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

Screening (FDGC)/ Developmental Evaluation

Developmental Profile

Caregiver/Child Interactions

Individual DifferencesDevelopmental Capacities

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…

1. Engaging with toys/objects or me?2. Reacting or initiating interactions?3. Opening/Closing a few circles of communication?4. Labeling/Creating own new ideas in play

conversation?5. 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

Specific Interventions

Developmentally Appropriate Practices and Interactions

Formation of Relationships

Secure Relationships

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