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DIR/Floortime Therapy for Autism
7. Oct, 2011
When autistic children stay locked out of relating, communicating, and thinking, they fail to climb the developmental ladder leading to empathy and creative, logical, and reflective lives. The developmental therapy DIR/Floortime (Developmental Individual-Difference, Relationship-Based Floortime model) uses a parent-child relationship to entice autistic children out of their private worlds and into an environment where they desire to interact with others.
Dr. Stanley Greenspan, founder and creator of DIR, discovered that children grasp ideas through their emotions. Within their personal interests lies the seed to their development. By using the interests of autistic children, parents can pull them into a shared world and help them begin to master the fundamentals necessary for social, language, intellectual, and emotional growth.
The Two Core Techniques of DIR/Floortime Therapy
The DIR model focuses on emotional development through individualizing a Floortime therapy plan that takes the child’s sensory issues and dysfunctions into consideration. Initially, the program requires six to ten 20-minute play therapy sessions per day with the hope that interaction and communication continues to increase until it becomes a major part of the child’s life.
Like all therapies for children with autism, an initial observation and assessment by trained Floortime specialists help to pinpoint exactly where the child is in his development. However, the program’s design requires full parental participation. Parents take the two core techniques and use them to help their child reach as many of the six developmental milestones as possible. These two philosophies are:
Follow the child’s lead
Pull the child into a shared world
No matter where the child falls on the development ladder, these two steps allow parents to enter the child’s private world, connect with him emotionally, gain insight into what he feels but cannot express, and help him ascend to his full potential. Parents do that by first observing; then using the child’s interests. When a parent follows the child’s lead, they get down on the floor with him – literally or symbolically – always with the understanding that through imitating the child, circles of communication can open.
When communication opens, if the child accepts the relationship, parents can introduce challenges designed to produce further communication, verbal language, or other developmental goals. These changes often initiate feedback, completing what Greenspan calls: one circle of communication.
For example, if the child is sitting on the floor lining up blocks, a parent gets down on the floor with him and does the same thing. If the child accepts this, the parent introduces a change designed to ignite some type of communication. In this case, the parent could place a block out of order. While verbal language is the ultimate goal, initially, success is defined as any type of positive response that requires the child to pay attention to his parent.
Break the DIR/Floortime Philosophy into Smaller Steps
A Floortime therapy session can be as structured or unstructured as desired. Whichever way works best, parents should always follow the two core principles in order. However, don’t rush from one to the other too quickly. Before introducing change, take the time to play for a while. Give the child a chance to enjoy the time spent together, to feel the happiness that comes from participating in a relationship. The goal is to ignite a desire to interact. An easy way to slow down the pace is to break the two principles down into smaller, more manageable steps:
Observe: Begin by watching and listening. Observe the child’s gestures, movement, patterns, expressions, and mood; anything that may help pinpoint what the child feels and why. Figure out a way to interact with him on his level.
Open the circle of communication: Attempt to join the child in whatever he’s doing, but don’t try to control the situation. Communication opens when the child believes the parent has a real, honest interest in him. If the child chooses to stim, wanders through the house aimlessly flapping his hands in front of his face, then parents join him by doing the same.
Follow the child’s lead: Unlike typical partners who play side-by-side but do their own thing, following requires parents to give the child full control over the activity. Allow him to lead by doing exactly what he does. Imitate him completely. This builds his self-confidence, and paves the way for the assertiveness he will need later on when it comes time to close the circle.
Introduce a change or challenge: Floortime sessions don’t need to introduce something disrupting like placing blocks out of order. Parents can introduce additional communication possibilities. Allow the child space to express his own ideas, ask him questions about his actions, ask what you should do, or encourage him to take a more active lead.
Closing the circle of communication: The child always closes the circle. He does this by responding in some manner, either by gesture or by verbal communication.
Once a circle of communication ends, Floortime protocol encourages parents to open another. In fact, keeping the circles going for as long as possible is critical as the child climbs the development ladder. When stuck, Greenspan recommends stepping back to return to the initial step of observation. Think about how to create interaction but in terms of what the child can do to the parent, rather than what the parent can do to the child.
The Six Developmental Milestones
The six developmental milestones are crucial to a child’s development. In DIR/Floortime therapy they help parents design games, activities, and interventions specific to a child’s developmental level. For example, a child at the first level of “attending" needs exercises that will catch his attention, keep him focused on his parent, and help him recognize his parent’s separateness. Once he masters that level, the parent offers him more speech-related activities.
Attending: Child notices things around them, finds interest in those things, and learns to calm himself.
Relating: Child learns to enter into relationships with others. He recognizes sounds and their source, like speech. He begins to scan the world for familiar faces and objects, and pays attention more.
Purposeful communication: Child starts to communicate with others, including gestures, in a two-way conversation. He realizes his actions cause reactions. Gestural dialogues begin which leads to opening and closing the circles of communication.
Problem-solving interactions: Creativity increases as the child moves into complex problem-solving and starts to link gestures into responses. The number and complexity of closed circles increases. Gestural dialogues now lead to speech, stringing themselves together in a series of actions that form more elaborate, deliberate problem-solving sequences.
Using ideas creatively: Child learns to create ideas; participates in pretend play. He discovers that symbols represent things and ideas, and are abstractions of concrete activities, things, or emotions.
Using ideas logically: Verbal communication and problem-solving skills increase. The child gains the ability to take ideas and make them real and logical. He begins to express feelings using words instead of actions and starts to link the cause of his feelings to specific actions or events. He understands the concepts of time and space in a personal, more emotional way.
Autistic children achieve these six developmental milestones at different chronological ages. Each stage mastered becomes the foundation upon which to build the next one. By incorporating the DIR/Floortime techniques of following the child and carefully engineering activities and challenges to persuade him to join a shared world of communication, parents can be instrumental in creating opportunities for emotional growth.
1. Gaston, Lynn and Randy Gaston. Three Times the Love: Finding Answers and Hope for Our Triplets with Autism. New York, NY: Penguin Group, 2009. Print.
2. Le Blanc, Raymond and Hennie Volkers. What You Should Know About Autism Spectrum Disorders: Signs, Symptoms, Treatments and Effects on Daily Life. Bangor, ME: Booklocker.com, 2008. Print.
3. Robledo, Jhoanna and Dawn Ham-Kucharski. The Autism Book: Answers to Your Most Pressing Questions. New York, NY: Penguin Group, 2005. Print.
4. ICDL – The Interdisciplinary Council on Developmental and Learning Disorders, DIR/Floortime Official Website. Web. 07 Oct. 2011. <http://www.icdl.com>.
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