what is dir / floortime?

What is DIR/Floorti

me?Rachel Emas, Kevin Le, Caitlin Lee, Taryn

Lozon

Rachel EmasB.A. in Communicative Disorders

M.S. in Occupational Therapy

Kevin LeB.A. in Liberal Studies

Minor in Mathematics

M.S. in Occupational Therapy

Caitlin LeeB.S. in Child and Adolescent Studies

M.S. in Occupational Therapy

Taryn LozonB.S. in Child and Adolescent Development

M.S. in Occupational Therapy

Objectives- The learner will become familiar with the DIR model and

understand who DIR is used for

- The learner will recognize the 6 different levels of DIR with the ability to discuss typical signs of a child at each stage

- The learner will understand the basics of sensory processing

AgendaPurpose of DIR

What is DIR/Floortime

Key Terms

Parent Education

Population DIR Addresses

ASD

Sensory Processing

6 Levels

Family Dynamics

Floortime Coaching

Siblings

Cultural Considerations

Questions?

Purpose of DIR/ Floortime- DIR is an approach that addresses the different developmental

milestones of a child.

- Floortime is an umbrella term used under DIR that is used as a technique to help support children’s emotional and social development

- DIR focuses to:- Encourage attention and intimacy

- Facilitate two way communication

- Encouraging feelings and logical thoughts

What is DIR/Floortime?D- “developmental” - the nine distinct levels and different tasks or goals that are accomplished

I- “Individual-difference”- how each child processes information different

R- “Relation-based”- relationships a child will foster a young age including parental and therapeutic

DIR/FloortimeFamily-first approach during intervention and at home

Built on the foundation of child and parental figures

Treatment is done in child’s naturalistic environment (home or school)

Parents should let child take initiative in activities

Parents should follow child’s lead to promote two way communication

Terms used by Greenspan and Wieder

1.Circle of Communicationa. Child→ adult→ child

2.Functional emotional developmental capacities (FEDC)a. 6 levels/stages/milestones

3.Affecta. Expressing emotions through facial expressions, gestures, and body language

4.Affective processinga. The ability to process and understand thoughts, feelings, and emotions of others

5.Regulationa. When the sensory information of the body is interpreted correctly by the brain

resulting in calmness and ability to tend to the environment

Importance of Parent Education

Parents and/or caregivers know the child best

Can provide ongoing, consistent intervention

Child may respond better to parents

Can help decrease treatment costs

Population DIR AddressesNormal developing children

DIR can be used to encourage the typical developmental milestone

Autism Spectrum Disorders (ASD)DIR is typically used with ASD because it addresses social deficits

Developmental Disabilities

ADHD

Intellectual Disability

Fragile X syndrome

Down syndrome

Autism Spectrum DisorderA developmental disorder that presents itself through deficits in social communication, forming relationships,

repetitive behaviors and function

ASD is considered a spectrum disorder

Symptoms/ behaviors of ASD

Social- emotional reciprocity

Nonverbal communication and behaviors in social interactions and personal relationships

Repetitive motor movements

Inflexibility and patterned behaviors

Fixations

Abnormal responses to sensory stimuli

Sensory ProcessingUnderstanding senses

How the body processes input How the body uses inputHow the body responds to input

Modulation- regulation of the intensity of the sensory input the body receives

Discrimination- being able to tell the difference between points

Single sensory sensitivities: Hyposensitive: low processing (no

discrimination)Hypersensitive: high processing

6 Levels1. Self-Regulation and Interest in the World

2. Intimacy, Engagement, and Falling in Love

3. Two-Way Communication

4. Complex Communication,

5. Emotional Ideas

6. Emotional and Logical Thinking

Level 1: Self Regulation & Interest in the WorldMastery age: 3 monthsTake interest in worldReceive input through smells, sights, textures, noises, and tastesRegulate feelings and senses

Translate input into state of calmness and self-regulation

Level 1: Do and Don’ts

Level 1: Goal➔ Become calm, attentive, and interested in the world➔ Regulate emotions

Level 2: Intimacy, Engagement, & Falling in Love

Mastery age: 5 monthsChild is reactive

Craves attentionResponds

CuriousAttentive

Level 2: How do you know?

Level 2: Goal➔ Emotional engagement and attachment

◆ Falling in love!

Level 2: Example

Level 3: Two-Way Communication

Mastery age: 9 monthsTake initiative

Power to make things happenGesture, eye contact, verbal

Open circle of communicationInteractions

Learning cause and effect

Level 3: Goal➔ Becoming a two-way communicator

◆ Opening and closing circles of communication◆ Initiation◆ Begin to understand affect

● Smile is happy; frown is sad◆ Begin to understand symbolism

● Stepping stone for verbalization

Level 3: Example

Level 4: Complex Communications

Mastery age: 12 months- 18 months

Stretching circles of communicationOpen and close

Complex circles:VocalizationsWordsGestures

Social cuesExpression and interpretationFeelings Shared problem solving Representative play

Level 4: Goal➔ Using a series of interactive emotional signals or gestures to

communicate◆ Approx: 10+ circles of communication◆ Growing patience with their current means of communication

● Specific gestures● Sounds and words● Able to initiate communication to deal and resolve distress

Level 4: Example

Level 5: Emotional IdeasMastery age: 24 months - 30months +

Expansion of vocabularyQuestions

Understanding and using symbols Pragmatic language Symbolic play

Isolated ideasNot connectedManipulation of ideas

Level 5: Goal➔ Using symbols or ideas to convey feelings or intentions

◆ Creates dramas and play ◆ Partakes in rule following

● Motor games◆ Expresses feelings, wishes, and intentions

● Words● Multiple gestures used● Touch● Recovery from distress

Level 5: Example

Level 6: Emotional and Logical Thinking

Mastery age: 34 months+ (approx. 3 years old)

Maintaining complex ideas and connections between conceptsExecutive functioningReality vs. fantasyRegulating impulsesDebate and negotiate

Logical thinkingSequences Imagination

Emotional expressionFeeling predictionImpact on othersEmotional problem solving

Level 6: Goal➔ Building bridges between ideas

◆ Even if illogical➔ Child can connect his/her ideas together

◆ Seeking opinions◆ Enlarging his/her pretend dramas

● Playing spatial games ● Building off real events● To recover from stressful situations

➔ Closes 2 or more verbal circles of communication

Level 6: Example

Family dynamics and DIR Family stress arises when raising a child with a developmental

disorderStress is shown through rigid and anxiety

Balance is achieved when looking at caregiver’s strengths and weakness

Family ChallengesHard day at work

Relationship troubles

Displacement (defense mechanism)Taking anger out on someone/something else

Floortime CoachingParents need to remain flexible and calm during DIR/Floortime

Children are able to sense tense and angry voices

Parents need toBe able to anticipate the child’s next move

Be flexible if the child does not do as expected

SiblingsMay feel jealous, anxious, or worried

May play a protective role or aggressive role

Sibling should be involved in family challengesAvoids exclusion

Can assist parents with DIR/Floortime

Parents can train the sibling in how to open and close the circles of communication

Cultural Considerations22.9% of US citizens report being a minority

Different beliefsPersonal space

Household responsibilities

Perceptions of authority

Parent Involvement

Language barrierDifficult understanding therapy and neuroscience jargon

ConclusionDIR according to Greenspan and Wieder

Developmental disorders

Parent Education

6 Levels

Family Dynamics

Cultural Consideration

Let’s See How Much You Learned!

ReferencesBastable, S., Gramet, P., Jacobs, K. & Sopczyk, D.L. (2011). Health Professionals as Educator: Teaching and Learning.

Boston, MA: Jones and Bartlett. IBSN 987-0763792787

Davies, A. (2006). [Connecting through play: A parent education workshop]. Unpublished raw data.

DeGangi, G. A., & Greenspan, S. I. (n.d.). Functional Emotional Assessment Scale. Retrieved

from http://www.icdl.com/research/functional-emotional-assessment-scale

Greenspan, S. I. & Wieder, S. (2006). Engaging autism. Philadelphia, PA: Da Capo Press.

U.S. Census Bureau (2015). Population estimates quick facts, United States summary. Washington, DC: Author.