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DIR at LISCA | 1 DIR FLOORTIME STANELY GREENPAN’S MODEL TRADITIONAL APPROACH (DDT) VS DEVELOPMENTAL APPROACH (FLOORTIME) The "D" D = Development: A child’s developmental profile is not solely about milestones, but rather how the "I" works together with the child’s "R" to shape development. I = Individual: Children have unique physiological, neurological, psychological, communication, motor, and sensory processing differences. Together these influence the child's trajectory. R = Relationship: Parent/caretaker relationships in a child’s life play a vital role in shaping development, social and emotional growth. FEDL's • The DIR® Functional Emotional Developmental Levels (FEDL) represent nine essential developmental capacities necessary in building the core foundation every child needs for optimum growth and development. • By contrast, typical chronological measures often miss the interplay between developmental systems at work in the emerging growth of a child, and how interdependent they are. Weaknesses in one will influence the advancement of others. • These nine core functional offer an integrative perspective on vital developmental domains, including health and well being, social emotional, communication and language, regulation, sensory-motor, visual-spatial and ultimately cognitive functioning. • Assessment and treatment is multi-disciplinary and highly collaborative. • The developmental systems at work include: Regulation, sensory-motor, visual-spatial, social-emotional, communication and language, cognition, health and well being. A Comprehensive DIR Program Includes in Floortime • Starts with frequent sessions (6-8, 20-30 min.) • Talktime Semistructured Activities • Social, Work, Groups Sensory-Motor activities • Movement, sports, gym Family Supports Other Interventions Education, special education, hybrid Therapies • Language, OT & PT. Visual Spatial, • Psychotherapy • Creative Arts Peer Play Dates • Social Thinking Bio-medical interventions DIR at LISCA | 2 EMOTIONAL SCALE: 1. Self regulation and interest in the world (3 months) 2. Forms relationship, attachment and intimacy (8 months) 3. Intentional 2 way communication (9 months) 4. Complex sense of self (12-18 months) 5. Emotional Ideas (24-36 months) 6. Emotional thinking (36-48 months) 7. Multi-casual and Triangular Thinking 8. Comparative and Gray Area Thinking 9. Reflective Thinking/Growing Sense of Self/Stable 10. Structural and Thematic Characteristics of Greenspan's FEAS Developmental Stages Stages of Development and Organizing Fantasies and Themes 1) Regulation and Interest in the World= Omnipotent control; being overwhelmed; falling apart 2) Engagement and Relating= Isolation; emptiness; inanimate objects; unconditional love 3) Intentional Communication= Part object pleasures or fears; chaotic, fragmented interactions 4) Complex sense of self= Narcissistic self-absorption; grandiosity; suspiciousness; somatization; global self deprecation 5) Emotional Ideas= Neediness, being taken care of and/or fear of separation and/or danger 6) Emotional Thinking= Power; being admired; respected; shame; humiliation; loss of love; injury or harm to self or others Capacity 1: Self Regulation & Interest in the World Discovering Your Child's Sensory and Motor Profile After nine months in darkness, a baby is born. Suddenly he is plunged into a world of light and sound, movement and touch, taste and smell. A sensory extravaganza! All this information is exciting and stimulating to the baby, but at the same time he has to learn not to be overwhelmed. His very first challenge is to take in this sensory panorama while regulating his response and remaining calm. Gradually he finds things that focus his interests and at the same time can be used to calm himself—Mother’s face, Father’s voice, the soft texture of a blanket next to his skin. Little by little the infant learns to balance growing awareness of sensations with the ability to remain calm. This pair of skills is the most basic building block of emotional, social, and intellectual health. Without it we can’t learn, we can’t develop relationships with others, we can’t survive in our highly stimulating world. How an infant modulates and processes sensations is an important contributor to this first milestone. DIR at LISCA | 3 From his earliest days, Peter was an irritable baby. He slept little and cried constantly, and nothing seemed to console him. When his parents sang him songs or rocked him in his cradle, he flailed his arms and legs unhappily. When they picked him up and held him he arched his back and screamed. His parents were despondent. Their baby was miserable and hard to live with, and all their efforts to help him only made him worse. Gradually, feeling frustrated, exhausted, and saddened, they simply stopped trying so hard. They left Peter alone for longer and longer periods of time, and after a while he would cry himself to sleep. By six months of age, he was sleeping or looking self-absorbed much of the time. He had already failed to master the first emotional milestone. The next step, intimacy, would not be possible until he mastered this step. Peter’s parents sought help from their pediatrician. A thorough examination determined that Peter was hypersensitive to touch, sound, and movement. This information enabled his parents to make Peter’s world a more comfortable place. They stopped rocking him so briskly and tickling him. Instead, they held him gently but tightly and substituted a gentle rocking rhythm. They softened their voices and facial gestures when they talked to him and spoke very slowly. Soon Peter could look at them for several moments at a time. They used their soft voices to attract his attention and keep him calm. With a little experimentation they found that lower tones were particularly soothing. They could then begin some simple movement-pattern exercises to enhance Peter’s pleasure in moving. They placed Peter on the floor and slowly moved his arms and legs. They massaged his arms and legs with deep pressure. Gradually, his tolerance for movement and touch increased, and Peter allowed his parents to carry him. Bit by bit, with patient help from his parents, Peter found the world a more hospitable place. And bit by bit, he learned to calm himself down without going to sleep. By the time he was a year old, by working with and around Peter’s individual sensitivities, his parents had helped him master this first emotional milestone. Unlike Peter, Angie appeared to be a lazy baby. No matter how much her parents talked to her or smiled at her, she seemed uninterested. She rarely made eye contact, didn’t brighten when they looked at her, and didn’t turn toward them when they approached. She was equally uninterested in their gestures. When they picked her up or tickled her, she flopped in their arms. Since her parents couldn’t grasp her attention and she seemed happy, or at least quiet, on her own, they began to leaver her alone for longer and longer periods. Angie had no trouble calming herself down. Her problem was the reverse: she had no interest in the world. Nothing drew her out of her quiet shell. She, too, had failed to master the first emotional milestone. Angie’s grandparents recognized that something was wrong and convinced her parents to seek treatment. An assessment revealed that Angie was underreactive to sensations, especially to sound, touch, and movement. In consultation with a therapist, Angie’s parents found other ways to attract their daughter’s attention. She turned out to be responsive to visual stimuli, so her parents grabbed her attention by using animated expressions. They also raised their voices and used brisk movements. Angie liked their silly faces and soon began laughing when they talked to her using higher-pitched voices. She also responded to brightly colored objects or pictures held in front of her, and as her parents waved the objects back and forth, Angie would break into a smile. They found that she liked being moved quickly in the air and swung briskly in their secure arms. She would kick her feet and tense her muscles, counteracting her normally weak muscle control. Gradually, by using visual stimuli and vigorous movement, and lots of finger and toe games to compensate for her underreactivity, Angie’s parents were able to get her to show an interest in the world. They also began experimenting with noises. They tried quick and slow rhythms to see what would cause Angie to react. They found that very energetic vocal tones in the middle range helped her tune back in to auditory information. Processing sound continued to be challenging, but by the time Angie was six months old, she seemed to find the world a delightful, stimulating place. With patient help from her parents, she had mastered the first emotional milestone and was ready to master the following ones. DIR at LISCA | 4 From Theory to Practice: Tips on how to help your child master stage 1 Stage 1: Self-Regulation and Interest in the World Discovering your Child's Sensory and Motor Profile o Entering your child's world involves more than simply intuiting what gives your child pleasure; it's a systematic process. You must first learn how your child's nervous system works, by understanding his or her unique style of hearing, seeing, touching, smelling, and moving. To help your child feel comfortable in the world you must first carefully observe which sensations help your child become calm and regulated, which ones overwhelm him or her, and which don't pull him or her in enough. - Source: Greenspan & Wieder (2006). Engaging Autism. Chapter 6. Goal: Becoming calm, attentive, and interested in the world. You can help your child improve in this stage by helping him or her to look, listen, begin to move, and calm down. Her sense of security and awareness will help her understand more complex thoughts, help her brain develop, and lay the foundation for future learning.
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