A Review of the DIR/Floortime Model for Autism Treatment Jessica Seeman & Jennifer Connelly Caldwell College Graduate Program in Applied Behavior Analysis

The DIR/Floortime Model: What Is It? DIR- “Developmental, Individual-Difference, Relationship-Based” Model “Developmental”- Six Levels “Individual-Difference”- Unique way in which a child processes information “Relationship-Based”- Learning Relationships necessary for a child to progress in his development

The History of DIR/Floortime Developed approximately 30 years ago Based on cognitive and developmental psychology Started with a six-year study based on typically developing infants Look at how typical development can be derailed Not only Greenspan

History of DIR/Floortime Used model to treat autism, and additionally focused on sensory/motor components In 1990 began training in assessment and treatment of autism using model In 1996 Greenspan and colleagues Formed Interdisciplinary Council on Developmental and Learning Disorders

History of DIR/Floortime Published own diagnostic manual, assessment intervention tools (measures), and videotaped training models Formed the Journal of Developmental Processes In 1999 began a DIR institute certificate program In 2003 the Floortime Foundation was founded

The Theory Behind DIR Language, cognition, social skills, and emotions are learned through meaningful relationships Underlying sensory processes determines how learners interpret and learn from their environment Progress in all areas of development is interrelated The theory is based on the understanding of autism as “unique biologies” of individual learners

DIR/Floortime: Treatment Claims Relate to adults and peers with warmth and intimacy Communicate meaningfully with gestures and words Think using abstract reasoning and empathy Integrates emotional, social, intellectual, educational goals

FEDCs FEDC- “Functional emotional developmental capacities” Stage 1: Regulation and Interest in the World Stage 2: Engaging and Relating Stage 3: Intentionality and Two-Way Communication Stage 4: Social Problem-Solving, Mood Regulation, and Formation of Sense of Self

FEDCs Stage 5: Creating Symbols and Using Words and Ideas Stage 6: Emotional Thinking, Logic, and Sense of Reality

DIR Approach to Evaluation and Intervention

DIR Components Floortime Semistructured Problem-Solving Activities Speech Therapy Occupational Therapy Peer Play Opportunities Educational Programs Biochemical Interventions

What Is Floortime? “Floortime” is only one component of the DIR- based intervention program, but is the heart of the home program Floortime is a family approach Two main goals of Floortime 1. Follow the child’s lead 2. Bring the child into a shared world

Floortime: How to Implement It Not about doing the right or wrong thing-only learning together Think of yourself as a “player” Parents coaching each other in order to analyze floortime sessions

Floortime: How to Implement It Voice (intonation) is the most powerful tool Meet on current developmental level, instead of expectations Giving things symbolic meaning No rush in floortime, moving at the child’s preferred pace

Floortime: One Example http://www.youtube.com/watch?v=vQW4TncfP7g

Floortime Checklist Involves following the child’s lead and pulling him into your world….Is he… Engaging with toys/objects or me? Reacting or initiating interactions? Opening/Closing a few circles of communication? Labeling/Creating own new ideas in play conversation? Marching to his own drummer/responding to my ideas as well as his own?

Floortime: Creating Learning Environments With siblings/peers Across settings Everyday activities At school

Creating a Comprehensive Intervention through Additional Components: DIR Intervention Pyramid

DIR: Views on Sensory Processing and Self-Stimulatory Behavior Sensory Processing- learners being overreactive or underreactive to sensory information Why learners engage in stereotypy, and how it is addressed through the DIR model

DIR Approach to Problem Behavior Avoidant Behavior Repetitive Behavior/Perseveration Dangerous/Aggressive Behavior Self-Stimulation

DIR Approach to Other Challenges Toilet Training Dressing Meal Time Social Skills Feelings Scripting Echolalia

DIR/Floortime: Research Support Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. Stanley I. Greenspan & Serena Wieder (1997) Can children with autism master the core deficits and become empathetic, creative, and reflective? Serena Wieder & Stanley I. Greenspan (2005)

DIR/Floortime: Scientific Validity Internal Validity = Functional Relationship Demonstrated no experimental control Measures biased Nothing operationally defined No explanation of data collection or reliability data DIR not only IV Behaviors were internal states (not measurable through observation) External Validity = Replication Method not described Various confounding variables No demonstration of internal validity

References Greenspan, S. I., & Wieder, S. (1997). Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. The Journal of Developmental and Learning Disorders, 1, 1-38. Greenspan & Wieder (2006). Engaging autism. Cambridge, MA: Da Capo Press. Wieder, S., & Greenspan, S. I. (2005). Can children with autism master the core deficits and become empathetic, creative, and reflective? The Journal of Developmental and Learning Disorders, 9, 39-61.

Questions Period