For the last several weeks you have read about the Developmental, Individual differences, Relationship-based (DIR) model and Floortime. This week let’s dive into a video example of doing some Floortime.
Today’s photo and video example display a beautiful little girl. At the time she was 3 1/2 years old and had a number of strengths and challenges, developmentally speaking. I had the wonderful opportunity to hold a few Floortime sessions with her as part of one of my early courses in DIR/Floortime.
THE ‘D’: DEVELOPMENT: This child has significant challenges at the first functional emotional developmental capacity (FEDC): shared attention and regulation due to her biological underpinnings. She shows competency in FEDC 2 (Engagement and relating) and 3 (Purposeful emotional interactions) from time to time.
THE ‘I’: INDIVIDUAL DIFFERENCES: Her sensory processing profile is that of mostly a sensory seeker and under-responsive to most sensory stimuli so moves around a lot, shifting from activity to activity. She has some visual challenges, is easily distracted by visual and auditory stimuli, and is constantly exploring with her mouth, biting and chewing. She has a few words and is delayed in expressive and receptive language.
THE ‘R’: RELATIONSHIP: Although I had established a relationship with this little girl over many months, I hadn’t worked with her in Floortime before so it always takes time to build trust between two people. Working with her, I found that she responded to high affect, interesting sounds, fun gestures and tone to entice her into interactions including warm and happy smiles, warm tone and high voice, funny sound effects and noises, and energetic movement and affect. However, because we are both high energy people, I also had to be sure to modulate my energy level to not over-stimulate her.
At the start of the video you can see that it is difficult for me to get a meaningful interaction with her. I followed her lead mostly with imitation at this stage but until I get the shared attention, I can not expand on it by adding a new element yet.
- For the first 2 minutes of the video footage, I am using imitation to entice her into engagement and we see a bit of interaction with her in the swing, bumping into the ball. The swing is giving her proprioceptive input into her body and vestibular input with the movement.
- She enjoys bumping into the ball so I am waiting for her to respond and she says “This” and “More” to indicate she wants more before getting restless. By waiting, I am giving her an opportunity to interact rather than just continually swinging her without an interaction.
- When we get to the chalk board, she is very interested in drawing and I continue to imitate what she is doing and we see a little bit of back and forth with eye contact, gestures, and her naming the object “heart“. She also visually references what I am doing from time to time.
- In the gym, she gets to move around and again I’m imitating and following her lead. I decided to present a new idea by rubbing the mat and saying “up up up” and “down down down” and she imitated me, exploring the feel of the mat. We ideally want the child to initiate a new idea and interaction, but if the child can imitate our new ideas, it is a start.
- At the 3-minute mark, we are back in the swing and this is where we see the best interaction between us. The swing is providing her body with proprioceptive input, and I am adding to this by driving a toy train where she can feel it, along her legs and back. She enjoys it and is telling me–both verbally and non-verballly–that she wants me to continue.
- She gets to hold the train and shows me that she wants me to do it again, gives me smiles and eye contact, and initiates wanting to continue. When I change it up by adding the “chugga-chugga” and change my tone to a high voice, she imitates me verbally.
- At the 5-minute mark until the end you see she is really engaged now. She is initiating interactions, wanting to move the train herself, making the sound effects of the train, and as my Floortime course instructor put it, “you got her…you got her mind activated, wondering where the train would go next…you could see her mind waiting, watching, and wondering, realizing she had to initiate to continue“.
- Floortime is about respect. Throughout the video I respected her space and did not force her to do anything. I watched her move and followed her lead. I did not have an agenda for her to follow. If I added a new element to the interaction, I waited for her response before proceeding.
- With her high arousal levels, the proprioceptive input is essential for this little girl. The hard banging on the mat got her attention and the swing provided her body with the input her body requires in order to get to the higher levels and have moments of sustained engagement.
- We had a nice two-way communication in the video and even got to capacity 3 in the swing with the train as we saw 15-20 circles of communication between us. She pushed my hand indicating with her body, vocalizations and gestures what she wanted and she was purposeful. You could see her mind working as she contemplated what to do next to keep the train game going.
- I was modulating my interactions with her, enticing her with affect but then slowing things down to stay engaged and work on the back-and-forth interactions. The “up up up” rubbing the mat and the “chugga-chugga” in the swing are examples of when I slowed the interaction down.
- She needs a lot of sensory input to register information which keeps her seeking the sensory input. Going forward with this child, we would want to see her on a sensory diet frequently each day to help her central nervous system continue to integrate her senses. By providing her with the input her body is craving, we will be able to work on reaching the higher capacities and begin to challenge her to move up the developmental ladder.
Until next week… here’s to affecting autism through playful interactions!