The DIR® Model is an ambitious one made up of many puzzle pieces. It involves a team of professionals who co-ordinate their services in the best interest of each child and family. It relies on an active participation from caregivers. The key aspect of this model is that it is a comprehensive model that has a developmental framework.
Today we will be breaking down all of the different pieces of an ideal DIR/Floortime intervention. It is a holistic developmental approach to child development that is respectful to child and caregiver alike, individualized, and it is also a family approach that will influence a conscious way of living with a special needs child.
“…we understand the way in which different capacities develop naturally as healthy foundations for intellectual, emotional, and social growth. Then we orchestrate approaches to build these healthy foundations for development“.Dr. Stanley Greenspan
Structure and Behavioral Goals of the DIR/Floortime Program
DIR/Floortime uses information from where the child is developmentally (the “D”) and the child’s individual sensory profile (the “I”) to provide the child with a specifically tailored set of interventions in the context of safe, nurturing, warm relationships (the “R”) that will help move the child up the developmental ladder to reach the child’s full potential.
These relationships include that of the child with caregivers and therapists delivering his/her programs. Within these relationships, the key ingredient necessary for success is affect, or emotion. When a child is emotionally interested, (s)he is motivated to learn. It is only through affective interactions that children are able to generalize what they learn.
The Pieces That Make Up A Comprehensive DIR/Floortime Intervention
Dr. Stanley Greenspan described the elements of a DIR/Floortime intervention (which is always individualized, thus no one-size-fits-all) on many occasions. He also describes at length the systematic assessment process that precedes the intervention (see Engaging Autism Chapter 19), but here we’ll focus on post-assessment aspects of the intervention.
Specific “Traditional” Therapies
- Speech and Language Therapy that includes targeting nonverbal communication, receptive and expressive language and pragmatic language skills, along with other as-needed activities including oral motor or articulation skills and auditory processing.
- Occupational Therapy that includes sensory integration (often focusing on vestibular and proprioceptive processing), fine and gross motor activities, visual-spatial processing activities, and motor planning & sequencing, This will include heavy work (pushing, pulling, or lifting), swinging, trampolines, balance beams, obstacle courses, wearing a weighted vest, climbing through tunnels or with resistance such as on a big pillow stuffed with foam, getting deep pressure and other such activities to help the child’s sensory systems.
- Other therapies if required, including physical therapy, educational programs, family therapies and developmental consultations including visits with a psychologist, medical doctors, developmental optometrists, social workers, or family counsellors.
UNSTRUCTURED, SPONTANEOUS SESSIONS:
- Dr. Greenspan always recommended that parents and other caregivers have eight or more 20-minute sessions every day of spontaneous developmentally appropriate interactions. This is the standard “Floortime” that we have discussed here at affect autism where you follow the child’s lead, tailor interactions to the child’s sensory profile, and expand and challenge the child at his/her developmental level.
- As you become more comfortable in this process, you can do Floortime anywhere, all the time. For instance, for children who are verbal and can open and close communication circles you can use it during dinner time. Offering the child his/her meal you can ask, “Would you like salt on that?” and then “Ok. Would you like a little bit (gesturing a tiny bit) or a lot (gesturing a big amount)?” and then “Ok! Should I sprinkle it on very quickly or s-l-o-w-l-y?” to slow down and stretch out the interaction.
STRUCTURED AND SEMI-STRUCTURED, SENSORIMOTOR, PROBLEM-SOLVING SESSIONS:
- In some of his radio shows, Dr. Greenspan spoke about a more problem-solving type of Floortime that was more structured with the goal of working on skills and/or problem-solving so the child learns something new (see TRANSCRIPT HERE). Similar to spontaneous Floortime sessions, we want to connect affect (emotion) to the activities, whether we’re working on motor planning, gross motor games, or sensory processing involving touch, visual-spatial or auditory senses.
- In addition to any problem-solving sessions that work on teaching skills using a DIR® approach, three or four times a day for 20 minutes would be allotted for physical activity to work on skills such as running, throwing, catching, kicking, dancing, obstacle courses, balance beams, treasure hunts, etc. You would want to elicit the expertise of an occupational and/or physical therapist for these activities that can be carried out at home between visits with the professional.
- Dr. Greenspan suggested that the child’s individual profile and developmental level will determine how structured or spontaneous these sessions need to be. Children who are already interactive could learn these skills in more spontaneous Floortime sessions, but those who aren’t yet as interactive might require more structure.
Other therapies or activities such as art, music therapy, gymnastics, swimming…
Music therapy can elicit more responsiveness and more emotional expression and social engagement during music therapy sessions (Click HERE for reference). One study found that music can help our children map sounds to actions “by connecting the auditory and motor sections of the brain, which may help improve understanding of verbal commands. By pairing music with actions, and with repetitive training, the brain pathways needed to speak can be reinforced and improved.”
Art therapy provides sensory stimulation such as tactile experiences and practice with fine motor skills while. Gymnastics is a sensory-rich activity that works on the vestibular system and visual-spatial awareness, and gross motor skills such as running, climbing, and jumping. Swimming provides a lot of sensory input especially for children with a lack of body awareness.
- Dr. Greenspan has written about how important it is to have four or more playdates each week with neurotypical peers of similar developmental age or older once our children are interactive and having a continuous back-and-forth flow at functional emotional developmental capacity levels 3 and 4.
- These experiences will help our children develop their communication skills and generalize them. We, the caregivers, need to facilitate the interactions at first and we want to foster the non-verbal communication and emotional signalling that neurotypical children naturally have.
- We want our children to get practice at picking up on subtle social cues while experiencing humour and shared pleasure so they can learn to spontaneously react in a more natural fashion as they develop. This is much more challenging to do once our children get older, but is still always possible.
It is rare to see children with a full comprehensive developmental program in place, but we can all aim to provide our children with the best that we can from this ideal model. Certainly the public funding for such an approach lags behind greatly. Ideally, we would have clinics that provide all of the essential services under one roof.
Although many clinics with comprehensive services do exist, they are typically behavioural in nature and rarely take a developmental approach. There are some good DIR/Floortime clinics though. See our links to them under our Services link.
A DIR/Floortime intervention is a comprehensive developmental approach that aims to build healthy foundations for children to develop their potential to relate, think, and communicate rather than focusing on surface behaviours. These healthy foundations are fostered through a variety of programs and therapies that are all provided with common individualized goals for the child and family, and using the DIR approach, taking into account the “D“, the “I” and the “R“.
Until next time…here’s to affecting autism!