Tuesday, September 7, 2010

DIR®/ Floortime™: An Introduction

Sara Chapman, MA

Navigating the world of autism is no easy task for parents, particularly with so much information -- and misinformation -- currently available. Parents spend hours searching for what is best for their child, understandably so, often confused or uncertain about what will truly help their child learn, develop, and grow into a warm, independent, and emotionally connected individual.

The DIR®/ Floortime™ model provides a framework for helping parents better understand their child and to re-establish those early connections that once seemed lost or unattainable. It is about finding the “gleam in the eye” and falling in love with your child all over again, no matter what your child’s challenges might be. In turn, this will lead to healthy foundations for social, emotional, and intellectual development.

What is the DIR® Model?

The DIR® Model, or Developmental, Individual-Differences, Relationship-based Model, is an interdisciplinary framework for assessment and intervention developed by Drs. Stanley Greenspan and Serena Wieder. It is used to guide parents and professionals in designing a program tailored to each child’s unique strengths and challenges and support developmental progress. The primary goals of the model are to help children:
  1. Better relate with warmth and intimacy to the important people in their lives
  2. Communicate more meaningfully, using words and gestures, through back and forth interactions
  3. Become more independent, abstract thinkers and problem-solvers
The “D”
The “D,” or Developmental, refers to the developmental levels based on typical emotional development. These six stages of early development include:
  1. Self-Regulation and Interest in the World. A child needs to be able to process sensory information (i.e. sights, sounds, tastes, smells, and touch) while remaining calm in order to pay attention to you. 
  2. Engagement. A child begins to relate with warmth and smiles and prefers interacting with you over inanimate objects. You become your child’s favorite toy.
  3. Two-way Communication. Your child begins to engage in increasingly complex back and forth exchanges with you that begin non-verbally and later incorporate more and more language. Your child is becoming more purposeful and intentional. A continuous flow of affectively meaningful interactions is crucial at any phase of development.
    The first three levels are the foundation for all learning.
  4. Shared Social Problem-Solving. Your child begins to see that you can help him or her in solving problems.  He or she will sequence several steps to achieve a desired goal, such as pulling you by the hand to the refrigerator, gesturing to open the door, and pointing to a juice container. 
  5. Creating Symbols and Using Words and Ideas. Your child begins using words or pictures to communicate meaningfully. He or she is beginning to use symbols to convey feelings or ideas.
  6. Emotional Thinking. Your child begins to connect ideas logically and respond to various wh- questions. This is the basis for more abstract, creative, and reflective thinking necessary for higher levels of learning.
The “I”
The “I,” or Individual Differences, addresses the way in which a child takes in and processes information through their senses (sights, sounds, tastes, smells, touch) and also includes motor planning and sequencing, proprioception, vestibular processing, and visual-spatial processing. We each have unique, biologically-based differences that make us who we are as an individual and these differences effect how we process information and interact with others. For example, if you are sensitive to sounds, you might prefer to keep the television or music low in the house and avoid concerts or noisy restaurants. As adults, we can compensate for these differences and make choices based on our individual needs. Children, particularly children with special needs, do not often have this level of awareness or a way to communicate it.

Sensory processing challenges can have a significant impact on a child’s ability to participate and function in daily routines and activities.  A child may exhibit subtle cues, making it difficult for caregivers to read or misinterpret, causing the child to disengage or even meltdown. Once we learn more about a child’s overall pattern, we can adjust the environment and interactions accordingly. For an under-reactive child, we can increase our “affect” -- emotions, reflected in our tone of voice, facial expressions, body language, and pace -- to wake up the child’s sluggish sensory system.  Affect is key to the learning process and gives meaning to our experiences.  For the over-reactive child, we can slow down and create predictable patterns to help the child feel more calm and regulated.

The goal is to help the child stay regulated through affectively meaningful interactions and to do so we have to understand a child’s sensory processing differences. It allows us to begin developing a deeper picture of why a child might exhibit a particular behavior, such as why a child might wave his hands in front of his face. He may feel so overwhelmed by increased sensory input that he cannot process adequately, so waves his fingers in front of his eyes to tune it all out. We have to address the root cause or we will see behaviors continue to resurface or shift to new behaviors. Think of putting a small band-aid on a larger injury. It simply won’t work.

Considering a child’s individual differences is a critical component of the DIR® Model. It allows us to gain a better understanding of a child’s sensory system and the role that processing differences play in how a child relates to others and his or her environment. Families can learn how to work with their child’s sensory processing challenges through affective interactions, ultimately leading to stronger connections and relationships.

The “R” 
The “R” represents the learning relationships that enable a child to develop. Parents are the first relationships for a child, and therefore are the driving force in the DIR® Model. You learn to play an active role within your child’s team, but this doesn’t mean that you have to become your child’s therapist. As an interdisciplinary approach, your child will  most likely work with a team that might include an occupational therapist, speech and language pathologist, an educator, a mental health provider, a physical therapist, etc. With the support of this team, you will learn to engage your child in new ways and the mutual joy will become infectious.

What is Floortime™?
Floortime™ is often used synonymously with DIR®, though it is just one part of the comprehensive framework. It is a specific technique of engaging your child by following his or her lead for 20 to 30 minute periods that can occur during any activity, such as play time, bath time, driving in the car, etc. During floortime, the child is engaged around his or her interests and encouraged to take initiative and direct the play. The caregiver’s primary goal is to keep the interaction going as long as possible and avoid taking over.

For children with more significant challenges, it may feel difficult at first to find something your child gravitates towards, but there is always something that will spark a child’s interest. You can always start with imitating what your child is doing and also make every action meaningful (i.e., if your child walks away, take that as an indication that it is your turn!). Your affect and pacing will help keep your child engaged, but keep in mind individual differences and how you might need to alter your interactions to support these differences.

How Do I Get Started?
The best way to truly learn and apply the DIR® Model with your child is to connect with a DIR®-trained professional who can assess your child and support you in developing a home- or school-based program that will meet your child’s individualized needs and work in coordination with other service providers. DIR® professionals come from a wide range of disciplines, including educators, mental health providers, occupational and physical therapists, and speech and language pathologists, and receive intensive and comprehensive training in the DIR®/ Floortime™ Model.

To find someone in your area who can guide and support you in this process, check www.icdl.com and search for DIR® Professionals by state. There is a wide network of DIR® professionals, but if you cannot locate someone in your area, many professionals work with families by reviewing and providing feedback on videotaped sessions.

You can read more about the DIR® Model on the Interdisciplinary Council for Developmental and Learning Disorders at www.icdl.com. There are a number of articles to get you started.

Remember, the best way to begin is to acknowledge where your child is now and build from there. Meet your child at his or her level and use your affect to keep your child engaged. Focus on having fun with each other at first.  If you are having fun, so will your child, and when he or she is having fun ... learning is happening. Be animated, use lots of gestures, and keep the interactions flowing!

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Resources

Engaging Autism: The Floortime Approach to Helping Children Relate, Communicate and Think. By Stanley I. Greenspan, M.D. and Serena Wieder, Ph.D. (2006), PerseusBooks.

The Child with Special Needs: Encouraging Intellectual and Emotional Growth. By Stanley Greenspan, M.D. and Serena Wieder, Ph.D. (1997), Perseus Books

Interdisciplinary Council on Developmental and Learning Disorders

The Floortime Repository (sign up required)