Guest Post from a Ph.D. Clinician: DIR/Floortime

DIR/Floortime: Promoting Development Through Connection and Play

The Kate Clinic

Stephanie Nilsen, Ph.D.

Many years ago, I fell upon the world of autism unexpectedly, but delightedly.  While in college, I took a job as a play therapist to help pay tuition bills while hopefully getting a little more experience towards my future career.  Little did I know that my whole life would change as I met a little girl with tight curls and a love for all things musical. This beautiful little girl filled my days with singing and swinging and drumming on all the furniture.  But the lessons she taught me changed the course of my very life and I am profoundly grateful for the things she showed me and the path she put me on.

This little girl, like many I have met since, was unique and passionate – a beautiful one-in-a-million individual that could not be defined in any other way but to describe her.  She had a label of autism, but she was so herself that even that category couldn’t contain her. And as I came to know, unique individuals require unique interventions.

This is how I stumbled across DIR/Floortime.

What is DIR/Floortime?

DIR/Floortime is an intervention, yes.  But it’s also a theory of learning and human development.  Originally developed by Stanley Greenspan and Serena Weider, it was conceived as a way to “seize the neuroplasticity of the brain by providing experiences that can create missing neural interaction” (Davis, Isaacson & Harwell, 2014, p. xii).  Basically, it is a way of using intentional methods of playing and interacting to help a child move along a developmental continuum, achieving skills and capacities along the way. Some use it as a primary intervention and some use it in tandem with other approaches based upon the unique needs of each family and child.  I use it every day in many ways.

Core Perspective

Coming from a background in child development and early childhood education, much of my understanding is based and built upon early childhood learning theories.  DIR/Floortime builds upon many theoretical perspectives, such as:

  1. Learning happens through constructive experiences
  2. Development happens in the context of relationships
  3. Play is a vehicle for development
  4. Nature and nurture both contribute to development in unique and individual ways

The Learning Tree

The letters in the acronym DIR stand for the three crucial tenants of the Floortime Perspective.  Together, they can be explained using the image of a tree (as seen below). D = Development; I = Individual Differences; R = Relationship-based.

(D) Developmental

This is the trunk of the tree.  There are six main developmental capacities (although there are three additional capacities that can be reviewed as well if the core six are strong).  Each developmental capacity builds on the foundation of the one before, with the lower capacities being the bedrock for following development. Often, I see the first three capacities hold kiddos back, but very little of the available therapeutic interventions addressing these three capacities.  This is one of the reasons I love Floortime – it supports the foundations and therefore changes the positive ways all therapeutic interventions impact the child. The six developmental capacities are:

For each developmental capacity, caregivers can interact with their child, focusing on strategies that can help their child build strength in the capacity.  Some examples of this are in the table below (as found in Davis, Isaacson & Harwell, 2014). For more information and explanations, I recommend the book by Davis, Isaacson & Harwell (2014) titled “Floortime Strategies to Promote Development in Children and Teens: A User’s Guide to the DIR Model.”

(1) Regulation & Attention
-Ability to be calm and alert, to focus-Caregiver attunement-Sensory profile
Strategies
-Support sensory regulation-Notice little cues & adjust interactions-Provide calming choices-Avoid flooding (slow down!)
(2) Engaging & Relating
-Connecting with others-“Gleam in the eye”-Falling in love-Seeking out and maintaining engagement with family & friends
Strategies
-Joint attention-Gaze tracking-Share pleasure together-Emphasize affect and emotion-Be necessary-Use anticipation
(3) Intentionality & Two-Way Communication
-Reciprocity-Give-and-take-Initiating & responding-Intentional interaction
Strategies
-Provide wait time-Sportscaster/narrator-Playfully persist-Offer choices-Total communication (not just words)
(4) Social Problem Solving & Complex Communication
-Moving from “islands” or isolated moments of reciprocity-Continuous flow of rapid, back-and-forth interaction-Sense of self and other-Initial development of theory of mind and intersubjectivity
Strategies

-Stretch out interactions-Feign ignorance, “play dumb”-Playfully obstruct-Devise problems and playful challenges-Assign meaning, treating all actions as intentional
(5) Symbols, Words & Ideas
-Creating own ideas-Pretend play-Abstract thinking-Expanding depth and breadth of ideas and emotional content
Strategies
-Pretend play!-Animate, bring characters to life-Thicken the plot, drama! drama! drama!-Vary emotions, use them in play-Take on dual roles in play (challenge & support)-Enrich play by using many forms
(6) Building Bridges – Emotional & Logical Thinking
-Emotional self-awareness-Emotional self-control-Empathy for others-Building bridges between ideas – own and others-Find logical connections
Strategies

-Narrate & reflect on feelings-Use play to master overwhelming feelings-Ask elaboration questions-Build bridges, make connections-Sequence, plan, and communicate about the past and future-Organize and summarize-Debate

(I) Individual Differences

These are the roots of the tree – the nourishing and anchoring strength to our tree.  Individual differences focus on the fact that all of us are individuals, with unique biological context.  Our bodies are different, our brains our different, our interests and processing the world are different. Our sensory systems vary, our motor planning skills differ, even our temperaments are unique.  Not one of us experiences the world in the same way. One thing we as caregivers need to do is really understand the lens of our kiddos. What do they experience in their bodies, their brains, and their own perspectives?

One major areas of concern for many of our children is their sensory processing.  We all process the five senses differently (visual, auditory, taste, smell, tactile) but we also have differences in our vestibular systems (balance & coordination), our proprioceptive systems (joints & muscles) and our introceptive systems (organs & internal sensations).  So what can we do?

  1. Learn the child’s profile!  There are many ways to explore this, but an occupational therapist might be a good start.
  2. Learn your profile.  How you perceive the world affects what you do and how you respond.  By learning how your system interacts with your child’s system, you can avoid tough situations and embrace the joyful moments of being together.  You can start to learn how to adapt yourself to help your child by calming/energizing; watching your tone, speed or volume; finding activities that are connecting.
  3. Use sensory strategies such as home/environment design, thoughtful material selection, sensory schedules or diets, practice during play, and self-monitoring.

(R) Relationship-based

No tree can thrive without nourishment.  Rich soil, warm sun, and rainwater are all necessary for the tree to thrive.  This is where we as caregivers come in! We nourish our children and the better we get at doing that, the more likely our children with thrive.  The National Scientific Council on the Developing Child states, “Nurturing and stable relationships with caring adults are essential to healthy human development beginning from birth.”  You are crucial to this process! This is why I try to teach parents – the priority relationship – how to work with their child rather than taking over therapeutic interventions myself. A strong parent-child relationship is the best intervention 🙂

So, what can parents do to increase their connection and strengthen their relationship?  A few simple ways to do this are as follows:

As I have gotten closer to the world of autism, I have been often disappointed with the focus on surface skills and behaviors without exploring the depth of the individual child.  It may be important for a child to be able to master certain behaviors (of course!), but without those behaviors being rooted in meaningful, connected, and powerful interactions, we are just teaching routines.  Development is not just the mastery of routines – it is the interactive, unique, and blossoming growth of a person. As I have worked with children over the years, I have found that we need to go deeper than just surface behaviors and seek to help our children become more of who they are.  We need to see the heart of our children and celebrate their unique, passion, beautiful, one-in-a-million individuals they each are. For me, DIR/Floortime helped me do that. And that is something I am so grateful to have stumbled across 🙂

For more information, check out the following resources:

THE KATE CLINIC: www.thekateclinic.com provides parent training resources in the Phoenix, AZ area.

PROFECTUM: www.profectum.org offers a full, free parent training toolkit with a manual, video modules, and professionals from a variety of fields focused on teaching parents how to implement DIR/Floortime with their child.

AFFECT AUTISM:  http://affectautism.com offers tons of ongoing training and topics to help verse yourself in DIR/Floortime.  She even has a podcast on iTunes that is awesome!

FLOORTIME MANUAL:  This is one of my favorite resources.  It’s user friendly and breaks down things you don’t realize you’re doing.  A great starting point!

ENGAGING AUTISM:  This was the original “manual” for DIR/Floortime.  It’s a lovely resource and a bit more technical than The Floortime Manual.  Full of depth and detail.

RESEARCH:  For research supporting the DIR/ perspective, check out the following articles:

Articles showing significant improvement in children with autism who used Floortime

  • Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program. Autism, 11(3), 205-224. http://dx.doi.org/10.1177/1362361307076842
  • Lal, R., & Chhabria, R. (2013). Early intervention of autism: A case for Floor Time approach. Recent Advances in Autism Spectrum Disorders, I. http://dx.doi.org/10.5772/54378

Articles showing the effectiveness of addressing the caregiver

  • Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program. Autism, 11(3), 205-224. http://dx.doi.org/10.1177/1362361307076842

Articles showing specific skill improvement (turn taking, two way communication, understanding cause and effect and emotional thinking)

  • Lal, R., & Chhabria, R. (2013). Early intervention of autism: A case for Floor Time approach. Recent Advances in Autism Spectrum Disorders, I. http://dx.doi.org/10.5772/54378

Pre-post survey resulted in statistically significant improvement in the children’s FD Levels and 100% of the parents reported satisfaction in participating.

  • Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program. Autism, 11(3), 205-224. http://dx.doi.org/10.1177/1362361307076842

For more research, see: https://docs.google.com/a/icdl.com/viewer?a=v&pid=sites&srcid=aWNkbC5jb218aWNkbHxneDozYjkxOTMzMDZkOGNkOGZm