a challenging task for me. I was happy to come here with my colleagues because I can’t be success in working alone with such issue. During the training, I found that every trainees comes from different backgrounds but most of the trainee’s purposes in this training are not totally different. The lectures were good even there was some problem with language and translation technics but it did seem to be ok after all. Beside sitting in class for lecture sessions, it is very interesting to have chance for field visit, even the time given is not much but the trainers and trainees tried their best to work together. Another thing is assignment which is also interesting but a bit challenging for me since it is my first time writing such project proposal so I know our work was not good. I fell sick several days after arrival in Chiang Mai. I got flu and I could not sleep well at night which made my body weaker day by day and I have to say it was a hard time for me to fight with it. It took almost 20 days to be better and I could not pay much attention on each session. It was really annoying. After training, I feel like I have some more ideas in helping my patients. Although, I am not a real expert in child development but I can help them by using the appropriate technics gotten from RICD. At the same time, I have known many expert people and they are very nice and kind. It sounds like this training is very useful but I have some suggestions. I think the timetable for field visit should be more than one session for each subject because there are many interesting places that I want to visit and unluckily some were arranged at the same time so I needed to miss one and sometimes too many participants in one place could interrupt the activities. All in all, I hope I will have a chance to join more training courses prepared by RICD again soon.

Ms. Saut Rachny Sharing happiness, this word came up in my mind during I have joint this training. People from different skill work so hard from their heart to have good collaboration in sharing happiness to children with special need and disabilities. They can smile, laugh, participant in social which got from their support and our support. This role model would be keep in mind and is going to be shared in bigger and bigger to all people who really need our support. I am

32 so happy to join this training course that remain me to contribute what I can do to my society more and more. Thank for having me in this training.

Dr. Yong Sokunthea From this training course, I’ve learnt many new things which I never know or experienced before. Before coming to this training, I did not really understand what is Holistic Approach. More than this, when I saw the title in the application link, I was really interested in the topic and wanted to join in the course to get more knowledge about that especially topic related to child. After studying with many skillful trainers, I got understand many kind of problems related to children from birth till their older age. I have learnt the way to use assessment tools such as DSPM, DAIM and TEDA4I from the theory and real practicing. I also learn many other approaches that can help children with the problems of their developmental or their disabilities. For example, AAC, PECS, speech therapy, are used for child with ASD. Moreover, there are other ways, which can help children with developmental delay/disabilities/disorders, such as occupation therapy, physical therapy, Thai massage along with Thai traditional medicine, sensory integration, social skills, neurofeedback, eastern psychology etc. Besides this, I can learn and share the knowledge with other group of people from Myanmar and Vietnamese, we did not only share knowledge but also we shared our work experiences, culture or others things with warm heart and joyful moments.

Dr. Kosal Kaknika I got warm welcome from the organizer and also I have got a lot of knowledge about child developmental delay such as DSPM, DAIM TDSI and TEDA4I and so on. It is very good to put it in practice. I like lunch box, it is delicious and the food was always new. Also, all RICD staffs are kind and friendly. One more thing, I am thankful and appreciated welcome dinner and farewell dinner.

VDO: https://www.youtube.com/watch?v=C3YL8VNgl_c&feature=youtu.be&fbclid=IwAR1Uz9466CQOFgnuw2b5eSs 4N9MXDIOf5Np0gqTwOPK_dqpgq62aQ-59v9o https://www.youtube.com/watch?v=66w0ph1- qdo&feature=youtu.be&fbclid=IwAR14B4lBViyVMIy0xQ4TQRoX5f4fcHVeTaNzoWTjBgjCmB3cJ3ffR2ouXPc https://www.youtube.com/watch?v=owKk5y4ktY4&feature=youtu.be&fbclid=IwAR2pp6H6axsoVKNcGCUvC2P rnEv_7-fYy1Yg-E2yM9sV7V7pmOc-mc-SCmU https://www.youtube.com/watch?v=dNMze03pkLs&feature=youtu.be&fbclid=IwAR1CUObjP5wKTiIsPZ5Tl7W M1FG8Fca2qO-aCLKMoC9FgSir11vpsdH6z9o https://www.youtube.com/watch?v=C0AEhEUUpfs&feature=youtu.be&fbclid=IwAR18eLflzEKIUv8IHG7jtW391 kuiSV0At60v1258o2pBEhUU_x8lXWRiRrc https://www.youtube.com/watch?v=gnqKEt_t4o8&feature=youtu.be&fbclid=IwAR2ZkuzyNTsr8t20V9QErtT4n- gIvlGaYKEA1NGTVFBaG0yTnq3F6a5U-IQ https://www.youtube.com/watch?v=ai8uk3PUUt0&feature=youtu.be&fbclid=IwAR3BhwYgrLytCqatelxmHD9Er DDsMOaV-8eE9u4vBDc6rSBR6ROeSoD2cMw

33 https://www.youtube.com/watch?v=zIvWEZz7h4s&fbclid=IwAR0zFyetFSJMfbXNa5yV9IAtMos5aoClOplQOEXu VNxlH9SV631ML0NRKvg https://www.youtube.com/watch?v=X1Z69OlqCz4&feature=youtu.be&fbclid=IwAR060nl5VGpP8z2jKMTQah8 Cj7-tpZVReIRlEr_To8-fdgtiWtRKdiRW580 2.2 Speakers’ suggestions 1. The speakers need to study and understand the learning plans and evaluate knowledge and skills of the trainees by adjusting the activities, contents according to the requirement and the context of the trainees. 2. The speaker need to gained two- years - working experience in children with developmental delay and neurodevelopmental disorders. 3. Give each speaker more time for their presentations and practice such as AAC, PECs, behavioral modification, social skills 4. Record speaker’s presentations and speeches is help to improve ourselves by watching video recordings after classes 6. Arrange meeting for correct the developmental assessment tool manuals 7. The classroom is not suitable to do activities

Corse Content Summary

Pre Training Evaluation and Course Overview The training course started with pre training evaluation about 150 minutes and continued with course overview. The aim of pre training evaluation to understand how much trainees are expected to learn in this training. Course overview, we discussed about the training schedule, team division on evaluation (Medical doctor team, multiple disciplinary team, and teacher team). And also, the assignment which decided to divide it to be done by four groups (2 groups of Myanmar team, 1 group of Vietnamese team, and 1 group of Cambodian team).

Topic: Thai Child Developmental System Model

We got the information about Thai child developmental system model by the wonderful speaker who dedicated and contribute a lot to develop an intervention program for the development of Thai children. Thailand has develop very well an M&E system to gather evidences for advocacy. Thai Child developmental system model which shared about how the project started and worked until nowadays. Nothing was created without reason and challenging. There are the increasing of child having problem in development delay. Meanwhile, in Thai’s public health system has created the tools of doing assessment and intervention for child development delay and got a huge supported from Her Royal Highness Princess Mahachakri Sirinthorn. Thus, under the huge supporting and attention of the team work at RICD, these tools can help a lot of child with development delay in Thailand. We learned about nerves proliferate more and more since birth to 6 years (window of opportunity). 700 synapses formed per second in the early years. However, if we stop learning or don’t use our brain, nerves can stop proliferating. Therefore, we can maintain a strong brain network by working our brain hard. We learned approximate percentage of children in Thailand who have delayed developmental risk. In Thailand, there are systematic assessment tools for children with developmental delay. Since birth, there are two tools depending on the children such as high risk group (Low Birth Weight and APGAR Scores <7) and normal group. “High Risk” is mainly determined by risk factors, and usually determined by a doctor. For high risk group of children, DAIM is used for assessment and for normal group of children, DSPM is used. Each has 5 domains; Gross Motor, Fine Motor, Receptive Language, Expressive Language and Personal Social. Not only systematic assessment tools but also systematic referral for children

who need individualized specialist from primary to secondary to tertiary hospitals. The good thing is that the assessment can be done even for the parents and caregivers at home. We could see that Dr.Samai and his group have been working hard to develop a system for children from birth to 5 years to get the systematic assessment tools from 2009. Moreover, every country should have same assessment tools for all professionals. The tools provides a common language between professionals, and allows for early detection of developmental delays. Furthermore the tools are designed to be both assessments and interventions. Parent interventions are key for the Thai Developmental System to work. The system in Thailand is based on norms researched in Thailand, therefore the developmental tools are appropriate and relevant. Thus, it is appropriate with the Thai culture.

Analysis of the Thai System The Thai system is developed with good research, and strong scientific background. The methodologies used in the Thai system is developed with current, scientific methods and knowledge of child development. For example the Thai system is based on the principle that the majority of intervention must be dependent on the parents. The system empowers parents, in teaching parents intervention strategies, and also empowers them by providing them with surveillance – where parents are given DSPM at birth, and are able to do assessments of their own children. Initially looking at the system it looks like there are a lot of tools, and many steps. However looking closely at the system reveals the need for each tool. For example, in the Thai system, there are at least 3 steps before children reach a professional. DPSM-> TEDA4I ->TDSI. The reason is that DSPM is an easy to use tool that parents can use and gives a simple “pass” or “fail” answer. The DAIM is specifically for children that are already determined to be at risk for developmental delays. So the DAIM is more in-depth, and more complex. It would not make sense to have parents doing a more complex test on their children if it was not needed. Another important point Dr. Samai made was that around 30% of children in Thailand have developmental delays. However, he said that 20% of Thai children are developmentally delayed due lack of stimulation, meaning that only 10% or less of children will end up having to go to tertiary systems to get diagnosed. So really, 2/3rds of children will not need to end up going to tertiary centers. With the Thai system, it gives parents opportunity to develop their children, 1 month after DPSM, and TEDA4I, provides 1 month (if they fail both assessments). Basically children get assessed 3 times, at DPSM (Parent), DSPM (screening professional), and then TEDA4I, before they reach a professional. So the majority of developmentally delayed children can become normal again before going to a tertiary center like RICD, and only the most severe cases go to tertiary hospital. Finally tools like the TDAS help with diagnosis on a large scale. The weakness of the system is that firstly, this is resource intensive. The burden is on the human resource system to do all the assessments. Secondly, as a screening tool, the DSPM has very few items (1 item per domain mostly). This means that it can be less accurate than a test with a higher number of items (like 5). The advantage is that it is quicker to administer. The Thai system depends on having strong tertiary centers, such as RICD. The system needs a lot of trained professionals. The system requires parents to be involved in the children’s development, so strong advocacy is needed. We learnt about Thai Child Developmental System Model, the establishment history of the RICD and how the 25 years journey of RICD with the magnificent research, project, and intervention for all children in Thailand. It was an tremendous influence of Dr.Samai and RICD Team who had involved in this enormous scheme that not even changed many lives of both normal and abnormal children and families in Thailand but this development may also influence and change the life of many families in Asia. All the children in Thailand will soon have a proper care and intervention since birth and the aim is to be able to give proper

36 developmental surveillance, screening, promotions by parents and health personnel as per ‘Diagram of the follow up care for Children aged from birth to 5 years’. He also pointed out the importance of care givers for children with developmental delay.

Topic: Introduction to RICD and Field Visit

We got the opportunity to see the facilities and services of RICD. RICD is an institute, official established in 1995 and is located in Chiang Mai province in the northern of Thailand. RICD provide medical services to children with developmental delay and mental health disorders such as autism, ADHD, cerebral palsy and intellectual developmental disorder. RICD also promotes and provides support for academic and technological research and development of related agencies, in order to improve child development and mental health. RICD constituted of Piano building, administrative building, rehabilitation building, family and child training building, traditional Thai medical center and old IPD building. We have visited Piano building and in Piano building we went to Autism research center, Toy library, and IPD building. RICD provided many service such as Outpatient services that provide diagnostic and medical treatment for children and adolescent. Inpatient service provides medical treatment and nursing care for children with developmental delay and behavioral problem. Psychology services provide a clinical psychological diagnosis using tests for IQ psycho neurological personality disorders, learning disabilities and other psychological tests. As we’ve believed that there’ll be many new things to discover around RICD. Autism research Centre with AAC -Augmentative and Alternative Communication room, we are amazed to know how the RICD team are working to help the children with Autism spectrum daily. There are also a special AAC room to provide support to the children and adults with severe speech or language problems and help them to find other ways to communicate with picture cards. Ms.Nicole briefly explained about the augmentative alternative communication (AAC) devices and it has been a fruitful experience to learn that symbols and pictures can enable many children with communication difficulties to effectively engage in a variety of interactions with AAC methods. That is a greatest support to increase the quality life for families with special needs children. Speech therapy room, explained about how they conducted the intervention lessons with the children. Although we do not have a chance to observe the children on that day, we were informed that we will have a few hours session to observe the speech therapy session during the training. Occupational therapy and Snozelen room, described about how occupation therapy and Snoezelen rooms work for the children and adults with Sensory Integration disorder. We all agreed that it will bring an incredible comfort to the children with sensory issue. It would also bring us an abundant of joy and honor if we could have a chance to experience the occupation therapy room and Snoezelen room on that day. Toy library, we were overwhelmed to see how RICD team systematized the toy library to be accessible to all families and children. The Toy

library reserved with many traditional and commercial toys according to the development skills of the children. The parents and children will just need to choose the toys from the categories that will help children developmental stage such as Fine motor, Gross motor, cognitive skill, communication skill, social emotional skills. During this tour around, we observed that the interior decoration of OPD and IPD are not even functional and pleasing environment and it is also attractive to children and enjoyable for all children and families who people visiting the place. We also visited two hydrotherapy pools in the RICD compound. We learned that children with physical challenges will gain confident in walking in the water and cooperate well in learning process. We are also briefly giving some details of the wheelchair project in RICD that reaches out thousands of children and adult with physical disabilities. It was interesting to see the percentage of diagnosis/disorders that come to RICD, where the majority have ASD diagnosis. While the experience was good, it would have been nice to see some of the technical aspects of the therapies. For example to see some physiotherapy in practice, or to see hydro therapy in practice, or to see speech therapy in practice. We understand the main issue is privacy – patients do not like to be watched. Maybe in the future we can get more specialized courses, where we can see maybe pre-recorded videos of therapies in practice. And there is other service. It is such a good system to provide multiple service to patients. The patient’s information could be well keeping, good cooperation between each service to improve the quality of help. The family of patients do not feel alone in taking care of them. We can clearly see that Thailand government invests in Mental Health for children.

Topic: Guide to Living in Chiang Mai

We learned Thai Culture such as greetings (how to Wai), polite and rude manners, popular food in Thai, Tourist attractions and some places in Chiang Mai, Good restaurants (described detail addresses and phone numbers) and transportation. With this topic we could release our tension/ stress in staying in the new environment. We learnt some word for communication in Thai language that we can speak to communicate with Thai people like greeting words, asking for places, etc. One more thing, we know the way to do respecting gesture and what should do and should not do wherever go to any touristic places to avoid some mistake and embarrassed. And for the transportations that we can use are public bus (RTC ChiangMai smart bus), Red car, yellow car, orange car, Tuktuk, taxi, cycle rickshaw and grab car. Also, there are many beautiful and interesting touristic places to visit and taste delicious food such as Doi Inthanon National Park, Kew Mae Pan nature park, Wat Phrathat Doi Suthep, Wat Phra Sing, Wat Chedi Luang, The Maiiam Museum, Maesa Elephant Camp, Canopy Walkway, Arid Plants, Wiang Kum Kam, Royal park rajapreok, Warorot Market, Sunday Walking steer Chiang Mai, Night Bazar, and others restaurants etc. It was a bit sad that we did not have chance to visit all those interesting places however we could go to Sunday walking street that we could see a lot of people there with many kind of food, drink, clothes and others. We visited temple, Doi Sethup mountain. Hopefully we have chance to visit more touristic place in Chiang Mai. Fortunately, for the last day of training, we could visit some place like temple and market. Chiang Mai is an ancient city in northern Thailand where its Old City area still retains vestiges of walls and moats from its history as a cultural and religious center.

Topic: Children with Developmental Delay and Neurodevelopmental Disorders

In this course we have learned about types of Neurodevelopmental Disorders such as Intellectual disabilities, Communication disorders, Autism Spectrum disorders, Attention deficit Hyperactivity disorders, Specific Learning disorders and Motor disorders. Furthermore, we understood about how neurobiology of autism was different from normal child and also early signs in infants, especially the red flags for ASD 12-24 months. This course gave us more information about neurodevelopmental disorder of children with developmental delay them we could have basic identifying or notice whether they are delay or not. The early identifying the best intervention we could provide to children like the researchers said “Intervention in early childhood may help the developing brain compensate by rewiring to work around the trouble spots”. This lesson also shared about the neuroplasticity, the more you stimulate them the more these networks of neurons will be developed and reliable. The brain has ability to change through our lives, it is adaptable like a plastic. Our brain as a dynamic linked power grid. There are billions of pathways, or roads, lighting up every time we think, feel or do something. We have the ability to learn and change by rewiring our brains. This topic is so interesting it does not mean our brain did not change and fixed by time when we become adults. People can change bad habit, think thing in positive way with practicing a particular task or feel a specific emotion then we can strengthen this road. For the members, many of the topics learned today where new. The information provided by Dr. Doungkamol felt like it was new especially for some participants, such as a physiotherapist, the technical aspects of diagnosis are not taught in school. However she has extensive experience in working with children with neurodevelopmental disorders such as Autism, ADHD, delayed speech, GDD, CP, Down’s syndrome, and other syndromes. Dr. Doungkamol broke up the diagnosis into different categories, which made it easier to understand. She discussed at length Autism Spectrum Disorder (ASD), Attention Deficit Hyperactive Disorder (ADHD), Intellectual Developmental Disorder (I.D), and Learning Disorder (L.D), Global Developmental Delay (GDD). Interesting fact: GDD can be diagnosed when there is at least two delays, not when all domains are delayed. Common mistakes. We learnt about different between Developmental delay and Neurodevelopmental disorder. We had more understanding about types of NDD are intellectual disabilities, communication disorder, autistic spectrum disorder, ADHD, other learning disorder and how normal brain and child with autism brain differ. Global developmental delay can be assessed by using GDD F88 in five development domains such as gross or fine motor, speech under five years. If the child is delayed in two domains significantly, we can provide the early intervention on GDD. Communication disorder can be classified into four groups including language disorder, speech

sound disorder, social communication disorder, childhood-onset fluency disorder. We have learned assessment tree of Thai Child development system by using DSPM, DAIM, TEDA4I, and TDAS. The second part of the presentation Dr. Doungkamol explained Autism at length, talking about the incidence of Autism in Thailand, and she explained the neurobiology aspects of Autism. In autistic child, they have no attention to face because the activation in the brain occurs inferior temporal gyrus instead of fusiform gyrus. So they have more attention to objects than people’s face. The ASD can be noticed by early signs such as loss of babbling, repetitive movement, poor eye contact. The caregiver has to be educated about the early signs of ASD because early intervention can be applied after the diagnosis in order to help the children to have the better quality of life in the future. We also get to know about early intensive intervention programs for ASD by RICD multidisciplinary team. She talks about how Autistic children see people differently, where when autistic people look at other people the same part of the brain that activates for objects is stimulated. Meaning Autistic children see “people” as “objects”. They place the same value on people as they do on objects. This is an interesting insight into Autism that helps explain their world. She talked about some early signs of autism – not definitive signs – such as early head lag, and early use of technology in eye tracking. Conceptually eye track technology is interesting, because the main idea is that Autism children do not have eye contact. However eye tracking cannot be used as diagnostic technology because the development of children with Autism is vastly different. Some children present with ASD behaviors at 1 year old, and then become completely normal at 1.5 years old. Similarly, with some children they can have completely developmentally normal behaviors, and present ASD symptoms within 6 months. Children especially at young ages have great variation in development, and a lot of the variation in development has to do with parental stimulation and other neurodevelopmental factors. Another interesting fact is Dr. Doungkamol presented research findings on early intervention therapy, and child development. Basically Dr. Doungkamol presented research showing that children should receive at least 25 hours of therapy per week. Which is around 5 hour per day, 5 days a week. In comparison to children that received 10 hours of therapy, children that received 25 hours of therapy had significantly higher IQ after 2 years. This highlights the importance of children receiving the maximum therapy hours – whether it is from a therapist or the parents. Along the same lines Dr. Doungkamol talked about neuroplasticity and the importance of early intervention. Interestingly Dr. Doungkamol bravely talked about her experiences with her son, whom she suspected as delayed speech. Now her son is adjusting well. She talked about the lessons she learned, especially in her role as a mother, and her responsibility to stimulate her own child. The technical aspects of the diagnosis was interesting to review. Also as a psychologists, learning about how Dr. Doungkamol diagnosis is different is interesting to learn. It was interesting to hear how Dr. Doungkamol approaches her diagnosis. The most interesting part of the presentation was about her presentation on the TDAS (Thai Diagnositc Autism Scale). This is a groundbreaking idea, and will have many benefits. First of all not many countries are doing this, and this proves that Thailand is in the forefront of special needs research. The TDAS is a diagnostic tool, developed in Thailand for the diagnosis of Autism. This is revolutionary because with a diagnostic tool, a trained person can be allowed diagnose autism. In Thailand because of the TDAS, now Nurses, Occupational Therapists, Speech Therapists, Psychologists, Doctors can do diagnosis of Autism. This is the future of diagnosis. Where diagnosis is less and less relied on highly trained professionals. We need a diagnostic tool like this in our countries, in order for the diagnosis of Autism to become more accessible. The next step is to develop more “Thai” or localized tools for diagnosis, such as those for ID, LD, ADHD.

We liked the class about neurodevelopmental disorders and early intervention for autism. We got the definition of neurodevelopment disorders and types of those diseases such as intellectual disabilities, communication disorders, autism spectrum disorders, attention deficit hyperactivity disorders, specific learning disorders, and motor disorders. 3 domains of EQ are: goodness, ability, happiness. In this class, we also got knowledge about the difference between a developmental delay and a developmental disability. The term developmental disabilities mean that kids do not outgrow or catch up though they can make the progress, while developmental delay means the child can delay in one of the areas such as gross or fine motor, language, social or thinking skill but early intervention can help the child to catch up. The data showed that 25% of Thai children are suspected of delayed development. The data also can show which areas and which provinces have the child with delayed developmental. Those databases were very amazing and from those data, the policymaker and health care personal can see very clearly the problem and find a way to solve it. We also had a wonderful time with the topic of early intervention for ASD. We knew that autistic children have different about neurobiology so they have no attention to the face, deficit in emotional recognition and repetitive behavior since serotonin deficit in the frontal cortex. We also got information about the prevalence which is 1:68 children and research showed that early and intensive intervention can get a better result. We knew the early signs for autism in infants and children so that we can educate the parent to monitor the child. The interesting point that we got in this class was some research for early detection in high-risk infants such as head lag sign, eye tracking, and the brain scan. About head lag sign, the research conducted on the population with high-risk children who had siblings were autism and the researcher did the test “pull to sit” and tested for 4 times at 6, 14, 24 and 30 months of age. The result showed that 90% of subjects diagnosed with autism had exhibition head lag as infants. About eye tracking, the research indicated that the autistic child has eye fixation to the people face decline at the cut point 6 months compared to the normal child. About brain scans, research showed that 28 out of 92 infants aged 6 months -2 years were diagnosed with autism and had differences in the brain scan. Therefore these 3 studies may provide early detection before the emergence of behavioral symptoms. Tool for autism evaluation: ADOS (Autism Diagnostic Observation Schedule); ADI-R (Autism Diagnosis Interview - Revised); TDAS (Thai Diagnostic Autism Scale): for children from 12 to 48 months, including Bahavior observation (6 activities) and Caregiver Interview. Also using camera to record child’s behavior. A research show that the autism children received intensive care (25 hours per week) improve their IQ in comparision to autism children received normal care (10 hours per week). Since many of us are very new to this field, everything she taught us was very information for us. She also explained about the practice of Thai Child Developmental System and how this system impacts the children with disabilities in their early age. As a result, many children can get help in order to have better qualities in their lifetime. We all hope that this system can be applied in our countries and every families and children can be benefit from it. We think our aim to study here in RICD about the children in developmental delay have been upgraded by all the informative lectures.

Topic: Developmental Surveillance and Promotion Manual: DSPM

Ms.Suphakphimon Papang shared the excellent process of DSPM. We have learned about the screening methods for developmental and chronological age, principles of promotion and institutions to guide parents in promoting child development skills. DSPM is entitled for preschool children with 15 age ranges by 5 domains. This tool was projected to study of child development from birth to five years old based on the five areas of development: We also get to have a hand-on practice with the teaching assessment tools and equipment of DSPM. Most of the age ranges can be assessed by caregivers or parents in DSPM. We have learned about details of DSPM and these assessment tools are performed as a tool to alert the parents and caregivers and assessor to decide the development stage of the children. We learnt how to use tools of development surveillance and promotion manual DSPM “before coming to the training, “as we read the manual which was given in advance, we read it, but we didn’t understand the way to apply that test in the real situation, but after got lecturing from the expert, we know how to do that test”. In order to perform the test, practice development delay testing in children we have to work it as a team, we are alone, cannot do that. Anyway, working with a child, especially with child who have developmental delay, working as practitioner or therapist, must be very patient and work with wholehearted to help them have a better life. During this course, trainer showed us the demonstrated video about how to practice DSPM. After each session, we were divided into three group in order to practice the tool of DSPM and were guided by the trainers and facilitators. In our group we took turn to practice or we can say that we did role play under the supporting by facilitator. It seems like easy to practice with just the toy but with real baby and child must be much more challenging to handle them. This session alerts us that we should not only let child to grow up naturally but we have to check whether they grow up was appropriate to their age. The more parents pay attention to their child the more problem prevention could happened. Hopefully, this manual could be used to all parents in our country for child wellbeing and development well in the future. Every mom needs to have one manual for the children. In labor room, children are screened and divided into two groups: normal and high risk group. For the normal group, DSPM is used for assessment tools. There are five domains in DSPM: Gross Motor, Fine Motor, Receptive Language, Expressive Language and Personal Social. We thought that Receptive Language and Expressive Language are in the same group. However, after Ms.Suphakphimom’s explanation, we understand clearly that they are divided into two groups to get more details. There are 116 items and 19 ranges in DSPM. For 19 ranges, 15 ranges are used for parents, 78 items (surveillance) and 4 ranges for health care professionals, 38 items (screening). Now we can differentiate surveillance and screening. Surveillance is assessment of the children by the parents. Screening is done by healthcare professionals at the health care center or hospital.

Parents need to do surveillance for every developmental milestone. There is only one item in most of the categories but in some there are two or three items. The child needs to do all the items in each category. If the child fails in one item, that category is failed. It means that the child is delayed in that category. The good thing is that when the child fails the assessment, parents or caregivers can do intervention as described in the manual at home. Moreover, healthcare professionals screen at healthcare centre again. If they see the child is delayed, the child need to do the intervention as described in the manual. Meanwhile, the healthcare professionals refer to the place if the child has another associated problems (e.g. hearing and vision problems). Then, the child has to reassess again after one month. If the child is still delayed, the child has to go to the secondary hospital then to tertiary hospital for further assessments. We did learn properly for DSPM. First, Ms.Suphakphimom explained briefly about the DSPM. Then we had to watch the videos to assess the child with DSPM. After that, we were divided into groups and did practical effectively for two days. Analysis of the DPSM Overall, the DPSM is a great surveillance and screening tools. It’s easy to use, with 5- 10 items on average per screening, and most often can be completed within 5-10 minutes at the most. The domains are well selected and comprehensive. The domains in the DPSM cover the developmental spectrum of children, and allows for the holistic assessment of children. The majority of children who are slightly developmentally delayed will benefit from just the DSPM alone. The DPSM is parent and family centered. However the DSPM has significantly fewer items than other developmental screening tools. The DSPM uses easy to use, readily available tools for assessment. The DPSM uses different developmental domains than the typical screening tool. Typical screening tools break down development into: Language/ communication, Fine motor, Gross motor, Personal/social, and cognitive. In the DPSM, cognitive is combined with fine motor, and language is broken up into expressive and receptive language. As a psychologist I can understand why they did that: the DSPM needed to be a short test with 1-2 items per domain. Speech is too complex to be tested in just 1 domain. Furthermore, many fine motor items do require cognitive skills. Because the items are so few, finding the norms becomes very important. Are the items developmentally relevant to the Thai children? Because there are so few items, each item has a greater impact in assessment. The DPSM does not give a range of answers, (like slightly delayed, severely delayed, at risk… etc). The DPSM gives a pass/fail answer. Which for the purposes of surveillance is good, but inadequate for delayed children (which is why the system has DAIM and TEDA4I). Overall the DPSM is a great surveillance and screening tool that fits well into the child development system. It was the most challenging task for some of us because some of us are very new bloomers in the special education and children assessment. The DSPM videos and manual books is the great help for all of us to learn the information and to get the instructions about how to establish a successful assessment with children and their families. After this lesson, we all are amazed by the system that is indeed effective to get early intervention of the children with developmental delay. After the child is assessed by DSPM, all parents will have more alert of their child’s developmental state. Although this system has not been carried out in our countries, this trip has been inspired us to working on a new project that will help the children back in our countries. All the hands-on training with equipment of DSPM had equipped us with the techniques and methods to help the children and families of our countries. We would like to share our knowledge that we learnt here with the parents, families, teachers, and social workers left in our countries. Furthermore, we wish our society will notice more children with developmental delay and give them the opportunities to development properly and support them to grow up to help the society in the future. Although we didn’t have enough time to practice all DSPM assessment tool programs.

Topic: Developmental Assessment for Intervention Manual: DAIM

The session started with the slide presentation about Introduction of Developmental Assessment for Intervention Manual which gave a summary information from the manual to make us easy to understand. In DAIM, there are Total: 116 items (Surveillance: 78, Screening: 38), 5 domains of development, 19 ranges of age (Surveillance 15 ranges of age, Screening: 4 ranges of age). Developmental domains: Gross Motor (GM): Movement (24items). Surveillance: 16, Screening: 8 Fine Motor (FM): Muscle usage and Intelligence (25 items). Surveillance: 16, Screening: 9 Receptive Language (RL): Understanding the language (22items). Surveillance: 15, Screening: 7 Expressive language (EL): Using language. Surveillance (22items): 15, Screening: 7 Personal and Social (PS): personal and social helping ((23items). Surveillance: 16, Screening: 7 DAIM was created for healthcare personal working in the field child developmental, volunteer and parents who have children to care for risk group (Risk group mean LBW and AB APGAR score at 1, 2 ,7 minutes equal or less than 7) and others suspected information of delay in development of the child that we got from the other field both before birth and after birth. We do the development testing begin with the point that is 1 range lower than the chronological age and start with any field of GM, FM, RL, EL, PS. If the child pass, record the result (tick sign) in the box. If the child cannot pass, then use the item one step prior to the beginning test. If the child pass, record (sign) pass, and stop the test. In this test, the examiner must review the test and inform the parents that their child’s development at which age and suggest the parents to enhance their child’s development at home then come to see the examiner or health giver again as in the appointment. After the slide presentation, lecturer showed the video of applying DAIM of expert with children, then participants separated into three groups to practice 116 items from the manual to gain more experience. DAIM is used for children with high risk group. For example, child with low birth weight, APGAR Scores <7, teenage mothers and etc. APGAR is an acronym for Activity, Pulse, Grimace (reflex irritability), Appearance (skin color) and Respiration. Like DSPM, one mom has to have one manual book. Also there are 5 domains and most of the items (108 items) are same except 14 behavior’s development items and 7 neurodevelopment items. Basically, the majority of the items in the DAIM, are like the DSPM, with only the listed above differences. In addition, parents need to do the assessment at home. If the child fails the test, parents need to follow the instructions in the manual book. Moreover, they have to show the healthcare professional in follow up date. Same steps like DSPM. We learnt more about the details about the age, sub skill, objective, test and judgment criteria and child development assessment methods and noticing more about the remark. The children will be assessed in Gross Motor, Fine Motor, Receptive Language, Expressive

Language, and Personal Social Skills. Assessments are different and specific according to the group age. Children intelligent and abilities are tested. After the application session, the instructor told us to conclude the results of screening and to inform the parents. For example, “I would like to thank you for your cooperation with the Child developmental screening tests”… etc. We could also suggest the parents or caregiver to teach the children at home. She also mentioned that we have to provide recommendations for the parents to promote the child development in the areas where the child can’t perform skills. All this skills is to support the children to have a life skill and self-help skill in their home environment. The hand-on experiences are performed in a group and that make us improve in our presentation skill and cooperative skill. This training was not only instilled us the child development knowledge but also benefit us to improve our interpersonal skill.

Topic: Thai Early Developmental Assessment for Intervention: TEDA4I

This lecture was started a game that help us to remember everyone nicknames. Ms.Wisalinee also taught us some Thai children rhymes. . We began our lecture by learning about Expressive language (EL) and assessment methods. In this session, we learnt about the development assessment manual and intervention tools of TEDA4I from 2month to 72month in five domains. DSPM, DAIM will be used by the health official of all levels for high risk group, LBW (low birth weight), birth asphyxia. If the children are suspected to have developmental delay, the children will be re-assessing with TEDA4I further diagnosis (autistic, GDD, DS, LD, ID, and CP) TEDA4I is assessment from special trainers. Today lecture is developmental assessment and guideline for parent intervention. We demonstrate the assessment experience in a group and we learnt that there are some varies between the book and real demonstration. In this lesson, the purpose is to understand the important of the early developmental support for intervention and the method of Thai Early Developmental Assessment for Intervention correctly, to have knowledge and skill in the Thai Early Developmental support for intervention and to refer the case to the department and organization involved with. TEDA4I aimed to early intervention for children with developmental delay. The tools are used by pediatricians/ well-trained staff. In this manual there are 5 steps of guideline for usage to assessment process, to summary from record of the assessment form, to communication and social and mental assistance to parents and guardian. For this lesson the training methods a bit different from previous lesson. There was slide presentation, demonstration from the speaker and facilitator as the video demonstration did not have full version. And after that participant separated as three groups to take turn in demonstration of the part from the manual. Each group took a randomized number to choose the item for demonstration and the role is the 2nd group observe and give comment to 1st group and 3rd group commented by group 2nd and 3rd group commented by 1st group and each group play role as assessor, child and instructor by using TIDA4I tools kit. In this session, we also have some activities of games which the first game is about remembering name of participants and it was the first day that we started to know each other name. For the afternoon game help us to feel fresh before the class too. Moreover, it is about children song in Thai language the human body part according to these activities we could learnt some Thai word as well. We had fun in class with a good time management. The TEDA4I is the second step in the screening/intervention program. In multiple studies published after the development of the system, research is showing that even though there is a large number of children developmentally delayed (around 25%), less than 5 % of those children have to go to tertiary centers for further assessment and evaluation. Meaning this Thai system is effective – the combination of the DPSM, DAIM, and the TIDA4I.

This means that children who are developmentally delayed because of poor stimulation are able to turn around and reduce the gap, through the parent led interventions. TEDA is the last step in the intervention process before children are required to go to tertiary centers. The purpose of TEDA is that research shows that the majority of children are able to reduce the developmental gap before they go to tertiary hospitals. So having the TEDA step allows more time for children to develop. From a developmental perspective the TEDA is more detailed than the DAIM.

Analysis of the DSPM, DAIM, & TEDA4I

There are several key differences between the DSPM and DAIM. Firstly the DAIM is based on the DSPM, so the majority of the items are the same. The domains remain the same. This allows for several advantages. First, a whole new test does not need to be developed. By using the old test as a backbone, this requires less development resources. Also because the backbone is the same, less training costs because the nursing staff already know the DPSM. The DAIM is different in two key ways. There are additional items, especially in the neurodevelopmental category. These items are added when the criteria in DSPM is not sufficient. This makes the DAIM more detailed in developmental items. The second key difference with the DSPM and DAIM is the way the test is conducted. First, the DAIM test is initially done one developmental age below the chronological age. So for example, a 1 year old will be assessed at a 9 month level, then if they pass at their original age. This extra level of assessment makes sure that the high risk child is developing as he/she should be. Secondly, the DAIM gives a developmental domain for each age. Instead of a pass or fail score, with the DAIM, we give assessment to the child until the developmental age is found. So for example the child may be one year old, but have the expressive language of a four month old. This allows the DAIM to give an accurate developmental age, and the assessor to see specifically where the child is delayed. This will help later on if needed in the TEDA4I. So even though the DAIM does not have that many items different, because of the way the test is done (developmental age of each domain), it provides the appropriate information needed for high risk children. In the topic about Developmental surveillance and Promotion Manual (DSPM), Developmental Assessment for intervention Manual (DAIM) and Thai Early Developmental Assessment for Intervention (TED4I), we have listened to a brief introduction of the construction manuals process, a flowchart of manuals and base on instructions for using them. We knew that preparation phase is also important, examiner must study the instruction for using manuals, study the content of the handbook in detail in regards to techniques, methods, criteria, and equipment for screening child development, study the detail of the equipment and methods used along with the screening items, prepare dialogs or question prior and rehearse the screening methods before the actual service. This will help the examiner understand the steps and methods of screening to make the screening session brief and to be familiar with the items and equipment. The examiner also making sure that the equipment is complete and clean as well as preparation of the testing location to make the child feel comfortable, relaxed and able to cooperate with the screening process. Moreover, preparing the child and establish close relationships with children before screening child development is also necessary to do. We learned theory and practice in groups on the process of assessment, screening, and follow-up each manual, we knew how to begin the screening process with greeting to the child and their parent or caregiver to become familiar and trust. We knew how to calculate the actual age of children, how to evaluate the child in every skill and how to conclude the results of the screening. Finally, inform for the parents and provides recommendations for the parents to promote child development in the areas where the child couldn’t perform the skill.

With lesson DSPM, this manual has a total of 116 items, 5 domains (GM, FM, RL, EL, PS) and 19 ranges, it is used to surveillance in 15 ranges of age, for normal group. This manual is done by health officials of all levels. If detecting a child with signs of delay, the personnel will guide parents to promote children’s development base on children’s age for 1 month. After that, if children still have delayed development when re-surveillance, then referring them go to secondary health care unit with physicians or pediatrics for additional assess children’s development and diagnosis. We observed teachers modeling and watched videos before practicing step by step, which allowed us to focus on every detail of each item and how to use tools such as red flannel ball, rattle, small objects… At the same time, we were asked the question that where to get started with the screening test and after listening teacher’s sharing, we answered for this question right in which the starting point is an item for any skill from the child’s actual age group. When the child passes, we will have to mark in box “pass” and mark in box “not pass” in the handbook if the child does not pass the testing. If the range of age consists of 2-3 development items, and the child does not pass in one of them, consider this range of age as a fail and mark in the “not pass”. For the test which considers ‘pass’ at 1/3 correct, if the child does correctly the first time though it’s not necessary to repeat in the second and third time. Also, repetition on the third time is not required for the test that considers ‘pass’ at 2/3 correct. And for the special case that requires re-check at the development level in the future, begins with subtests that the child did not pass in the previous evaluation. Moving to the topic about DAIM, there is a different between DSPM and DAIM, this is manual which is used to assess children at-risk group includes children who have low birth weight, birth asphyxia, and teenage mothers. This manual includes 5 behavior aspects in 20 ranges of age and behavior’s development of 122 items. Implementation process DAIM basically like DSPM, but if in DSPM, we have to start screening with an item from the child’s actual group while DAIM we begin with developmental point that is 1 range lower than the child’s chronological age and starts with any field gross motor, fine motor, receptive language, expressive language, personal social skills. If the child passes the first test, record the result in box “pass”. Continue with the next item in the higher age group in the same skill until the child cannot perform the test; then record the result in box “fail” and finally, stop the test. If the child cannot pass the first test, record the result in box “fail”. Then, use the item one step before the beginning test item. If the child can perform the test, record the result in box “pass”, and stop the test. Follow the flowchart of the Surveillance and Promotion for child development that we have been conveyed, we understood that if children still had a delay after re-surveillance, then it was referred to assess by Thai Developmental Assessment for Intervention (TEDA4I) in the secondary health care unit. With TED4I, we will begin the assessment with the development of the age range under the actual age. If after assessment, children have delay development, children can use the service unit’s developmental promotion program to solve delayed development problem for 3 months. After that, family and children come back and pediatricians or well-trained staff will re-assess children’s development, in case the result that the children have delayed development, children can be re-assessed children’s development using TDSI III and carried out additional diagnosis and then provided care, treatment based on disease and periodically follow up on their development, helping them to have a better quality of life. Summary of surveillance and screening tools in a following table:

DSPM DAIM TEDA4I TDAS When to use Apply for all Apply for risky After 1 month Suspect autism children after group: low birth of assessment given birth weight, by DSPM, asphyxia, DAIM, still adolescent suspect delay, mother use TEDA4I Purpose Surveillance and Surveillance Surveillance Diagnose screening and and screening and screening autism intervention and intervention and intervention Who use it Parent, primary Primary health Secondary Health care health care staff care staff health care staff has been staff trained on how to use it

The knowledge about those tools is fundamental knowledge and it is very important to help us a better understanding of a system that promotes the development of children. Through practicing each item of the manuals helped us mastering the milestones in the children development according to age groups, we understood each item and 5 aspects such as Gross Motor, Fine Motor, Receptive language, Expressive Language and Personal Social Skills and as well as how the parent can promote and improve those skills. The combination of learning styles as observation and practice gave us an overview of the comprehensive service system. Once we have a good understanding of the manuals set, we know how it can be suitable tools for screening child development to find out the group at risk of improper development for early intervention.

Topic: Pediatric Physical Therapy in Children with Motor Development Problems

The performance objective of this module is to help all the trainee to understand of how to give appropriate intervention for children with developmental delay and neurodevelopmental disorders. Ms. Ngamphan Chitmin shared the main point of her slide presentation that is about children with motor development problem, conceptual frameworks, assess basic physical therapy regarding motor development problems, and manage basic physical therapy regarding motor development problems. Those contents gave us an image of her team action of providing treatment technique for cerebral palsy children and others developmental delay. The lecturer gave a brief explanation on what developmental delay is and how it occurs when a child doesn’t reach the developmental milestones at her chronological age. The development delay mostly takes places in one or more areas for example, gross or fine motor, language and social skills etc. She continued lessons by explaining about the cerebral palsy. Cerebral palsy can be caused by damaged brain or abnormal brain development which occurs before or after birth. She showed videos about children with motor developmental problems. We also learnt that children will develop by doing physical therapy in the early age. Pediatric physical therapy plays an important role to assess the children at first visit and get back home with early intervention home program for parents and children. Physiotherapy assessment are examined seven problems such as general observation, Muscle Tone, Passive Range of motion (ROM), Muscle length, Gross motor function, Primitive Reflexes. Functional Balance grading helps children for neck control and bed mobility training, crawling, sitting, and standing training. Cerebral palsy is caused by brain damage or abnormal brain development before birth or early in life. Cerebral palsy can be classified into according to side of lesion of brain. Cerebral palsy can cause during prenatal, perinatal, and postnatal. The primary roles of physical therapy focus on mobility, ambulation, and balance and prevent secondary complications. Moreover, we learned about physical therapy in early intervention that can help both children and family by using home program (POST Model, Manuals, Follow up). The conceptual frameworks of physical therapy are to help them to help themselves. We want to learn reflexes management and POST Model. For the assessing the child, one of the important categories is to assess the general appearance of the child. Although the child has motor problems, we have to assess the mobility. We shouldn’t think they cannot move. Moreover, therapists need to observe generally the child. Whether the child use the adaptive equipment like wheelchair, walker and etc. Some children have hypotonia in early stage. Later, they get increased muscle tone (hypertonia). If they have still hypotonia in the late stage, they might have some medical problems. Also, the therapists need to look at the relationship between the caregiver and child. We could learn that in Thailand there are a lot of

therapy used in Physiotherapy Department such as Vojta Therapy, Hippo therapy, Hydrotherapy and Neurodevelopmental Technique (NDT). Currently, we are using NDT in our hospital. Some places use hydrotherapy in their department but not in our hospital. We learned the introduction of Vojta Therapy in our countries before. However, I did learned more in here. Vojta Therapy stimulates the paralyzed muscles. I could learn that in RICD the child has to be given for 10 minutes per session and the adult 20 minutes per session. We could see that some of the governments staff (soldiers) help while giving the Hippo Therapy. It can have benefits for both children and horses. Hippo Therapy can be done with Physiotherapy, Speech Therapy and Occupational Therapy. We had a chance to visit Physiotherapy Department. And I saw therapeutic equipment used for soft tissue injuries, musculoskeletal and orthopedic conditions. After that we went to Vojta Therapy Room and Hydrotherapy with Snoezelen inside the room. In Hydrotherapy they use foam to use as a weight. Although it look as small weight, it can use as a resistance exercise in the water. Finally, we visited to Hydrotherapy pool with warm temperature water. The child needs to do hydrotherapy with activities. However, as a physiotherapists, we wish to have an experience of looking at giving the treatment to the child. Although we watched some videos in power point slides, we think it’s not enough. In our opinion, this lecture doesn’t make so much difference for us. We already knew most of them. We want to learn more about the techniques and treatment of the child with developmental delay. For teachers this training topic is the most challenging and difficult lessons for some of us because we have no background knowledge related to this topic. After the slide presentation, we had 30 minutes’ chance to visit her working area to see real material. The pediatric physical therapy clinic provides skills for child development and neurodevelopment treatment which was developed to treat underlying neural motor deficits posture and movement disorder and encourage increased functional skill development. she also had a license of Vojta therapy that treat children who have movement problems by using acupressure and posture to cause various muscle contractions and stimulate muscle function according to brain and nervous system procedures. And the Hydro therapy also in there which was designed the swimming pool like the sensory room. Physiotherapists apply other special techniques in clinic such as hippo therapy, Vojta therapy, hydrotherapy, and NDT. During Hippo therapy session, physiotherapist work together with multidisciplinary team such as occupational therapy and speech therapy. In RICD, there is a Snoezelen pool only one in Thailand to improve attention and participation. Parents and caregivers in Thailand are able to detect the children developmental delay with the tools and manual and children will come to RICD for intervention and reassessment. There are long time and short time goals for the parents and caregivers to do with children at home. That will be great if we could experience how RICD staff teaching children in the Snoezelen pool.

Topic: Early Stage Development and Postural Support Devices

At the beginning of this session, Mr. Joey showed us the slide presentation about the introduction and overview of Postural Support. Next, he gave us about 10 minutes to do disability simulation by dividing us into 3 groups. These activities made us experience about the disable children’s difficulties in their daily life so we can know how they feel and how difficult they are. Lecturer continued his lesson about the development of spinal curve in early age (first year). after that, it is time to do group activities about 10 minutes. The second part of this session is about Postural Devices. After this course, we can familiar with different types of devices, identify use and purpose of the different devices, understand fundamentals of positioning and altering and understand safe and proper use of equipment. Mr.Joey brought some devices to show us such as Head Supports, Lateral Supports, Butterfly Harness, Lap Belt, Cushions and Standing Frame. The last part of this lesson is about Postural Device in Therapeutic Setting with the objectives to identify therapeutic benefits of postural devices, to identify specific devices appropriate to different therapy settings and postural challenges and practical ways to utilize devices effectively with your patients. Uses The stage of new born is very important. Although we know that the muscles of the body develop from head to feet, the development of the 1st spinal curve is ‘Thoracic Kyphosis’, not Cervical Lordosis. At the age of 3-6 months, 2nd spinal curve develops, ‘Cervical Lordosis’. Moreover, tummy time is essential part of the child development. The child has head control, increased spine and muscle strength, awareness to environment and learning what the people are doing by having a tummy time. In 6-12 months, ‘Lumbar Lordosis’ develops, 3rd spinal curve. This stage includes the most important part of the milestones such as sitting and crawling. They did research and compare children who can sit and cannot sit. They found out that children who can sit can use both hands alternatively but children who cannot sit use both hands simultaneously. Sitting includes a part of the development of fine motor skills (cognitive). Also, after researching and comparing the children with crawling and without crawling, crawling children can physically imitate and can use the hands alternately because crawling needs to be done by alternate arm and leg and crossing the midline. Crawling can also strengthen the ‘Cervical Lordosis’, improve hand-eye coordination and strongly related to lower motor skill development. I found out that children who couldn’t crawl in the childhood when they become a toddler, they would have bad hand writing and coordination is very poor. Therefore, some of the gross motor development can interfere the fine motor skills. We did some activities to understand the performance of children who have disability and developmental delay. Activities such as 1. Sitting on the wedge: button up the shirt by wearing two mitten gloves. 2. Playing jenga by wearing heavy or small weight

54 on the wrist. 3. Copying the given pictures by wearing strip on wrist and drawing by looking through the mirror. We learned about the different types of postural support devices such as corner chair to enable floor sitting and peer group interaction, lateral supports to compensate for trunk stability, head supports to support the head, butterfly harness to stabilize the upper trunk and lap belt and cushions to support posture. All devices are used for postural support. However, we need to use less pressure to avoid pressure sores when adjusting the devices with children. Difference between corrective and maintenance. Corrective is generally used in young patient who still develop muscles and skills and can see a lot of improvement. Maintenance is for old patient who doesn’t have dramatic improvement. Postural devices are widely used in therapeutic setting like speech therapy, occupational therapy, physiotherapy, art therapy, drama therapy, music therapy and etc. Group activities: Early intervention techniques for gross motor developmental problems including physical therapy, vojta therapy, hydrotherapy, hippotherapy, snoezelen. One of the wonderful experiences that we had throughout this course was the class about postural support devices. In this class, we got the knowledge of the first-year development, long term effects of postural deficiency and how those affect other aspects of children. About the first-year development, the development of spinal curve, the primary sitting or crawling can trigger neurological and the different pathway related to each other. In the other hand, the first-year development reflects the typical neurological development. The postural support related a lot to gross motor development, however, impairment of gross motor does directly affect fine motor development, intellectual development, cognitive development, speech, and so on. We were experienced as disables people. From early childhood and even in our everyday life now, we have met and worked with very special people with vastly different disabilities. When we were young, we always were told to respect each person that we meet and that helped us a great deal when we would meet people that were different than us because we are all crafted from bones and the same skin, we all have the purpose to live. The experiences as disabled people helped us to understand the difficulties that they have to encounter in their lives. They can have problems as inaccessibility since most of the government buildings or private offices and other infrastructure are inaccessible for disabling population or attitudinal barriers like stigmatization and discrimination, deny people with disabilities their dignity and potential. Furthermore, one of the most important things that we learned was how physical difficulties can affect other skills. In particular, the children who have difficulty about physical movement or gross motor skills will affect to their ability to explore and learn about the surrounding environment so that it can inhibit the development of cognitive and language skills as well as the fine motor and personal self-help. To understand this, the teacher gave us a few different disability simulations, in particular, we experienced three different activities to help us understand the disability symptoms. The first activity, there was a mirror and a rubber band and we need to draw follow some priors shapes when wearing a rubber band and look at a mirror. Throughout this activity, we can experience the symptom of people with visual problems combined with physical movement problems and how difficult those people need to deal with when they study. The second activity was the game that we wore either the light or the heavy band at our wrists and used the chin to keep a piece of paper while playing the timber tower wood block stacking game. These were very interesting experiences because we used to play this game before but now it became really challenges with us. The third activity was button up some shirts while sitting on the different types of cushions. We just experienced a few minutes as disable people but we can understand how stress and how difficult they are when they study and learning some skills. In this class, we also got the knowledge about different devices. The corner chair is one of those devices that help the child sit in front of the ground, this is suitable for the child with hypertonia. Wheelchair with lateral support can help for the trunk instability like hypotonia or hypertonia and for those who cannot sit independently. When using this device, we need to

remember that always give in pairs on both sides and not too much pressure. About the head support, we use this device in case the child cannot control the neck. Moreover, the butterfly harness also a good device to support for people to stabilize the upper trunk, especially helpful to counter lumbar posture correction as well as helps direct users’ attention away from the balance. However, when using this device, we need to consider the pressure to prevent pressure ulcers. The lecture went on with a lap belt which starts with the pelvis and to support of lock the hip into place as well as the force is against the muscle and directed downward not backward and wider is usually better. The most basic postural device is the cushion. This device directly affects the user’s posture and have different kinds such as foam, gel, air and so on. In this class, we also had a chance to try out some of the postural devices such as cushions, a wheelchair with head and lateral support, lap belt and butterfly harness, and standing frame to understand the feeling the comfort level to adapt these devices to our patients Mr.Joey and his team guided us and explained about the technical information and equipment. We learnt about how Postural support and early intervention impact on all children from new born to adulthood. The stage of development milestone and the support and posture that the children need are very informative. It's about supporting our parts of the body to be able to walk or move confidently. We also play a game to learn from the shoes of people with learning disabilities. Postural support devices are important for ambulation of disable person and can be used for 2 purposes. Young people should be used corrective device to gain further improvement while other people used maintenance or comfort. The cushion, Head and neck support, lateral support, lap belt and butterfly harness are used when setting with wheelchair. This session is the eye opener for us to understand the real daily experience of the physical person and the support and understanding they might need in their life.

Topics: Thai Massage Therapy for Children with Cerebral Palsy and Autism Spectrum Disorder

Thai Traditional Medication provides integration of traditional and modern medical treatments to do diagnose and rehabilitate by utilizing traditional treatment such as traditional message, compress massage and herbal medication. It helps to stimulating learning ability of the brain for calming children down for better control of their behavior and for strengthening their muscles, increasing joint movement and helping reduce muscle spasticity. For the first session of this lesson was shared about the history of Thai traditional medicine. It is being recognized by WHO. Some participants asked about the Thai traditional medicine. This course is available for anyone who are interested and it has curriculum for international students too. During the session the Herbal ball was demonstrated the way of packed it which showed about what herbal we could put in the herbal ball for applying in the face. And last, the herbal ball was given to participant as a gift back to our country. There were two speakers in this lesson. Other speaker presented about the understanding of basic Thai massage with self-practice in the meeting which separated as a group of three to four person in each group. The session ended with group photo with our souvenir of herbal ball. Thai Traditional medicine is an ancient form of medicine, developed thousands of years ago, and passed on from culture to culture. Traditional medicine practice is different from culture to culture, and refers to a variety of practices including medicinal herbs, massage, meditation, aroma therapy, and much more. It is a diverse set of treatment, not just medicine. Traditional medicine is recognized by the WHO, and its practice is encouraged, especially in developing countries. Thai traditional medicine is broadly based on Ayurvedic (Indian) principles, and pathology is defined by looking at the 4 elements: fire, earth, water, and air. These 4 elements need to be balanced. Traditional medicine treats the entire body and it not just to cure the illness alone. TCM had been treating many Thai people who do not have access to the modern medical service. Since ancient time, Thai Medicine was adopted from the well- known doctor of Buddha, Dr.Jiwaga Komaraphat. After that, everyone had herbal bag to try out and we proceed to Thai massage session. The ingredients in the Thai herbal are similar to the herb that we can get in our countries. It is interesting to understand that how TCM and acupuncture can help to relief the children with disabilities. We also learnt that TCM help to improve our circulation system, musculoskeletal system, Nervous system, Respiratory System, Respiratory System, and digestive system. Autism in TCM is to cure wind and earth plus Fire and the retreatment is interesting because it is giving aromatic medicine to decrease aggressiveness. Massage is to balance the blood and balance the nerves and brain well. We believed that would help the ASD child who has meltdown and tantrum. Although the research is in progress, we hope that many researches will soon be proven to support TCM for all special children in the world. After the lecture, we all practise on how massage therapy work on our body.

At RICD, research is being done on treating ASD, and CP with TTM methods. Thai massage in particular has many benefits for ASD children, both on a cognitive, and sensory level. In EEG (brainwaves) research, it shows that doing Thai massage activates a part of the brain that promotes relaxation. For CP children traditional massage has many benefits including improvements in mobility, and muscle tone. Other therapies are used as well, on a case by case basis. For example aromatic therapies is used for relaxation/stimulation. Thai massage can be also used to treat sleeping and eating problems, constipation, chronic pain, and even sensory issues. Overall, Thai massage has a lot of proven physiological benefits such as reducing cortisol, and showing improvements in muscle range of motion, and improving mental health. We also got the opportunity to learn practical methods of massage. We learned the very basic points, and we can see that traditional massage is a very complex skill and will take lots of training hours. We got good practical experience of how to do Thai Massage. Overall TTM is a good form of alternative therapy that has a strong research basis. Parents often times consider the “traditional” therapies such as speech therapy, occupational therapy, and physiotherapy. However, parents today should also consider traditional therapies as a valid and effective form of treatment. In the class about Thai massage therapy for children with Cerebral palsy and Autism spectrum disorder. We got some basic knowledge about traditional medicine. We knew that four elements which are earth, wind, fire and water are the basic heart for Thai traditional healing. We learned about Thai massage therapy. There are many benefits of massage to the body system. Firstly, Thai massage can reduce muscle contraction, release cortisol, stimulates blood flow and other systems or work well such as digestive system, better sleeping. Thai massage focus on energy flow so in order to do Thai massage, we learned 10 energy lines. Leg massage include 4 lines which are Line 1: Tibia line from under the knee to the ankle, line 2: Upper thigh line, line 3: lower thigh line (along the trouser stitch), line 4: lower leg line from under the knee to talus. For back massage, line 5 starts from the upper hip to the next base which beside the spinal column. For shoulder massage, line 6 start from the next base to shoulder. For the arm massage, there are two parts which are inner and outer side. The upper part is from armpit to upper the elbow (line 7) and lower part from under the elbow to the wrist (line 8). We need to remember 2 lines for facial massage which are head’s eyebrow to eyebrow’s tail and above the upper lip (line 9). The lastly is stomach massage which is clockwise direction around the navel (line 10). In this class, we also experienced how to make an herbal compress. Firstly, we put the portion in the center of the calico and then we fold the cloth from the two corners before folding another two corners. Secondly, we arranged it well and make it in round shape before binding with string and tighten it. Thirdly, we made the handle by overlapping the edge of cloth then fold it to hide the edges. The next step was to hide the end of the string in the fold of the handle to make the ball stronger. The interesting thing was we can use both fresh and dry herbal. For the dry herbal, we have to sock the ball in water for 15 minutes before steaming. There are many benefits of hot herbal ball compresses at which the people can get physical, emotional and mental health benefits. In particular, the child with developmental problems such as body’s balance abnormality, spasticity, sleeping disorders get a lots benefits from Thai massage.

Topic: Sensory Integration and Snoezelen

Occupation Therapy is the most powerful therapy in early intervention for children with disorder or developmental day. It can empower the children with lifelong living skill, and promote the quality of life. We learnt about how Sensory Integration helps parent groups with ASD, CP, GDD, ADHD and LD. Sensory Integration is the neurological process that organizes sensation from one’s body and from the environmental. That could help relief the child and adult with sensory issue to live their life to the optimal. We learned about Sensory Integration and Snoezelen. We got information about the definition of sensory integration which is the neurological process that organizes sensation from one’s own body and the environmental. People who have disorder problems such as ASD, AP, GDD, ADHD, LD normally have sensory disorders. The sensory disorders include 3 main types which are vestibular processing disorder, proprioceptive system disorders, and tactile system disorders. Sensory Integration was an interesting topic, the lecturer got a lot of question from participant. Anyways, they tried their best to answer to our questions even with the language barrier. The lesson started with slide presentation, continuing with game which divided into four groups with the candy gift. The game helped us to work as group, to be quick reflection to the lesson and had fun during the session. The focus of this lecture was occupational therapy. Children with good sensory integration are able to balance their senses, and able to focus, and have attention. However children who are not able to balance their sensory issues will have difficulty concentrating, and even have emotional and behavioral issues. For example, sitting in a classroom, a child may not be able to filter out the sound of air-conditioning. There are many sensory systems, but occupational therapy focuses on 3 sensory systems, such as the: Vestibular system, Proprioceptive system, and Tactile system. Each system was explained at length, and the activities to stimulate each system was discussed. For example to stimulate the tactile system you would do activities such as: brushing, massage, or wrapping in a blanket. Each system can be hypoactive, or hyper active. Hyperactive sensory systems have low thresholds, so they are sensitive to slight sounds and touches. They are easily stimulated, and will often have behavioral issues because of their sensory problems. Hypo active children have

very high thresholds, where they have less sensation in these systems. Because they have less sensation, and a high threshold, they become sensory seekers, where they look for sensory stimulation. Depending on the issues of the child, treatment is given based on the needs of the child. For example hyperactive children will have low threshold activities that are gradually graded into higher thresholds. The goal of all these activities is to increase the quality of life, improve movement and coordination (such as crossing the midline), and emotional stability. During the lecture, a short sensory profile was filled out to give us a sensory assessment tool. We also played a game, but we did not all get an opportunity to answer questions. In related to vestibular processing disorders, there are 2 types of disorders: hyper- responsive and hyporesponsive. Since the vestibular system has the function for balancing and posture and help us know where our bodies are in space so the one who has hyper-responsive normally fell scared of playground equipment or doesn’t like to be turned up-side down…, in contrast, the one who have hypo responsive needs to be in constant movement, impulsive behavior…There are some activities to promote the vestibular system such as jumping on the trampoline, dancing, swinging on a sensory swing, walking barefoot on uneven surfaces such as grass or sand, jumping rope, climbing on playground equipment… About the proprioceptive system, is the sense of the relative position of one’s own parts of the body, for example when closing the eyes, the people can touch two index fingers together. There are many signs of proprioceptive system problem such as easily frustrated or lacking confidence, frequent crashing, bumping, enjoyed deep pressure, use too much force for wring or coloring, play too rough with peers or pets, misjudges the amount of force need to pick up objects, difficult isolating body movements of locating body parts such as touching the tip of their nose with a finger particularly when eyes are closed. There are some ways to improve or strengthen the child’s proprioception such as take the child to the playground for jumping, running…Deep pressure therapy to puts pressure on their sensory receptors, ask the child to do the chores like clean up the toys, carrying laundry basket. About the tactile system, is the sense of touch. This is an important sense that helps the child get information about surroundings through receptors on the surface of the skin to feel different surfaces and textures. There are some activities that we can use to strengthen the child’s tactile system such as painting with different types of brushes on different textures, playing with sensory objects like water, sand… We also knew how to assess the sensory profile as well as we can interpret the scoring One more interesting in this class is about “Snoezelen”. Snoezelen can be an adventure room where the children can climb hill/mountain, jump on tramping…or relaxation room where the children can be relaxed if they are stressful. Snoezelan is a tool for sensory integration. Like “sensory rooms” of other countries, Snoezelan is a multisensory stimulating room. These room provide multiple benefits including reducing anxiety and agitation, stimulate reactions, encourage communication, and also be a great and fun place for children. The room in RICD is broken up into two rooms, exploration room, and relaxation room. Snozelan is a system developed in the Netherlands, and the applications of Snoezelen is not just for sensory integration. Snoezelan is a diverse tool that can used to treat all kinds of disorders. Snoezelan can be used for autism, for OT, management of challenging behaviors, learning disabilities, mental health, early years children (normal or delayed), brain injury, trauma, and even the elderly. Overall snoezelan is a great tool for occupational therapists, and can help with sensory integration. Snoezelan can be used by other professionals as well, speech therapists can use it to stimulate speech, the games and tools inside the room can be good for cognitive development, and CP children can use the room as an alternative to traditional physiotherapy. At RICD, they also do extensive vocational training. They train disabled children to be able to fit into society, and become beneficial people. The vocational training system at RICD

is amazing to see. We can see that so much work went into training these children, and these children/adults have much more fulfilling lives because of their jobs. They work hard, and enjoy their jobs. What is amazing to see is that some of these children are almost non-verbal, with lower than average IQs, and yet they are able to do their jobs at a high standard. The steps into vocational training are: Pre-vocational Training, vocational training, and post vocational training. Pre-vocational and post vocational training takes the most time. Basically it takes the most time to get children ready for vocational training, and once they have been trained it takes a lot of time and effort to keep training them on the job. There are many children like that in our countries, who have gone through the special school system, and now when they are older, need a support system like the one they have in RICD. This is something that will take time to develop, but hopefully in the future we can replicate something in our countries. Vocational training is an interesting topic that the occupational therapy group shared to us. The children can be assessed for different skills like motor, performance, communication and interaction skill then the children were taught the basic work skill like cleaning, laundry, cooking... The most impressive thing was children have the chance to get a job at RICD at different positions like cooking, prepare food, coffee, wash the dishes, cleaning the room… In this class, we also got lots of fun with the game and through this game, we can understand more about sensory integration.

Topic: Applied Speech Therapy for Children with Autism

ABA is the use of scientific principles of learning and motivation to teach effectively by using positive reinforcement, behaviors that produce a good outcome are more likely to occur in the future. After slide presentation, lecturer showed the video of her activities with children which was an interesting motivation to keep children focus on their activities. And last, she also shared about the program for producing sounds. The next topic was about how ABA principles and speech therapy go together hand in hand. She talked briefly about the basics of ABA concepts, and how they are applied in therapy. Secondly she talked about some technical aspects of speech therapy. She brought out videos of children in speech therapy to show how some of the technical aspects are applied. These videos were overall very helpful and interesting to watch. We hope to learn more when we visit her clinic. The sing language is limited in vocabulary so verbal is important. Speech therapy based on four systems. They are respiratory system, phonation system, articulation system, and resonance system. This is focused on communication and ways to communicate; the skills to interact, behaviours and tools using to communicate with the environment. After seeing all the word social skills, four facts came to our mind: (1) Rules for interaction, (2) Behaviour’s which express emotions and (3) Back and forth conversations, (4) Sharing interests and gestures. She mentioned that an ABA (Applied Behavioural Analyses) method is giving positive reinforcements to autistic children and to motivate them to do something by getting what they prefer. They stated that ABA is an old method which is still very useful and helpful in teaching. And I knew that we should never blame children for not being able to learn and it’s the responsibility of the teachers, parents, or caregivers to help them achieve the goal such as daily tasks. And I’ve heard the effectiveness of DTT (Discrete Trial Training) which is proven by hundreds of studies. Another new technique is ABC (Antecedent Behaviour Consequence) which is about changing the situation before the behaviour and it’s a new method but it takes time to achieve ABC. And the lecturer stated that ABA is commonly used rather than ABC since it’s easier and takes less time to practice than ABC. This session had been a great lecture for us who are working and teaching with young children with learning disabilities.

Topic: Picture Exchange Communication System, PECS

Everybody needs communication in everyday life and every occasion. Most of the people use verbal communication, writing, pictures, sign language, gestures and facial expression. For most of the special need children, it is not feasible to use verbal communication. Therefore, we need to use alternative method of communication to support the children with communication problems. In our experience, most of the ASD cannot express their needs by words. They use nonverbal communication like pulling and pushing the adults’ hands, pointing, making tantrums. Some cannot use even the gestures; don’t know how to communicate. When the adult can’t understands their needs, they make tantrums such as shouting, crying, whining, hitting and biting themselves or adults, lying down on the floor that lead to behavioral issues. In our countries, parents of communication difficulty children think that they need to teach lot child how to speak in every circumstances. However, they don’t know it can lead to further behavioral issues. One of the most significant issues is that they ask to repeat the sentence and say again and again. Whenever the child needs to communicate, they say first and ask the child to say. If the child needs snack, they ask to say snack. They wait till the child speaks, after that they give the snack. That means if the child doesn’t speak at that moment, they will not give the things. That leads to behavior problems. Secondarily, the child can have echolalia and become dependent on prompts not speak spontaneously. We learned about PECS and Aumentative Alternative Communication (AAC), PECS is one part of Augmentative and Alternative Communication (AAC). This method can be used to help the child initial communication with other people. As we have known, communication is the basic human need and a high function of humans. There is information exchange that the receiver and the communicator can get the same massage so that they can understand each other. We had lots of reasons for communication like exchanging the information, making a relationship with other people, talking about our hope, dream, and sadness, obtaining things, requesting, expressing our experiences, give instructions. About giving the instruction, not only the adults need to do this, but the children also need to know how to give the instruction as well as making comments and telling a story. To perform these functions, there are several communication modalities that we can use such as verbal, gestures and facial expressions, sign language, pictures, and writing.. For the children who have problems with communication, unable to use functional communication, limited or no speech due to autism or other

communication disorders can get benefits from PECS. The other benefits can include decrease negative behaviors that were caused by frustrations, increase availability for learning and interaction. PECS does not require complex or expensive materials and can be used by different people and different settings. In the PECS class, we also learned about the protocol for using PECS which is a very important part. This includes the preparation phase and the implementation phase. For the preparation phase, we need to interview the parent’s children to collect the child’s favorite things. These things can be food, beverages or toys. After that, we need to establish an inventory that includes all the child's favorite things, which is reinforced inventory. And then we need to prepare the pictures of these things. For the implementation phases, there are 6 phases which include from phase 1 to phase 6. About phase 1, the goal is to show the child how to communicate to a communication partner as well as how to initiate social communication. There are 3 actions that the child has to do in this phase which is pick up, reach for and hand the picture/symbol to the communication partner. Within this phase, two trainers are used, the first one acts as the student’s communication partner, the other one acts as a physical prompter who prompts the student to reach towards the communication partner. There are different levels of the prompts which hold student’s hand, hold student’s wrist, touch to prompt and verbal prompt. The system goes on to phase 2 in which the child was taught to initiate social interaction when a communication partner is not nearby and waiting. The distance between the child and the communication partner starts with 1m then this distance is increasing to 3m and lastly, the child is far away from both the pictures and the communication partners. The child overcomes this phase when he/she must do successfully in three different contexts. The system continues to phase 3 to teach the child discriminate pictures. Children learn to select from two or more pictures to ask for their favorite’s things. These are placed in a PECS communication Book with a self-adhesive hook strip where pictures are stored and easily removed for communication. The phase 4 is how to put pictures in sentences. The children learn simple sentences by using “I want” picture followed by a picture of the item being requested. Phase 5 and phase 6 are more advanced phases that taught the child to use modifiers, answer questions and comments. All in all, the primary goal of PECS is to teach functional communication. Some children can also develop the speech from PECS PECS can make the children to communicate easily and spontaneously without any behavioral issues. There are 6 stages. In Phase I, we could see that the child has to sit and exchange the pictures. Also the communication partner needs to show the thing only on the first time. The prompter only has to wait 1-2s if not the prompter need to prompt the child to pick up the picture, reach for and hand the picture to the communication. After the first time, the communication partner won’t show the thing. However, in Phase I, our understanding is that the child doesn’t need to sit and exchange. First, the communication shows the things that the child likes most. When the child sees the things, the prompter has to wait for the child reaching out, only then the prompter assist the steps what the child need to do. The communication partner always shows the thing in every exchanging and does continually. But if the communication partner knows the child doesn’t like the thing anymore, the communication partner change the another thing. ASD children are visual learners. So, the pictures don’t need to be big, it can be small. However, for the children like motor planning issues like CP, it will be difficult to look and hold small pictures. We think the pictures need to be big and add some assistive object like sticking a little heavy object like magnet at the back of the picture to be held more easily. From Phase II to IV, we didn’t have much theory knowledge. Therefore, we could learn much more from this training. We did do some practical and learn new techniques. Analysis of the PECS

PECS is a great tool to augment communication. PECS allows for children to communicate in ways that they would not be previously be able to do. The common misconception is that PECS makes verbal language develop slower. On the contrary, PECS makes language develop faster in children, and allow children to develop language when previously unable to. For example, even the most severe children, such as Non-verbal autistic children, can learn to communicate through PECS. PECS is based on strong scientific principles, such as ABA (Applied Behavioral Analysis). PECS is based on the system of give and take where one is reinforced for desirable behaviors. Therefore PECS is applicable to children of all disorders, ID or Autism. PECS teaches children initiation. It teaches children to initiate communication, to come to contact the adult for communication. This is a key factor in Autism, where children rarely initiate communication. Even just the concept of using alternative communication in general is greatly valuable for children with special needs (especially complex special needs). Of course PECS as a system is difficult to implement. First of well trained teachers are required who understand the PECS system. Secondly, the system takes time and consistency to implement. Logistically, PECS is complicated, even though it is a low tech, students have to carry around a PECS book, teachers have to create the book, teachers use their own book, the books need velcros, so it takes a lot of time investment. Parents also need to be involved. PECS is a great system… it just takes a lot for it to work properly.

Topic: Augmentative and Alternative communication, AAC, for children with complex communication needs.

There were a lot of tools in the training room. The lecturer showed us a lot of thing which were used in her clinic to support children to have better way of communication. People need communication for 4 reasons, Social Closeness (Greet Others, Show Affection and Share Dreams and Secrets) Obtain (Make requests, Express opinions, Refuse) Information (Ask questions, give instructions, make comments / describe, tell a story / what happened, Indicate a problem). AAC is a set of tools and strategies that an individual use to solve every day communicative challenges. AAC includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. It is kind of creative work which made something interesting and useful for children with developmental delay. Without those material it could be much more challenge even for their daily life. Teacher Nicole, and Cute talked at about the basic principles of AAC, and how to apply them. The goal of the presentation was for us to understand the core concepts of AAC and apply them. She did not want us to think about using high technology gadgets or expensive equipment. She wanted us to learn how to provide augment or alternative communication to children who cannot otherwise communicate. AAC, or Augmentative or Alternative Communication generally refers to a system of enhancing or replacing speech for those who have complex speech difficulties. We can either augment speech with supporting devices, or completely replace the speech system with something else – such as a picture system or body language, or using communication boards or buttons. In essence finding the right communication tool (or tools) for a patient is a complex process, and it involves assessing the capabilities of the child, the preferred method of communication of the child, the environment he/she is going to be in, the tasks the communication method is needed for. For those that have speech challenges, the disability is deeply debilitating, and providing them with the right

communication tools can enhance their lives in a deep and meaningful way, as well as help their development. The children who have the problem with communication cannot perform those basic functions of communication and so they need to use the AAC to help them to achieve all of those functions more effectively and social acceptance. AAC can help with different situations such as children with complex communication needs, Down’s syndrome, dementia... The first thing that AAC brings to the special need children are the visual supports which can help for their receptive language and increase the understanding so that this can reduce the unexpected behaviors. Every person needs to have clear timetables in a day and so do the child. Based on the visual support, the children will know about their schedules, they will understand what will happen in their daily lives. The finished box is also very important. Just imagine that if you have the schedules and you never finish that, it will be terrible and can cause the tantrum of children. Furthermore, with the visual supports, we can analyze the tasks and divide into step by step so that the child can learn better. For the child who plays a lot on the phone or just wants to stay in his/her interesting activity, we can use visual support as the timer on the phone to help them understand. We also can use “First-then” visual supports to help the child understand that they need to do the required job before they can get their choices. Besides, the contingency was very interesting and help the child can understand the rule of any activities that we give to them. Visual support also can be behavior cue cards. These are visual reminders of behaviors that may help to reinforce or replace directions or prompts. Personal passport or personal communication dictionary contained the child’s communication behavior that makes other people understand him/her. AAC can be unaided communication or only use alternative communication such as facial expressions, or body language to communicate with others. AAC can be light tech like different types of visual supports. AAC can aid mid-tech devices by using voice output communication aids or Speech generating devices, or AAC can aid high tech devices like tablet application. When we develop the material, we need to consider the model of SETT. S stands for the student. There is one thing you need to remember is that whether the child can access, whether the child can point with the finger to that application. In the class, we also learned about communication matric. This is the wide tool that was used to assess the functions of communication and how the child demonstrates these functions and what functions do the child need. After that we need to assess for E-stand for the environment, whether the child can use it under the water, or at home or at school and whether the family can have two tablets at home. When we look at the T-stand for the task, if the child uses it at school, we might need to think about the vocabulary that related to academic, felling…The teacher in this class also taught us about the vocabulary selection. It includes core vocabulary and extends vocabulary. This is very important for the child. First, this will include core vocabularies as the words that we use usually like go, have, in, like. Secondly, extend vocabulary is the felling or can be categorized or short phrases. All in all, the vocabulary selection has powerful and is very important, whether the child can use those vocabularies to express all the functions of communication are important. One more interesting thing that we can learn from this lecture was about how we select activities to improve the language of the children. For example, the mother can use songs to teach kids about body parts and select the activities that motivate the child to evolve. We always need to remember that motivation is more than the effort. We understand Augment as a supplement to conversation like eye contact, gestures, and Alternative as another way to communicate through signs and symbols. AAC is mostly used by a person who has communication problem, for example, CP, Intellectual Impaired, Autism, and Developmental delay. We also come across to understand the difference between AAC and PECS (Picture Exchange Communication System) as the lecturer explained PECS is also one of the systems that work like AAC but it’s more simple and easy to understand by children. After that she showed tools used in RICD AAC room. There are many tools (High

Tech, Mid Tech, Applications to communicate, Visual Schedules, Cue Cards, and Core Vocabularies etc.) AAC is defined as a set of tools or strategies that a person used to solve everyday communication challenge. She also gave the experience of what would you choose if we could have only 16 vocabularies to use? And I recognized that it’s never enough to use those limited words and the important of vocabularies in language, in communication. Not only vocabularies but also the symbols are important. Then she explained the assessment framework which includes STUDENT, ENVIRONMENT, TASKS, and TOOLS. After that we realized the importance of daily partner involvement for AAC users and the goal is to be able to communicate and to get language development. To summarize, I learned that there are many aids and updated tools to help children with communication problems. There are many AAC users who could enjoy their life as normal people do. Effective communication occurs when the intent and meaning of one individual is understood by another person. AAC is a successful communication tool the takes place when the receiver correctly interprets the sender`s message. Communication is social closeness, obtain, refuse and information. South East Asia region has second highest prevalence of moderate disability, third highest prevalence of severe disability. Speak and hearing impairment is ranked among the top three areas of in South East Asia region. Complex communication need -CCN is an individual unable to use speech to meet their communication requirements given their age and culture. Causes of CCN may include congenital, acquired, and degenerative. AAC is a set of tools and strategies that an individual use to solve every day communicative challenges. We believe that we could apply this method while we are teaching the children in Myanmar.

Topic: Social Skills Training

The lesson started with self-introduction between trainer and participant (name, country, background of work). Then, the course continues after that, the most target group of children who absolutely need social skill training are ASD, ADHD, Conducted disorder, Social anxiety, low self-esteem. She also shared about basic curriculum on group training do assessment for each children before put them in a group 1hour per session 1 per week and 12 weeks totally. After finishing with children, parents meeting to provide feedback about their children performance in group and what parents can do at home. Almost the end of the session she showed and let us plays about game which using during work with group of children and adolescent. Those games help children to learn about sharing in group work, taking turn, empathy and dealing with anger or emotion which could happened in group. The lecturer seems skillful on teaching with clear and interesting topic. That’s the first thing we received from lecturer today is how normal people interact and how the children with communication problems interact. Social Skill is competence facilitating interaction and communication with others. People can communicate with verbal and non- verbal ways. For example, children with ASD have repetitive patterns of behaviours, interests or activities and the symptoms together limit and impair everyday functioning. There are 3 deficits in social skill: (1) Deficit in social emotional reciprocity, (2) Deficit in non-verbal communication behaviour, (3) Deficit in developing, maintaining and understanding relationship. Abnormal social approach, failure of back and forth conversation, reduced sharing of interest are sign of deficit in social and emotional reciprocity. In the beginning, some of us had no encounter with three deficits, after this lecture, we think it means poor social skills like there are difficulties, abnormalities, lack of understanding or interests and failure to imitate or no response. No facial expressions, lack of eye contact and body language, lack of use of gestures are signs of deficit in non -verbal communicative behaviours. Deficit in developing, maintaining and understanding relationships are difficult in making friend and sharing imaginative play. We can teach social skills in group setting and structured learning method which involve didactic institutions, modelling, and role playing with feedback. The group

setting takes one hour section for twelve weeks including some games like UNO and picture card. She also shared the methods to teach the social skills. Moreover she acknowledged the improvements gained from group setting, games, activities, role play. And I learned that the children can benefit emotional management, taking turns, problem solving or relaxation skills, listening skills, conversation skills etc. Social skills are the skills we use to communicate and interact with each other, both verbal and non-verbal, through gestures, body language and our appearance in which the social rules and relations are created. Our social skills can develop in many ways to exchange our thoughts, and feelings with others. Autistic children have a persistent deficit in social communication and social interaction across contexts and restricted and stereotyped patterns of behaviors and interests. One of those deficits include deficits in social-emotional reciprocity. The autistic child usually lacks responses to other people emotionally. Therefore, when we resemble the child with autism, we should exaggerate our emotional to involve the child’s attention. The autistic child also cannot read non-verbal communication like facial expression or gesture. These children also failure of normal back and forth conversation as well as reduced sharing of interests, emotions. Moreover, these children might have abnormal social approach in which they do not know how to approach other people in the normal way, they might flap their hand or do not give the eye contact or sit or stand too close, or run right up in front of the friend’s faces. So, people just see them as a strange or odd approach. The autistic’s child also has a deficit in developing and maintaining the relationships appropriate to developmental level such as difficulties adjusting behavior to suit various social contexts, difficulties in sharing imaginative play, difficulties in making friends and absence of interest in peers. All in all, the autistic child needs to learn about social skills to communicate with others. The research showed that poor social skills can lead to psychological symptoms, poor psychological wellbeing, and depression. So the question is raising that how can we best teach social skills. The answer based on an established empirically based treatment is a group setting. One important thing in this class we need to consider when setting a social skill group, we need to assess whether children have the same level of functions. In the social skill groups, it can have different children with a variety of disorder, and this can be good at which the strength of one child can help the other child. For example, some autistic children can imitate very well, and these children can help other people. There are lots of methods that can be used in the social skill group. It can be structured learning consisting of directing lecture, modeling, and role- playing. The directing lecture is normally short and just lasts for 3 minutes to capture what the groups will do. The role-playing was used lots in social skill class to teach children how to approach and how to communicate with others. The feedbacks were used immediately right after the role-playing. The good way that we can learn from the teacher in class is how to give feedback. The teacher will ask every child in the group to give the feedback and then the teacher will synthesize those feedbacks into something that positive. If we want to have effective results, the child needs to practice the social skills in the class setting as well as the outside of the session. In order to help the child, practice these skills at home, the teacher must co-ordinate with parents and parents must commit to teaching their child at home. In the class, the teacher can set up various activities, games and visual aids to facilitate learning. Moreover, the behavioral reinforcement is used to promote rule compliance, participation and use of appropriate social skills. The groups take place over the course of 12 one-hour weekly sessions. There is a basic curriculum for the social skill group which includes: introducing self, listening skills, conversation skills, turn-taking and sharing, providing compliments and taking interests in others, understanding emotions and nonverbal cues, building empathy and conflict resolutions, keeping calm and relaxations skill. However, in reality, it might not be really in the sequent, sometimes one section goes over and over again. We can play different games and throughout those games, we can teach children many different skills. The important thing is

when the teacher facilitates or when the teacher asks the question to help the child learn the social skill through these games. Understanding about basic social skills training curriculum included following topics: Introducing self, Listening skill, Conversation sharing, Turn taking and sharing, Providing compliment, Understanding emotion, non-verbal cue, Empathy, conflict solution, Calm down and relaxation skill. When play a game, the role of facilitator is explain about the rule, notice what they did, how they did, what they observe their partner. The facilitator can ask questions like how to work in a team, how to solve problem, how to control emotion, how to keep calm, ask advice from peers... Dr. Kulvadee talks about her experiences running Social Skills groups for children. Social skills groups for children with ASD is supported by research. However, social skills is an important skill to learn for all children, not just those with Autism. Dr. Kulvadee talks about how children with various diagnosis come to her practice, such as children with ADHD, children with anxiety (social anxiety, selective mutism), social communication disorder, or even just children with emotional problems. Any child with a mental health diagnosis is at risk to have poor social skills. Therefore social skills training can help children get along with others, make friends, and have more satisfying and fulfilling lives. As we get older we develop our own “social map”, our own system of rules of knowing how to navigate the social jungle. Dr. Kulvadee runs her social skills in group settings with multiple children. She mentioned usually groups of 5-6 children. The groups lasts 10-12 weeks, 1 hour sessions, 45 minutes with the children, and 15 minutes with the parents. The groups are given in a structured learning, with didactic instructions, including modeling, role-playing with feedback, and practice in and outside the group. Actually the easy way to explain the group that Dr. Kulvadee runs are called “process groups”. Basically, she already has a set curriculum, and the curriculum gets increasingly complex topics. For example she may want to teach “empathy”. She will then pick an activity that may illicit reactions or situations from the children that show empathy. She will take these small social interactions that the children have with each other and her and “process” them by reflecting on them. She lets children see how they react and act in certain social situations, and provides them with instant feedback. She will use peer feedback as a way for children to get increased awareness. Basically, it’s group therapy for children. Every social interaction that happens in that room is a teaching opportunity. She talked to us about designing our own social skills training groups. This is something that we are very interested in, and hope to establish in our own clinical practice. She also talked about the importance of the role of the parents. She encourages parents to play with their children in similar ways, and encourage them to be reflective and process oriented. Overall, Dr. Kulvadee was an excellent teacher, and had interesting things to say, and we were sad to see her teachings cut short. I would be interested in meeting Dr. Kulvadee more, and learning more from her experiences. From this lecture we gain knowledge in understanding children point of view and how to communicate well with children with tools and games. A kid with poor social skills doesn’t mean the kids are not learning. We have to take responsibilities to find methods to reinforce the desired behaviour. This social skill training class is fun and active because it includes some game and we also learnt to understand our own way behaviour that can assist us find a way to improve on it. In some case, some people think social skill is learnt automatically, but some kids will not be able learn it naturally and we have to teach them properly with social skill trainings. Especially Autism kids are hardly communicating well because their decoding issue on gesture, body language, spoken language in order for them to improve in social skill this training help us to discover the social activities. We could be able to apply all the games and activities in the real classrooms effectively. Even the child can’t use verbal communication we can also use card and other tools to communicate with them.

Topic: Applied Behavioral Analysis

There were two speakers who are clinical psychologist from Bangkok to shared her work experience in behavioral modification for ASD children at their hospital. It was so interesting to learn about the technique which they have done. It helps us to gain more image and knowledge to apply after back to our work. It is not only helpful for people work with ASD but it is also important and could be apply in general. Clients are taught to make changes in their environment and to practice procedures that lead to modification of their own behavior. The topic was so interesting that came up with some questions and sharing from participants. They provided hands on techniques to modify behavior, providing lots of examples. This was one of the best lectures of the whole trip, and provided a lot of value. They talked about the ABC of behavior: A (Antecedent), B (Behavior), and C (consequence). They talked about how you can modify behavior by changing the A (Antecedent), changing the behavior, or changing the consequence. These are the three ways of conducting behavioral change. They also talked about the function of behavior, meaning that in order to modify behavior, you have to know the purpose of the behavior – what is the function of the behavior? For example is the child doing the behavior for attention? Or for a snack? There are 4 main functions of behavior: Attention, Tangible, escape, and automatic. Once you figure out the function of the behavior, you can modify the antecedent (before the behavior occurs), or replace the behavior, or change the consequence. Moreover, we understand about ABA, that A: antecedent; B: behavior; C: consequence, very effective. We saw lots of videos that showed us how to teach the children in funny ways and without stressing. 2 core principles of behavior modification are: Good consequence will increase behavior. Bad consequence will decrease behavior. Challenging behavior need to be replaced by a new appropriate behavior. Different behaviors may have the same function. 4 main forms function of behaviors: Attention, Tangible (item, activity), Escape, Automatic reinforcement. How to assess behavior function: based on ABC model: A provides us a cue, B provides us nothing but need to be specific in a certain circumstance, C provides us confirmation about the cue: Behavior modification, Antecedent modification (before challenging behavior happen), Non contingent reinforcement, Demand fading, Task

modification, Behavior momentum, Providing choices, Consequence modification (after challenging behavior happen), Extinction: Ignore the function of behavior not ignore the child, Differential reinforcement, Overcorrection, Response cost, Time out, Token economy, Replacement behavior, Teach the child the way to ask for what they want (PECS), Different between reinforcement (children control themself) and punishment (other control children)

Topic: Shared Action model for treating children with ADHD in Taiwan

This topic helps us to have an image of created new idea and increase human resource to support our work with very good quality one. Taiwan ADHD shared-action Model was such a good idea and useful. The first main concept Dr. DJ taught us was the importance of patient and family centered care in the practice of medicine. As health care professionals we should move away from one dimensional decision making, and move towards multi-dimensional decision making. Meaning instead of the “doctor” making all the decisions in the welfare of the patient, the decision making should be a collaborative effort between all parties. In the case of ADHD children, parents are significantly more knowledgeable about their own children than the professional, and can often find the solution to their problems. As a result multidimensional decision making, or “shared action” refers to involving the parents, the school, the therapists, and the doctor all being a part of the treatment and outcomes. ADHD children are often comorbid with other disorders, such as oppositional defiant disorder, conduct disorder, and other problems such as anxiety and depression. As ADHD is a life-long disorder, as they get older, they are more likely to become substance abusers, and will also have difficulty with learning. Therefore, ADHD children are often a source of stress for their parents. Parents are often blamed for the failure of their children, and even the therapists and doctors blame the parents for not practicing interventions at home. Therefore a community outreach program was developed, such as the “parental support group for parents of children with ADHD” The community outreach program is designed as once every 3 months training and meeting program for parents of children with ADHD. The goal of these outreach programs were to educate parents on teaching them about their children, and learning how to deal with their behaviors. Furthermore these groups allowed parents to meet with each other, network, and become peer supports to each other. The face- book group, and line group are also sources of peer support for the parents. The groups, workshops, and online support and knowledge all empower the parents, to take better control of their lives, and helping their children. This model can be applied to other disorders as well.

We understanding about the Taiwanese Shared-Action Model for ADHD children that consist of 3 implementation phases: Phase 1 Set up ADHD family support group: raising awareness; study on parental problems in ADHD, education sessions, share experience from parents; organize book sharing, games, competition... for ADHD children and family Phase 2 Set up ADHD family youth support association Phase 3 Evidencing the core values of the model We also understand why we have to have such a support group for ADHD and care givers: Lack of man power, Empowering, Mutual benefit, Long term care, Teacher. This training is about ensuring dignities for families of children with ADHD. And the main contents under this topic are Shared-Action model, Developmental phases for Shared Action Model. Firstly, the lecturer explained about Medical Professionalism and the value to have in professional life, then he also explained welfare and patients’ anatomy, addressing the quality of life concerning with ADHD. That is different from our country where it is only available to help social issues only in clinical settings. They can also help the mental health there. The characteristics of ADHD contain Inattention, Impulsivity, and Hyperactive. It’s the lifelong Developmental disorder. If the treatment is not applicable, that will lead to negative consequences and might involve the losing lives. In Taiwan they used Shared-Action Model method, which provide the caregivers and therapist shares the facts and conditions about the ADHD patient. In this model, the caregivers are playing an important role in the life of ADHD children. Moreover, the parent’s knowledge sharing and teaching are done by the experienced parents. He also mentioned that this not only help the parents but also help the children ADHD children enjoy the happy life. Although some treatments and special education programs for ADHD are available, but the main challenges in ADHD are real for examples, the long term stress on parents and children with ADHD symptoms. In the past with the shared model, the caregivers are usually the first person to be blamed because the children problems are not solved expected. After providing the shared decision model, the desired knowledge and information are shared among the caregivers and the the patients will be well informed on the complete information to choose the treatment and intervention according to their own value and children condition. This concept has been adapted in Taiwan as Dual-subject concept. Firstly, this is to involve medical professional and care giver and second is to sharing information for public education, family ADHD experience, and activity that can be done within the family. The last concept is to find the positive way of life to eliminate the negative impact of ADHD symptoms in many families. This model will definitely have the positive impact on the families and children living with ADHD. In some case, ADHD symptoms decease as the children grow up, but the condition will be better if the children and families get support and treatment since young in order for them to recover speedy from those symptoms. Parent sharing session would serve as a bridge to link the correct information to the families. Overall, this is a parent education and support program that focuses on empowering parents. Furthermore it takes advantage of current technology to further connect parents. This program is not different from our project proposal. However, the “Parent support group” in Taiwan is done in masses.

Topic: Neurofeedback

The lesson was so clear to understand about the function of Neurofeedback. It is so beneficial to the clients. Today we learnt about how Neurofeedback work on the brain and help us to understand about the brain wave that we or the patient can control and regulate according to the program. This program will be help the children and adults to lead a healthy life and have a proper skill in the daily life. Beta, alpha, theta, delta waves are the feedback from the brain and the program create a game for the patient to play and manipulate it to get the high scores or to get the better brain wave work in all occasions. According to the researches, the autistic children are lack of interest in the environment change and communication, nerofeedback can improve this by providing the stimulation to the brain and help children to manipulate his own brain wave and control his own emotion or consciousness. Most of the children with autism have social communication problem and it can be seen in the brainwave clearly and this wave help the patients to have the appropriate brainwave feedback treatment and stimuli to reach their learning potential. This makes us believe that the Nero feedback can help the brain improve in the life performance. The lecture also explained the role of mirror neurons and the NF protocols in autism too. ASD brain has poor interconnection. The treatment is varying to every single child due to the different in how the brain works on the brain waves. The main effect of neurofeedback for ASD is improving social interaction skills. Before this training, we didn’t know there would be nerofeedback treatment for ASD children. It’s really an effective treatment for many adult and children who suffer from sleeping disorder and intellectual learning disabilities. Even though the topic is quite unfamiliar to most of us, we could absorb most of the information since the lecturer could give clear a simple explanation in our level of understanding. We think we could be able to share that knowledge to new learners like us when we get back to our country.

Topic: Applied Eastern Psychology for Children with ADHD

Eastern psychology is a psychological system in the core belief of Eastern culture/philosophy, include Yoga, Tao, Zen and can be an effective activity for improving Children with ADHD. Eastern psychology is based on eastern culture and it’s kind of treatment that can be done by themselves at home. She gave a brief talk of the differences between eastern and western psychology. Western is based on scientific facts and eastern is based on experiences. She shared applied Eastern psychology for ADHD. As we all know the problems of ADHD are inattention, hyperactivity and impulsivity. To balance the needs of function she use Yin and Yang theory. The goal is to reach pleasure, successful and happiness for children. For attention training, Breathing exercise, Visual Sustained Attention, Auditory Sustained Attention, Balancing & Seated Yoga poses and Walking Meditation could be done. Not only the health care professionals give treatment but also the parent training is necessary. Moreover the child should take treatment regularly. After that we will see the child improvement. So today we realized the collaboration treatment between psychology and medication. I admired to those who discovered that collaboration method. Since it’s the last day of training, I wanted to pay more attention to lecture. And everything, every training at RICD were worth making efforts. It was such an honor to attend the RICD training course.

Field Visits 1. Regional Special Education Center 8, Chiangmai.

Speaker gave us the slide presentation about Regional Special Education Center 8, Chiangmai. The special education centre is supported by government and trains the students to improve various skills including FM, GM, independence living skill, social and emotional skill, language and communication skill, academic skill, special skill (PT, OT) , learner development activities (field trip, games, sport, recreation). The Special Education Center Chiang Mai is the regional center for special education, and gave us a look into the Thai Special education system. Before, we only focused on screening, intervention, and hospital care. At the center we saw how strong the Thai special education system is, where the center was able to provide a lot of different types of services with limited staff. They not only provide center based services, but they provide a lot of different outreach programs, and also do early intervention programs in addiction to special education. We are divided into 2 group in order to visit around the school. We visited sensory room, library, neurofeedback room and classrooms. We saw some students was doing the activities in class. They are so lovely. We are interested in this school because it’s a big school that have a lots of activities and toys that we have never seen before. At the center, according to their needed skills, the children are divided into 3 groups like early intervention, intermediate group, and vocational training group. The foundation accepts the children up to 24 years old. We learnt all three places provide their students vocational and other skills training. Moreover, we studied Neurofeedback technique which stimulates the brain by using special music. We got knowledge about the curriculum of Individual Education Program and Community Based Rehabilitation given to the outreach region. We hope that our country also have many CBR services to the urban and rural area.

2. The Healing Family Foundation

The founder told us the history of this foundation, about the activities of all members and he showed us the products that was made by all artists who are disable people. The Healing Family Foundation was the most interesting place. This is a parent organization run facility that provides vocational training to older, trained children. They provide these children who have gone through the system an opportunity to earn money. They are also a center for trainers to train other vocational programs. The students in the foundation weave different high quality products and sell them in order to develop a sustainable and long term program. We are so impressed. There are a lot of handmade products such as T-shirt with animal picture, scarf, bag, purses, wishing card… and we bought some of them. The Healing foundation was organized by the parents group who have special need children and most of them are Down syndrome children and adults with the support of JICA. We knew JICA supports techniques and other needs except money to produce their qualified product. They also raise fund by selling handmade products which is made by special need children and their family members. We found that all the art pieces created by their down syndrome volunteers and disable residents are considered artists and their products are valued to raising fund products and not to be waste products. The foundation can raise funds by producing weaving products like shirts, bags, scarfs, and postcards etc.

3. Dulabhathorn Foundation

Dulabhathorn Foundation which provided us a short presentation about their foundation by Project Director. The Objectives of Dulabhathorn Foundation was to generate funds for the support of education agencies, both government and private sectors that contribute to expansion of opportunities for primary and secondary education of very poor children. To support activities, which will result in realizing maximal learning potential among children with developmental, and learning disability. To identify and support a well learning and student to receive the scholarship from funds of the education for university degrees. To undertake or cooperate with other charity organizations for public benefits and not to undertake any political activities. Children in special needs and their families in Sansai District and neighborhood area were supported by DBF which was provided individual and group activities to preschool aged to adult. Also, there were activities to community and partners like home visits, school visits, training for teacher, community health volunteers and parents. The foundation venue looks so fresh, clean and comfortable. It could be good environment for children and staff to work there. Also the vision of founder so interesting which he wanted to have every service in that place but the project was stopped after he was died with severe illness. Another interesting is they tried to support or never ignore any children who needed their support. The Dulabhathorn foundation is a beautiful and unique place. They primarily provide community activities for children with special needs. They allow a place for children with special needs to commune and have a place to go, learn and have fun. They also provide special therapies to children that need it. Overall, they are a good complementary system to the current government system. All those 3 places support disabled students well and they all aim to give best services and to develop their skills and to increase knowledge of children. It doesn’t matter how difficult in their early years, the children and adults are getting help and improving their life quality with the support from many people in Thailand. That is the learning point for us about how humanitarian work is important in our society. All 3 locations were significant and unique in their purpose, but all an essential part of the system.

Elective Courses (Field-based observation) 1. OPD Observation

Today we have opportunity to visit OPD. It’s a very nice experience. We meet doctor and stay with her about 3 hours. She is very friendly. At the beginning, we started to introduce ourselves to her and she also introduce herself to us. She also asked us the reason why we want to be a psychiatrist. She arranged the chairs for us so we can seat properly and observed her activities with the patients. She consulted seven patients and spend about 20-30 mins in each case. After she finished each case, she asked us about the reason from the observation during her consultation. As we don’t understand Thai language so we observed only the activities of the children and their parents. Most of the children are ADHD patients. We were so interested in all of cases and asked her a lots of question about treatment and not only medical treatment but she also shared us about how to do psychoeducation. We really had a nice time with her.

2. RICD Wheelchair Project

RICD Wheelchair Project We learned the history of wheelchair project and in Thailand; there are 300,000 disables, both children and adult. Although RICD Wheelchair Project is the biggest wheelchair project in ASEAN, not all the disables from Thailand get wheelchairs. One container that has a lot of wheelchairs comes to RICD every month. In true, two to three containers can come every month. Because of narrow warehouse, it doesn’t have enough space to keep the wheelchairs. All the wheelchairs are for donation. Moreover, patients need to wait for a couple of months to get the wheelchair. We saw different kinds of wheelchair, postural devices and cushions. We did learn how to find the best wheel chair that fits for individual, environment, daily living and also the patient can go outside with the wheelchair. Wheelchair project provides mobility aid and other medical equipment to the disabled poor people in Thailand. They also raise awareness about the needs of Thai people with disability and other ethnic minority groups, to empower and encourage them to become more fully integrated into society. They work to improve of the quality of their lives. According to WHO guideline, appropriate wheelchairs should be meets the user’s needs and environmental conditions, provides proper fit and postural support, is safe and durable, is available in the country and can be obtained and maintained and services sustained in the country at an affordable cost. Through the observation to the Wheelchair project what I noticed was how wonderful wheelchair supported people with disability. It helps them in independent mobility make it possible for people to study, work, participate in cultural life and access health care. It seemed like it gave a world for them, new life, new experience. Children and adult with disabilities have chance to have better way to handle themselves, to move around, to communicated in social. It is also helpful for caregiver in taking care of them. People seem worked with their heart to share happiness to those disabilities people to reach their need with the comfortable feeling. I am so proud of them. We could see that all the volunteer and specialist are very patient and they are very good at their jobs. The best things that we like are PVC wheelchairs and postural supports. In our country, there is no project especially for children like RICD wheelchair project. Rarely, some of the association came to donate but only some could get. For the region like our country, handmade wheelchair is the best option for children. We want to thank the genius who created this kind of wheelchairs and postural supports.

3. AAC Lab

Augmentative and Alternative Communication We can surf about Autism Research Centre at RICD from the website. However, we wish to read with English Language. We use Jellow application and snipping tool to make activity specific schedules (task analysis). We had to do together with Teacher Nicole and now we can do by ourselves. She also explained how to use this schedules properly. Moreover, we did learned by using another board maker website (www.boardmakeronline .com) to make Yes or No, visual schedules, vocabulary books, core boards and etc. Another website (tarheelgameplay.org) is used for adapting songs. We really created with nursery songs from our country. Mrs. Nicole and her assistances taught us how to do sing words, video song for using as communication way by ourselves through some link from the internet such as www.TarlteelFameplay.com, www.JellowAAC.com, www.opensymbols.com, www.mycoughdrop.com. Then we have some showing of our signs created to be as a song from each group. Lastly, we went to see more equipment/tools in that center. We got the ideas of making the child to learn new vocabularies, being interested of what happened to the next, combining with other activities. Symbol Talk is a good application for children with communication difficulties. Children can use this application to express their needs and can communicate with others. We can add and adjust the pictures that we like. Also, we can teach the children vocabularies, phrases and sentences. After checking this application, we could understand that although it can use with phones and tablets, we will be easier to use with tablet because of large screen size. We cannot adjust and add picture properly with phones. Coughdrop is also a great website for core vocabulary book. The best thing is that we can use our own language and sounds (however, some countries can’t use the sounds including our country) by creating a core vocabulary book starting from 24 words -60 words -112 words. We can search pictures by using Open symbols. In this website, we can search different kinds of pictures and get different designs from same thing. We can create picture song boards, vocabulary books, communication books and other boards. We did learn the easiest ways of doing DIY toys by using technology and toys. Also, using visual supports for poems and stories. Most of the techniques are very easy to do with low technology. We can do very easily even for the parents. Also we don’t need to go to buy and go somewhere to get these materials. We really got a lot of experiences and knowledge. We could see that teacher Nicole and her team have enough knowledge to do the training. We appreciate her skills and attitudes. She did share and teach all without leaving anything. This session had been a great hand-on experience and we get to create our own AAC card and tools for the children to learn from music and song. In the process of creation all the teaching aids, we also learn to view from the perception of the children. The website and products that introduced in the lectures are very useful for the parents and teachers who are living in the area that can assess internet.

4. TDSI

Observation of TDSI, the latest TDSI has 666 items. We could see that the professionals from RICD use TDSI for screening the child from district referral. We saw ASD child who is screened by psychologist. This is the 3rd time she is assessed with TDSI. Before we didn’t think that she has ASD because she has eye contact with adults and is calm not hypertensive. She has done a lot of interventions since 2 years. That’s why she improved a lot. It takes approximately 1 hour to assess this child. However, the psychologist said that it took 2 hrs to assess the child and give home training in the 1st time. After assessing the child, the examiner has to calculate the scores and developmental age for each skill. Moreover, the examiner needs to give home training book for parents or caregivers. In the home training book, there is a graph for child development for all the time the child comes. Also, the examiner gives intervention for each skill with check tables (30 days for 30 squares). We could see that most of the parents and caregiver in Thailand cannot do the intervention properly. As I saw this girl, the parents couldn’t do intervention at home and didn’t come to hospital on follow up day. She came after 9 months. However, some parents or caregivers can do more than 30 days. During this observation session, we learn how the parents and teachers work together to train the children in the intervention process. The records book, assessment and teaching tools are all within the reach of the assessor and parents are also participating in the game and teaching session. Teaching children can be stressful when the children are aggressive or unable to control their emotion or if the parents are not well informed the process of intervention. We found that the intervention process in RICD are well prepared and all the staffs are following systematically. We could learn that Thailand has a good network team and data base system to collect all the data from child and professionals can manage through accounts. These data can use all the professionals from every hospital and healthcare centre. Although she couldn’t do intervention at home, we could see the result of improving. After calculating all the scores she has mild ASD. Because she got all the interventions from RICD and medication. There is a score for family that decides whether the family can do intervention at home or not like A,B,C,D. She got grade C.

5. Speech Therapy

We also got basic knowledge about speech therapy. We learned the International Phonetic Alphabet pronunciation and how to make a speech program. Therefore, we can apply this knowledge into our language by distinguishing between consonants and vowels in our alphabet as well as designed a sound program for children in our country. The way to develop a program producing sounds for our langguage as an example follows: Vietnamese alphabet has 12 single vowels: a, ă, â, i, e, ê, o, ơ, ô, u, ư, y 32 dipthongs: ai, au, ay, ây, oi, ơi, ôi, iu, ưu.... 5 tripthongs: iêu, ươu, yêu... 17 consonants: b, c, d, đ, h, k, t, p, m, n, l, kh, th, ch, tr, ng, ngh, g, gh.... Program producing sounds will be: Ba, bi, be, bê, bo, bơ, bô, bu, bư.... Bai, bau, bay, bây, boi..... Biêu, bướu... Ca, co, cơ, cô.... Cai, cau, cây... Diêu... Ms.Pornpiriya taught us about how to write a simple speech program using our alphabets and the sound. It is amazing to learn how the oral motor and articulation work to produce a sound to the speech. We all learnt to write the vowel sound and program to teach the children correctly. This speech program and teaching methods is important for all special need kids because the speech therapy the professional is really rare in this special need education industry in our country. She touched how to produce sound and created a program based on the program from Iowa University. There are 2 methods in American English that we can choose the one that can apply to our language. 1. The consonants sounds have 3 types: Manner, Place, and Voice 2. The vowel sounds have: Stop, Fricative, Affricate, Nasal, Liquid, and Glide After explaining the method and to create in our language, she brought us to her clinic to visit her place and to observe the session. Luckily there were 3 different types of sessions on that day. The 1st one is the old case that diagnosed as Autistic and coming for improving how to use a sentence with proper grammar. The second one was the new case with a history of spoiled child and the aim of this session is to deal with his challenging behavior of tantrum. The 3rd one is also the new case coming for 1st assessment with similar problem to the 2nd one.

6. Snoezelen/OT

The benefits of Sensory Integration for children: To achieve development milestones, to respond appropriately to the environment around, to fuel an inner drive and motivation to conquer challenges. The child’s drive urges child to participate actively in experiences. Child explore the environment, tried new activities and strives to meet increasingly more complex challenges. Mastering new challenges makes the child feel successful and give them the confidence to try more different tasks. Firstly, we went to Snoezelen (exploration) room. Snoezelen is a tool or instrument in sensory integration therapy. The child can increase attention, relaxation, self-control after the therapy. Secondly, we went to adventure room. In this adventure room, children need to do the interventions with activities. Intervention has to be fun. The intervention in the adventure is for 40 minutes. After 40 minutes, they can go to exploration room to give them as a reward. It takes 5 to 10 minutes. The benefit of Snoezelen for children: Relaxation, Reduction in distress and stereotypical behavior, less aggression and self-injury, Increase in motivation to succeed, Improvement in concentration and coordination, To stimulate multi-sensory in children with disabilities. During the filed visited we visited the sensory room which made us feel calm and comfortable to be inside. And adventure room, there were two boys and one girl were playing at that time. Children were trying to control and follow the role of therapists. They have improved a lot after few sessions in the occupation therapy.

7. Music Therapy/Opti Music/Drama Therapy/Art Therapy

In music therapy room, they use opti music combine with gross motor activities, fine motor activities, early intervention like increasing eye contact, memory, and etc. It is a tool that needs to be fun for children. The child can get intervention through doing fun activities. If we know the concept of this therapy, we can think and create our own activities depend on the children’s needs. Art Therapy is good especially for who has ASD, delayed fine motor skills. They use pictures to draw and color. While drawing and coloring, children need to focus on what they are doing and manage the coloring skills. That can increase attention, fine motor skills and reduce behavioral problems. If children can draw and color great pictures, their pictures can show and sell in art galleries. In addition, if they are very good at this, they can continue their live by doing this. Drama therapy is also good for children who are interested in acting. It is also a tool that can promote the child’s life. Although they are working, they are happy and being fun in doing this.

Project Proposal Presentation

Project proposal presentation for three countries which joined by three experts include Dr.Samai (deputy director general, Dr Kanchana (deputy director), and Dr.Duankamon (deputy director). Each group have time for the presentation about 20-40min include question and answer. First Group (Vietnam Team)

Second Group (Myanmar Team, New Hope Association)

Third Group (Myanmar Team)

Fourth Group (Cambodian Team)

It was a very excited day for us because this is the first time experience for us to present our work in another country.

Chapter III Improvement of the Training Program

The stages were as follows. 1. Integrate the results of phase II, suggestions/comments of the trainees and speakers (in chapter II) to be as the development frame program as shown in Table below.

The draft training program Medical Doctors Medical multidisciplinary Teachers team Training Course: Level of training course Target Audience: Specific professional Special education teacher Methods of Instruction: Lecture, practicum with Lecture and practicum with Lecture and practicum supervision and case discussion supervision Duration of the course: 1-2 weeks 2 weeks 2 weeks Include content in: 1. Assessment tools 1. Assessment tools and how 1. Assessment tools 2. Referral system to calculate the result 2. Speech therapy 3. Speech therapy 2. Social skills 3. Psychology 4. Behavioral 3. Neurofeedback 4. Children with special Modification 4. Speech therapy needs 5. Eastern psychology 5. Occupational therapy 5. TDAS, TDSI 6. AAC 6. Physiotherapy 6. Field-Based Observation 7. OPD 7. Vocational training 8. Occupational therapy 8. Hydrotherapy 9. Clinical practice 9. Opti-music 10. TDAS 10. Thai traditional medicine 11. Eastern psychology 12. AAC 13. Wheelchair 14. NDD 15. Behavior modification 16. TDSI, TDAS 17. Field visit

2. Adjust the training program for medical doctors, medical multidisciplinary team, and teachers acquired from the result of the trainees’ evaluation and speakers suggestions 3. Adjust the qualifications and roles of participants

Qualifications of participants 1. The organizer of the training 1.1 is as a hospital worker in a hospital specializing in Child and Adolescent Psychiatry affiliated with the Department of Mental Health, the Ministry of Public Health 1.2 Graduated with a minimum educational background of a bachelor degree. Experienced in management of the training project for multidisciplinary team for at least 1 year. 2. The speakers 2.1 is as a hospital worker in a hospital specializing in Child and Adolescent Psychiatry affiliated with the Department of Mental Health, the Ministry of Public Health or related 2.2 is specializing in their topic 2.3 Gained two- years - working experience in children with developmental delay and neurodevelopmental disorders. 2.4 is able to communicate in English 3. The trainees 3.1 Graduated with a minimum educational background of a bachelor degree. 3.2 Gained one-year- working experience with children with developmental Delay or neurodevelopmental disorders. 3.3 is able to communicate in English

Roles of participants 1. The organizer studies the training program manual to: 1.1. Inform the administrators and the team to understand the purpose of the training course. 1.2 Plan the training management. 1.3 Carry out the training. 1.4 Evaluate the training. 2. The speakers study the training program manual to: 2.1 Study the manual thoroughly. 2.2 Prepare the learning plans. Train the trainees to gain knowledge and skills according to the learning plans. 3. The trainees study the manual of the training program to: 3.1 Study the assessment criteria through training. 3.2 Understand the content and the details of the course before the training. 3.3 Prepare to do assignments, follow the guidelines in the manual thoroughly.

Appendix

Speakers 1. Dr.Samai Sirithongthaworn, Deputy Director-General of Department of Mental Health 2. Prof. Dr. Duujian Tsai: Pingtung Christan Hospital, Chair Professor, Director of the Center for Bioethics and Social Medicine, Health Asia Co., Ltd. President 3. Dr. Doungkamol Tangwiriyapaiboon, Deputy Director of RICD 4. Dr.Prew Tailangkha, Child and adolescent Psychiatrist, RICD 5. Dr.Panu Kuwuthayakorn, Psychiatrist, Suan Prung Psychiatric Hospital 6. Ms.Suphakphimon Papang, Nurse, RICD 7. Ms. Wisalinee Veyrudit, Nurse, RICD 8. Ms.Amara Thanasupaputana, Nurse, RICD 9. Ms. Atchara Choomputhan, Nurse, RICD 10. Ms. Chayanit Anantaworawong, Nurse, RICD 11. Ms. Chulaphorn Somchai, Nurse, RICD 12. Ms. Noppawan Bautong, Nurse, RICD 13. Ms. Ngamphan Chitmin, Physiotherapist, RICD 14. Mr. Joey Tell, Voluntter of RICD Wheelchair Project, RICD 15. Ms. Preechaya Phrommin, Medical Technologist, RICD 16. Mr. Takkin Teriyapirom, Physiotherapist, RICD 17. Ms. Chadaporn Sornjai, Thai Traditional Medical Doctor, RICD 18. Mr. Krugchai Pichai, Occupational Therapist, RICD 19. Ms. Jiraporn Thungtanaopakun, Occupational Therapist, RICD 20. Ms. Pornpiriya Apirajeeranan, Speech Pathologist, RICD 21. Ms. Nicole Marie Bender, Volunteer of AAC, RICD 22. Ms.Panida Ratanapairoj, Head of Nursing Department, Rajanukul Institute 23. Dr.Kulwadee Thongpaiboon, Department of Psychology, Chiang Mai University 24. Ms.Pornpun Orachon, Clinical Psychologist, Yuwaprasat Vithayopathum Hospital 25. Ms.Proud Pongpipat, Clinical Psychologist, Yuwaprasat Vithayopathum Hospital 26. Ms.Siratchaya Wongfhun, Music teacher, RICD 27. Ms.Chadaporn Pengta, Art teacher, RICD 28. Mr.Johannes Jansen, Volunteer of RICD Wheelchair Project, RICD 29. Ms. Saowalak Langgapin, Psychologist, RICD

Training Organizer 1. Ms.Saowalak Langgapin, Project Manager 2. Ms.Matsawee Manonai, General Manager 3. Ms.Pakpimintra Waratchayathon, General Manager

Trainees

N Name Position Workplace Country 1 Dr.Sor Sivleap Psychiatrist Provincial Referral Hospital Cambodia 2 Dr.Yong Sokunthea Psychiatrist Preah Kossamak Hospital Cambodia 3 Dr.Kim Sophea Psychiatrist Preah Kossamak Hospital Cambodia 4 Dr.Ka Mikazer Psychiatrist Preah Kossamak Hospital Cambodia 5 Dr.Kosal Kaknika Pediatrician Kantha Bopha Children’s Hospital Cambodia 6 Ms.Saut Rachny Psychologist EMDR Association Cambodia Cambodia 7 Ms.Khanh Thi Loan Nurse & 1. Faculty of Nursing and Midwifery, Vietnam Lecturer Hanoi Medical University. 2. Mental Health Faculty, National pediatric hospital 8 Mr.NguyenVan Child and Basic Needs Vietnam Vietnam Manh Adolescent Clinical Psychologist 9 Ms.Tran Hoang Social Worker Danang Social Work Center Vietnam Ngoc Tram 10 Dr. U Thein Oak Clinical Myanmar Autism Association Myanmar Sein Psychologist Parami Hospital Consultant 11 Ms.May Thandar Physiotherapist Parami General Hospital Myanmar Khin 12 Ms.The The Aung Physiotherapist Physical Medicine &Rehabilitation Myanmar Department, Bedded Mandalay Children Hospital 13 Ms.May Myanmar Physiotherapist Beded Mandalay Children Hospital Myanmar Khant 14 Ms.Hnin New Staff nurse Mental Health Hospital, Mandalay Myanmar Hlaing 15 Ms.Khin Lae Lae Physiotherapist Bedded Mandalay Children Hospital Myanmar Win 16 Ms.Hnin Pwint Teacher Little Aces Pre-School and Special Myanmar Khaing (Principal) Education Center, Yangon 17 Ms.Amy Jun Mi School advisor Smart Kids college, Myanmar Myanmar Zhang New Hope Foundation 18 Ms.Khin Cho Myint Teacher New Hope Association Myanmar 19 Ms.Htet Thinzar Teacher New Hope Foundation Myanmar Aung 20 Ms.Yin Myo Htike Teacher New Hope Association Myanmar 21 Ms.Yi Mon Htay Teacher New Hope Association Myanmar 22 Ms.Su Myat Mon Teacher New Hope Association Myanmar 23 Mr.Myint Oo Founder Future Light Special Myanmar Education Learning Center 24 Ms.Tin Tin Aye Teacher Future Light Special Myanmar Education Learning Center

Training Schedule “Holistic Approach to Improving Children with Developmental Delay” 7th – 31st May 2019 (Official holiday 9, 20 May 2019)

Week Day Date Times Topics Duration Training Venue (minutes) 1 1 7 09.00- Pre-Training Evaluation 150 The 2nd floor May 11.30 Ms.Saowalak Langgapin meeting room in Ms.Pakpimintra Waratchayathon main building 11.30- Course Outline 30 The 2nd floor 12.00 Ms.Saowalak Langgapin meeting room, main building 13.00- Opening Training Ceremony The 4th floor main 13.30 Chairperson: Dr.Samai Sirithongthaworn meeting room, Deputy Director-General of Department of Piano building Mental Health Module I Surveillance, Screening, Evaluation, Diagnosis, and Early Intervention 13.30- Thai Child Developmental System Model 180 The 4th floor main 16.30 Dr.Samai Sirithongthaworn meeting room, Deputy Director-General of Department of Piano building Mental Health 1 2 8 09.00- Introduction to RICD & Field Visit 120 The 2nd floor May 11.00 around RICD meeting room, Ms.Preechaya Phrommin & Piano building Ms.Pakpimintra Waratchayathon 11.00- Guide to Living in Chiang Mai 60 The 2nd floor 12.00 Mr.Takkin Teriyapirom meeting room, Piano building 13.00- Children with Developmental Delay and 180 The 2nd floor 16.00 Neurodevelopmental Disorders meeting room, Dr.Duangkamol Tangviriyapaiboon Piano building Medical Staff Organization 3 10 - 09.00- Developmental Surveillance and 360 The 4th floor VIP 11 16.00 Promotion Manual: DSPM meeting room, May Ms.Suphakphimon Papang Piano building Ms.Chayanit Anantaworawong Nursing Department

4 14 09.00- Developmental Assessment for 180 The 4th floor VIP May 12.00 Intervention Manual: DAIM meeting room, Ms.Amara Thanasupaputana Piano building Ms.Atchara Choomputhan Nursing Department

13.00- Picture Exchange Communication 180 The 4th floor VIP 16.00 System, PECs meeting room, Ms.Panida Ratanapairoj Piano building Head of Nursing Department Rachanukul Institute 2 5-6 15-16 09.00- Thai Early Developmental Assessment 720 The 4th floor VIP May 16.00 for Intervention: TEDA4I meeting room, Ms.Wisalinee Veyrudit Piano building Ms.Chulaphorn Somchai Ms.Noppawan Bautong Nursing Department

Module II Management

Week Day Date Times Topics Duration Training Venue (minutes) 2 7 17 09.00- Pediatric Physical Therapy in Children 180 The 4th floor VIP May 12.00 with Motor Development Problems meeting room, Ms.Ngamphan Chitmin Piano building Department of Physical Therapy 13.00- Early Stage Development and Postural 180 The 4th floor VIP 16.00 Support Device Uses meeting room, Mr.Joey Tell Piano building RICD Wheelchair Project 8 21 09.00- Thai Massage Therapy for Children with 180 The 4th floor VIP & May 12.00 Cerebral Palsy and Autism Spectrum main meeting room, Disorder Piano building Ms.Preechaya Phrommin Ms.Chadaporn Sornjai Department of Thai Traditional Medicine 13.00- Sensory Integration and Snoezelen 180 The 4th floor VIP 16.00 Mr.Krugchai Pichai meeting room, Ms.Jiraporn Thungtanaopakun Piano building Department of Occupational Therapy 3 9 22 09.00- Social Skills 120 The 4th floor VIP May 11.00 Dr.Kulwadee Thongpaiboon meeting room, Department of Psychology Piano building Chiang Mai University 11.00- Applied Speech Therapy for Children 60 The 4th floor VIP 12.00 with Autism meeting room, Ms.Pornpiriya Apirajeeranan Piano building Department of Speech Therapy 13.00- Augmentative and Alternative 180 The 4th floor VIP 16.00 Communication, for AAC, Children with meeting room, Complex Communication Needs Piano building Ms.Nicole Marie Bender AAC Clinic 3 10 23 09.00- Ensuring Dignities for Families of 300 The 4th floor VIP May 15.00 Children with ADHD: Taiwan ADHD meeting room, Shared-Action Model Piano building Prof.Dr.Duujian Tsai Pingtung Christian Hospital, Chair Professor Director of the Center for Bioethics and Social Medicine Healthy Asia, President Module III Field-based Observation (choose only one from your interests below) Elective course for medical resident/physician (1800 hours) 3-4 12- 24, 09.00- A. Medical Staff Organization, 1800 OPD 16 27-30 16.00 Rajanukul Institute, Bangkok May Remark: pays to book your flights, accommodation, and activities yourself

24, 27 09.00- B1 Field visit 720 1. Chiang Mai Special May 16.00 Ms.Saowalak Langgapin Education Center 2. Healing Family Foundation 3. Kawila Anukul School 4. Heaw Kean Temple 5. Dulabhathorn Foundation

Week Day Date Times Topics Duration Training Venue (minutes) 28-30 09.00- B2 Medical Staff Organization, RICD 1080 OPD, Main building May 16.00 28 May 2019 OPD Observation 9.00-12.00 Dr.Prew Tailangkha 13.00-14.30 OPD Overview Dr.Chutinart Sakarinkul Dr.Rachaya Pingkalasai The 2nd floor meeting room, Main building 29 May 2019 OPD Observation 9.00-12.00 Dr. Kanchana Koonrungsrisomboon 13.00-15.00 OPD Observation Dr.Arkorn Sanchai 30 May 2019 9.00-12.00 Neurofeedback Dr.Panu Kuwuthayakorn The 4th floor VIP meeting room, Piano building Elective course for medical multidisciplinary team (1800 hours) Week Day Date Times Topics Duration Training Venue (minutes) 3-4 12- 24, 09.00- A. Medical multidisciplinary team, 1800 Medical 16 27-30 16.00 Rajanukul Institute, Bangkok multidisciplinary May Remark: pays to book your team flights, accommodation, and activities yourself 24, 09.00- B1. Field visit 720 1. Chiang Mai Special 27 16.00 Ms.Saowalak Langgapin Education Center 2. Healing Family May Foundation 3. Kawila Anukul School 4. Heaw Kean Temple 5. Dulabhathorn Foundation 28 09.00- B2-1 Observe and train the language and 180 The 4th floor VIP May 12.00 speech developmental practices for meeting room, autistic children (please bring your own Piano building laptop) Ms.Pornpiriya Apirajeeranan Department of Speech Therapy 9.00-12.00 B2-2 RICD Wheelchair Project 180 RICD Wheelchair Mr.Johannes Janzen Project 13.00- B3-1 AT/AAC Lab: Tool Development - 180 AAC Clinic, Piano 16.00 for individuals building wanting ‘hands on’ time to create materials ex. DIY adaptive switch, communication boards (please bring your own laptop) Ms.Nicole Marie Bender AAC Clinic 13.00- B3-2 Behavior Modification in Children 180 The 4th floor VIP 16.00 with ASD meeting room, Ms.Pornpun Orachon Piano building Ms.Proud Pongpipat Yuwaprasat Vithayopathum Hospital

Week Day Date Times Topics Duration Training Venue (minutes) 29 09.00- B4-1 Observe and train the language and 180 The 4th floor VIP May 12.00 speech developmental practices for meeting room, autistic children (cont.) Piano building Ms.Pornpiriya Apirajeeranan Department of Speech Therapy 08.00- B4-2 Hippo Therapy 60 Pack Squadron 10.00 Ms.Peechayanan Arkniyarn 13.00- B5 Snozelen 60 Department of 14.00 Mr.Krugchai Pichai Occupational Department of Occupational Therapy Therapy 14.00- B6 Opti-Music 60 Music Section 15.00 Ms.Siratchaya Wongfhun Ms.Chadaporn Pengta 4 16 30 09.00- Neurofeedback 180 The 4th floor VIP May 12.00 Dr.Panu Khuwuthyakorn meeting room, 1. Psychiatrist, Suan Prung Piano building Psychiatric Hospital 2. Director of Neurofeedback Center, RICD 13.00- Applied Eastern Psychology for Children 120 The 4th floor VIP 15.00 with ADHD meeting room, Ms.Saowalak Langgapin Piano building Eastern Psychosocial Treatment Center 4 17 31 09.00- Presentation 180 The 4th floor VIP May 12.00 Ms.Saowalak Langgapin meeting room, Piano building 13.00- Examination 150 The 4th floor VIP 15.30 Ms.Saowalak Langgapin meeting room, Ms.Pakpimintra Waratchayathon Piano building 15.30- Discussion & feedback 30 The 4th floor VIP 16.00 Ms.Saowalak Langgapin meeting room, Piano building 18.00- Certificate Distribution Ceremony TBA 21.00