My Friend Jacob

DIR/Floortime Model

Dr Stanley Greenspan

Developmental, Individual differences and Relationship-based

DIR is the theory, ‘Floortime’ the intervention techniques

DIR/Floortime Model

An Introduction

by

Dr Stanley Greenspan

DIR Model

Six Functional Developmental Levels1. Self regulation and shared attention (FDL 1)

2. Attachment and Engagement (FDL 2)

3. Purposeful Gestures/Two-way Communication (FDL 3)

4. Complex two-way Communication and Problem Solving (FDL 4)

5. Shared Meanings & Symbolic Play (FDL 5)

6. Logical Play and Emotional Thinking (FDL 6)

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Six Functional Developmental Levels

1. Self regulation and shared attention (FDL 1)

birth to 3 months

Learn to focus, be calm, and take in the sights and sounds of the world.

Learn to be “with” us.

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1. Self regulation and shared attention (FDL 1)

birth to 3 months Focus on faces and shift attention between people and

objects

Cry to indicate discomfort, hunger, displeasure

React to sound and turn head to caregiver’s voice

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2-4 months Develop a desire to be a part of a relationship

you see this when you see that “gleam” in

their eye and their face light when they hear your voice.

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2-4 months Begin to respond to and engage care-givers with smiles

and cooing. This is the beginning of communicating and connecting “affect to intent”-they see you come into the room, they feel a warm fuzzy feeling and they smile.

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2-4 months Discriminate and make vowel and consonant

sounds, synchronize sound and mouth movements with caregiver’s vocal rhythms

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4-8 months Begin to show very intentional communication like

using gestures to get what they want.

Ex: Baby reaches up toward their care-giver when they want to be picked up, or move their bodies to show excitement.

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4-8 months Begin to intentionally communicate by using back and

forth circles of communication and exchange(1-3).

What is a circle of communication?

Turn taking interactions

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4-8 months Ex: Mom shows the pacifier to the baby (opening a

circle) baby sees it and reaches out and takes the pacifier(closing the circle).

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4-8 months Gestures-facial expressions, arm and leg movements,

pointing, vocalizations

Discriminates between people

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4-8 months Begin to understand simple play sequences like: “Peek

a Boo”, “Ring around the Rosie”.

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9-18 months Can use a back and forth interaction to solve a

problem- take mommy by the hand, lead her

to the refrigerator to get something to eat.

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9-18 months Develop verbal language-This is when they learn to talk.

Use words to express emotions

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9-18 months

Begin to see a continuous flow of interaction (3-10

circles).

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9-18 months

Learn how to control their behavior.

Follow 1 step directions like: “Go get your shoes.”

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18-30 months

Use their language to express themselves- They see mommy coming into the room, they get a warm fuzzy feeling, ask her for a hug and tell her “I love you!”

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18-30 months

Use meaningful words and phrases in interactive pretend play with care-giver’s.

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18-30 months

Language ability is growing rapidly because images acquire meaning through many more relevant emotional experiences.

Can answer “wh” questions.

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6. Logical Play and Emotional Thinking (FDL 6) 30-48 months

Think logically and connect ideas and experiences

Example: You ask him if he wants to go to Johnny’s or Sam’s house? He says: “Sam’s”. You say: “Why?” and he says: “Because Sam’s mom always gives us ice cream.”

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6. Logical Play and Emotional Thinking (FDL 6)

30-48 months Develop a logical story within symbolic play with a clear

beginning, middle, and end.

Understand time concepts and sequence of events, if I clean my room now, I can watch tv later.

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What do these levels look like?

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Individual Differences

Biologically based differences in: Regulatory Capacities Motor Planning and Sequencing Abilities Receptive and Expressive Language Visual Spatial Processing

Praxis

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Regulatory Capacities/Sensory Processing

The body’s ability to take in information from the environment through the sensory systems,

organize it, and respond appropriately to it.

For example: A baby sees mom coming into the room and the baby coos to get her attention which brings mom over. (Level 1-2)

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Example: A teacher gives the instruction to complete the math worksheet, the student is able to follow the instructions and complete the assignment. (Level 4)

Example: The five year old child comes home from Kindergarten and shows her mom the dance moves she learned in music class. (Level 6)

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What are the sensory systems?

What we:

See-Visual

Hear-Auditory

Touch-Tactile

Smell-Olfactory

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Regulatory CapacitiesSensory Processing/

What are the sensory systems?

What we:

Taste-gustatory

How we experience: movement & gravity

Vestibular

Proprioceptive

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Regulatory Capacities

When these systems work well we have: functional or “normal” sensory integration or sensory processing.

When one, two or several of these systems are not working well we have:

Sensory Processing Disorder or Sensory Integration Disorder.

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1.Look at child’s response to each type of sensory information

2.Do they have typical sensitivity or is your child hyper, hypo, or mixed.

3. Does your child have a dominant reactivity?

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What does hypersensitivity look like?

A heightened awareness of the sensory information

Response: Child tends to avoid that input if at all possible.

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What does hyposensitivity look like?

A decreased or lack of awareness of the sensory information

Response: Child can be a seeker (craving) that input or an avoider.

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What does mixed reactivity look like?

An inconsistent response to sensory information, sometimes over responsive, sometimes under responsive (difficulty with modulation)

Response: Child can be a seeker (craving) that input or an avoider and this can change from moment to moment.

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Sensory Processing Disorders can lead to many developmental challenges that affect a child’s emotional development.

activity level may be either unusually high or low, or fluctuate between extremes

child may be in constant motion or fatigue easily

child may become impulsive, easily distractible

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Sensory Processing Disorders can lead to many developmental challenges that affect a child’s emotional development.

show a general lack of planning

gross and/or fine motor coordination problems

speech/language delays

academic challenges

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What can we do to help our children?

Be good detectives!

What’s your child’s sensory motor profile?

What sensory information helps regulate your child? What sensory information does your child crave? Like?

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Motor Planning and Sequencing Abilities

Can a child have an idea and follow through with it?

1. Ideation-can the child develop his/her own ideas

2. Planning-can the child plan out how to accomplish the idea

3. Sequencing-can the child plan out the activity

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Motor Planning and Sequencing Abilities

Can a child have an idea and follow through with it?

4. Motor execution-can the child accomplish follow through with the idea

5. Adaptation-if it doesn’t work quite the way the child thought it would can they adapt and change their plan

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Receptive Communication

Can the child understand other’s attempts at communication?

1. Orient to sounds in the environment.

2. Tune into tone of voice, facial expressions gestures, and key words of another.

3. Engage in shared attention with care-provider

4. Switch attention from one person to another and back.

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Receptive Communication

5. Understanding of simple words, phrases, complete sentences.

6. Understand “wh” questions including “how”.

7. Understand “what if”, “then what”, questions

8. Follows commands (simple one step, one step, two step, three step).

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Expressive Communication

Can and How Does the Child Communicate?

1. Mirroring gestures and vocalizations with intent to communicate.

2. Intentional use of gestures, facial expressions, tone of voice and sounds to convey intentions.

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Expressive Communication

3. Use single words

4. Use sentences meaningfully

5. Use phrases and sentences in back and forth exchanges

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Visual Spatial Processing

Can the child use visual spatial strategies systematically to explore and discriminate desired objects?

1. Observe and focus on an object

2. Alternate gaze from object to person for joint attention.

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3. Follow another’s gaze to determine the object of attention

4. Switch visual attention back and forth between self and other

5. Differentiate important to unimportant (background) visual information.

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6. Actively search for hidden objects

7. Explore several areas of a room for hidden objects

8. Explore more than two areas of space with active visual assessment of space, shape, and materials

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Praxis

Putting it all together

1. Initiates ideas in play with clear goals and purpose

2. Is able to associate sensory perceptions from the body, visual system, auditory system

to develop a plan

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Praxis

3. Is able to develop the steps of the sequence

4. Is able to execute the steps and persist

5. Is able to adapt plan if it does not work or is Interfered with by another’s action

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Relationship BasedLearning/Intervention is done in the context of

relationships through affective interactions (emotionally driven).

Focus on Relationship and Affect makes DIR/Floortime different from other developmental approaches.

Interactive relationships support development.

Floortime

Intervention or treatment technique

Child centered - meet’em where they’re at and take them where they need to go using the information gained from evaluating the D…I…R of the child.

Use playful interactions to help children move up the developmental ladder

Parent Coaching Model

DIR/Floortime Model-Assessment

D- Functional Emotional Developmental Level (FEDL’s)

I-Individual Differences

R- Relationships

Assessment-The “D”

Background Information

Greenspan Social Emotional Checklist

Functional Emotional Assessment Scale (FEAS)

Clinical Observation by a trained professional

Assessment-The “I”

Pediatric Neurologist or Developmental Pediatrician

Primary vision and hearing testing

Specific evaluations: Occupational, Speech and Physical Therapy

Educational

Assessment-The “R”

Functional Emotional Assessment Scale (FEAS)

Greenspan Social Emotional Checklist

Parent/Caregiver Report

Clinical Observation

Floortime-Basic Ideas

Follow the child’s lead!

Be with the child… OWL -observe, watch, listen Wait

Imitate Join


Follow the child’s lead!

Make whatever they are doing interactive by: Playfully Obstructing Trying to read their intentions and helping them Narrating Making random behaviors purposeful


Where is your child at emotionally?

What are your child’s communication skills?

Join in at the child’s

developmental level!


What are your child’s motor skills?

What are the child’s Visual Spatial abilities?

What is the “just right’ level?

Join in at the child’s developmental level!


Open and close circles of communication!

Take out a really fun or exciting activity or toy.

Find ways to make them laugh! Be silly!

Surprise them.


Open and close circles of communication!Expectant Waiting!

Add a routine with a clear beginning, middle, and end to the activity.

Use “Playful Obstruction”


Use rhythm and music

Open and close circles of communication!

Introduce simple games like: Peek a boo, Ring around the Rosie, London Bridges


Create a play environment!

Use your child’s sensory motor profile to help you design your play area and purchase toys/equipment.

Use your child’s interests as a guide


Create a play environment!

Think about what has been successful in the past and slightly vary the toys, equipment, or activities.


Extend the circles of communication!

Theme and Variation. Do something different with the same activity or change the activity slightly.

Add a different sensory component to the activity.



Stop doing what you always do and wait for them to do ask for help or see if they can do it on their own and then celebrate the moment with them!



Be a actor in their play-yourself, using a puppet or stuffed animal, or using a favorite character.


Broaden the child’s range of interactive experience.

Allow/introduce a wide variety of play activities and emotions

Include pretend/symbolic play when the child is ready.



Why is Symbolic Play Important?:

Safe way to practice, re-enact, understand and master full range of emotional ideas,

experiences and feelings.



Why is Symbolic Play Important?: Allows flexibility in reasoning, thinking, and

problem solving leading to abstract thinking and differentiation of sense of self and

others.



Symbolic Play Themes: Earliest symbols-Blankie, Teddy Bear, Barney,

Sesame Street, Dora, Farms, Dinosaurs and dragons, etc.



Symbolic Play Themes: Symbolizing-comfort, reassurance, real life learning and feelings, explore and think, safety and danger



Symbolic Play Themes:

Fairy Tales and feelings-Goodnight Moon, Goldilocks, 3 Little Pigs, Billy Goats Gruff, Cordoroy


Broaden the child’s range of interactive experience. Symbolic Play Themes:

Symbolizing-separation, getting lost, disappointment, rescue and safety, fear and danger, joy, anger, sadness, good and bad guys



More advanced symbols-Pirates, Knights and Kings, Princesses, Wizards, Superheroes, Witches, Joker, Dracula



Symbolizing- good and bad guys, more complicated and rich themes, discriminating between real and imaginary


Tailor interactions to the child’s individual differences in sensory processing and modulation.

Go to their “comfort zone”

Use your child’s sensory motor profile to support your child’s regulation


Tailor interactions to the child’s individual differences in sensory processing and modulation.

Use your child’s interests to guide you in play.


Simultaneously attempt to mobilize the six functional emotional developmental levels!

Be in the moment and let your child guide you!

Have fun!

DIR Framework (Greenspan)

Children’s Therapy Unit

We offer this model within our interventions-O.T., P.T., S. T., and Psychology and have been for the last 11 years.

DIR Framework (Greenspan)

Children’s Therapy Unit

Recently, we started a new program called the PLAY Project which uses the DIR/Floortime Model as an intensive developmental intervention for children with autism in the home.

Case Studies

DIR/Floortime

Where Can I Learn More?

The Child with Special Needs: Encouraging Intellectual and Emotional Growth

by Dr Stanley Greenspan and Serena Weider, PhD

DIR/Floortime


Engaging Autism: Using the Floor TimeApproach to help Children Relate,

Communicate, and Think by

Dr Stanley Greenspan and Serena Weider, PhD

DIR/Floortime


Autism Solutions: How to Create a Healthy and Meaningful Life for Your Child

by Ricki G. Robinson, MD

DIR/Floortime

Where Can I Learn More? Websites:

www.icdl.com (Interdisciplinary Council on Developmental and Learning Disorders

www.playproject.org

www.profectum.org

www.stanleygreenspan.com

http://www.icdl.com/

http://www.playproject.org/

http://www.profectum.org/

http://www.profectum.org/

http://www.stanleygreenspan.com/

DIR/Floortime

Dawn Heino, O.T.R./L

Pediatric Occupational Therapist

PLAY Project Home Consultant

[email protected]

(253) 697-5200

mailto:[email protected]




DIR/Floortime

Never underestimate the Power of

Play!

My Friend Jacob

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