DIR®/Floortime™ Sharon Duval, M.A., CCC/SLP The Monarch School Autism One 2008 Conference

DIR® is the Developmental Individualized Relationship Approach developed by Stanley Greenspan, M.D. and Serena Wieder, Ph.D.

It is a developmental approach that engages a child at his/her current level of functioning, works with the unique features of their nervous system and utilizes intensive interaction experiences to enable them to master new capacities.

In the last years,The Interdisciplinary Council on Developmental and Learning Disorders put together what they call a functional developmental roadmap that reflects their understanding of the core levels that synthesize and integrate all of the developmental capacities. “D” REPRESENTS FUNCTIONAL DEVELOPMENTAL LEVELS

“I” REPRESENTS INDIVIDUAL DIFFERENCES IN PROCESSING

“R” REPRESENTS INTERACTIVE RELATIONSHIPS AND USE OF AFFECTS

6 Core Functional Developmental Levels 1) Regulation and shared attention 2) Engagement 3) Two-way communication 4) Interactive problem solving 5) Functional use of ideas 6) Building bridges between ideas

Children are individually different in the way they process information. Variations exist in underlying motor and sensory processing, i.e. regulatory capacities. These are the important underlying processing capacities that are behind children’s worrisome behaviors such as self/absorbed/withdrawn, self - stimulation/repetitive movement, rigidity, inflexibility, difficulty making transitions, aggression, self-abuse, destructive behaviors.

Studies have documented that interactive experiences can actually change the physical structure of the brain.

Affect, emotions and relationships are important for the growth of the brain and mind.

The mind and brain grow most rapidly as an outgrowth of interactive experiences.

After 20 years of studying large numbers of children and their families, the fundamental types of interactive experiences were identified that are most critical for healthy development.

CRITICAL FEATURES OF THESE INTERACTIONS Interactions which feature warmth and security Interactions which feature regulation so that the child is not overwhelmed Interactions which feature a lot of relatedness and engagement Interactions which feature a lot of back and forth emotional signaling and gesturing Interactions which feature problem solving Interactions which feature using ideas in a meaningful and functional way Interaction which require thinking and reasoning

Most essential are lots and lots of interactions with children that exchange emotions and have to do with the fundamental sense of relatedness.

Language, cognition (including math and quantity concepts), as well as emotional and social skills are learned through interactive relationships which involve affective exchanges. Without fundamental relating, language and cognition do not develop well.

Affective Exchanges A child can control and regulate emotions and facial expressions that convey emotions much earlier than they can control motor behavior Emotions lead the way all the way through Emotions activate the motor system Emotions are the organizer for all parts of the mind. They are especially important when we get to abstract thinking.

Two levels for Child to learn emotional concepts Lived emotional experience Must live every word first to understand it.

A Relationship-based approach to children with special needs that is family, cultural and community based.

Relationships and emotional interactions occur within Child/caregiver Child/educator Child/therapist Whole family pattern Cultural and community contacts

The DIR® Approach enables caregivers, educator and therapist to construct a comprehensive program to mobilize each child’s intellectual and emotional growth.

DIR® Comprehensive Program includes: A model for assessment A model for intervention

DIR® MODEL OF ASSESSMENT Begins with a review of a child’s current functioning, history and observations of the child with caregivers. The best assessments take place over a period of time rather than in the space of a single day.

OBERVATIONS OF CHILD WITH CAREGIVER INCLUDE Looking at biological challenges – individual processing differences and motor profile. Identifying individual differences in each child’s strengths and weaknesses. Looking at the way child relates to caregivers and the way his/her caregivers relate to him – patterns of interaction. Observing the use of language, cognitive capacities and overall health. Observing where the child is in Functional Developmental Levels. We observe the ways in which his profile influences his interactions with caregivers and ways in which caregiver patterns influence his developmental progress.

Parent/child interactions reveal the child’s capacity for relating and interacting and may the venue in which the child is most likely to perform at his highest level.

Standardized Tests If needed, standardized tests are used after the child is observed interacting and playing with caregivers.

DIR® MODEL OF INTERVENTION Construct a child’s unique profile which includes his functional abilities.

Child’s Individual Profile includes: Identifying unique processing differences in terms of how the child reacts to sensations, processes information, plans actions, and sequences behavior and thoughts. Level of functional emotional, social, and intellectual capacities Typical and necessary interaction patterns Family patterns.

The profile enables parents and professionals to construct an intervention plan geared to each child’s individual characteristics.

Comprehensive Functional Developmental Intervention Program Specific Therapies Home program School program Family support Medical Intervention

Home Program Spontaneous developmentally appropriate interactions (Floortime™) Semi-structured problem solving interactions Motor, sensory, and visual/spatial activities.

CONNECTED CHOICE ACTIVITIES:  Play a Board Game  Puzzles with Someone  Make or Build Something with Someone SOLO CHOICE ACTIVITIES:  Build something with Legos  Build a model  Read a book on a favorite topic  Play an approved computer game MOVEMENT CHOICES:  Play with neighborhood kids  Jump on trampoline  Play actively with dog  Play creatively and actively outside  Swim  Play basketball  Ride bike  Skate

School Program Class Structure Spontaneous developmentally appropriate interactions (Floortime™) Semi-structured problem-solving interactions Motor, sensory, and visual/spatial activities.

FLOORTIME™

Intervention Strategies to Develop Mutual attention and Engagement Follow child’s lead and join them – it does not matter what they do as long as they initiate the move Persist in your pursuit Treat what the child does as intentional and purposeful – give new meanings Help child do what they want to do Position yourself in front of the child

Invest in whatever they initiate or imitate Join perseverative play Do not treat avoidance or “no” as rejection Expand, expand, expand – keep going, play dumb, do wrong move, do as told, interfere, etc. Do not interrupt or change the subject as long as it is interactive Insist on a response