Experts agree—when diagnosed with a developmental disability
such as autism, early intervention is crucial. Yet, the same experts don’t
always agree on which interventions are most effective. With some professionals favoring behavioral
approaches such as Applied Behavior Analysis (ABA), Pivotal Response Training
(PRT) and Verbal Behavioral Analysis (VBA), others believing in developmental
models such as P.L.A.Y. PROJECT, SCERTS and DIR (Developmental, Individualized,
Relationship-based model) Floortime, and still others recommending a
combination of interventions, parents have their work cut out for them. It can
be overwhelming to decide what therapies will best meet your child’s needs.
In this week’s blog post, we learn about the DIR Floortime
approach and speak with Sima
Gerber, Ph.D., CCC-SLP, a trained DIR Floortime practitioner,
speech/language therapist and professor of of Speech-Language Pathology in the Department of Linguistics and
Communication Disorders of Queens College, City University of New York. Gerber
specializes in working with children on the autism spectrum and has been using
the DIR Floortime model in her therapeutic work with children for the past 25
years. She has worked as a speech-language pathologist for 40 years.
E.D.: What is the
history of DIR Floortime?
S.G.: The DIR
Floortime model was conceived by the late Stanley Greenspan, a child
psychiatrist and Dr. Serena Wieder, a child psychologist. In the 1970s Dr. Greenspan was working on the Clinical Infant Development Program, an
NIMH clinical research study research study and he asked Serena to join him in 1978. In those days,
autism was [at least thought to be] relatively rare.
Dr. Greenspan thought the usual ways of describing
development were not holistic enough. He wanted a model that brought together
all aspects of a child’s biology and environment. In DIR you’re looking at where
a child is in terms of her social and emotional development, regulation, cognitive,
motor and communication skills.
Can you summarize DIR
Floor-time?
DIR is a paradigm for describing a child’s developmental
status. Floortime is a way of interacting with a child that
facilitates development. DIR has nine functional emotional developmental levels, each
of which is a capsule of what’s happening in the child’s development. While the
levels are chronological, since this paradigm is used to describe children with
developmental challenges, a child’s level could vary significantly from the
chronological developmental stages of typically developing children.
Please provide a
general idea of how Floortime works
During Floor-time [preferably during play], the adult
interacts with the child, following his lead. It doesn’t have to look like
typical play. The adult tries to woo the child into a reciprocal, engaged
interaction and to gradually move the child from the developmental stage where
he’s at, to the next stage. For example, when I work on language using a developmental
approach I start where the child is. If he’s 4 and just making sounds, I don’t
try to teach him to speak like typically developing four-year-olds speak. I
join in his sound making and see if we can expand on it.
If a child is rolling a car back and forth but not really
interacting with his parent, the parent can get down on the child’s level and
join in his delight about rolling the car.
The parent might get a car herself and try to bump it into the child’s
car so he notices her. She might bring a
little ramp and then try to catch the child’s car or say, “Wowee look at that
car go!”
[The parent can] play
a little game with the child; perhaps playfully try to take the car away. Even
if the child becomes upset that’s still progress since that’s an interaction
that‘s interpersonal. Of course, don’t overdo it or the kid will get too
frustrated.
The point is: When
the child is doing something repetitive like rolling the car back and forth,
don’t try to stop him from doing that. Instead, join him. Sometimes when I’m working with a child, I might have a more
physical option such as a trampoline available. If he doesn’t go to the trampoline on his own, I might jump
it or say some words that remind him of the chase game. “I’m going to get you …” I might put a stuffed animal on the trampoline and make the
stuffed animal jump up and down. It’s all about what the child is doing.
How much time does a
parent need to dedicate to DIR Floortime?
As many hours a day as possible, but it doesn’t only have to
be during playtime. Let’s say it’s bath-time. Pay attention to what the child is
doing. If she’s obsessively popping
bubbles, you pop bubbles too. Try to make a game of it.
Which children can
benefit from DIR Floortime?
Any child can benefit from DIR Floortime. It’s a way of interacting
with children that promotes healthy interpersonal development. It’s become
associated with autism but its benefits are not necessarily limited to kids on
the spectrum.
Can you describe a success
story?
I’ve worked with 15-year-old Matthew for 10 years and I
attribute his success to his mother. She was either a Floortime “natural” or
just learned it very quickly. It was easy for her to get the principles and get
“in the Floortime zone.”
Matthew did a lot of scripting. He would recite lines from movies and TV
programs. My suggestion to his mother was to join the script. So, if Matthew
said a line from “Finding Nemo,” his mother would say, “Finding Nemo?” So he would keep scripting. She would say, “Really?” “He
did?” Or she might take a line from the
script and say it back to him. It’s very hard to listen to a kid who goes on and
on talking about the same thing. Many parents would say, “No more talking about
Nemo.”
But when you join kids who script, 99 percent of the time,
they’ll look at you. They’re saying something meaningful to them and if you
join them there’s a better chance they’ll interact. Matt’s mother did this with
every interaction. And she was very laid back. If he was doing something
inappropriate in my waiting room, she didn’t keep saying ‘Stop it Matt, “Come
back here, Matt.” Instead, she waited and let things happen. That way, he wasn’t
always being told he was doing something wrong. She was also very tuned into his regulatory
problems. By that, I mean she understood his bodily needs. For example, she
knew he was often agitated and had trouble focusing during therapy. So, before
his therapy session, she would do physical activities with him to help center his
body. Now he’s a skateboarder. Matt’s mother had energy for everything he wanted to do. She
took him to the skateboard park as frequently as possible, despite having two
other children, one with special needs.
Where is Matthew now?
He just graduated from a special middle school for children
with language and communication challenges. He’s very social, interested in having girlfriend. He plays
drums. He’s interested in sex, drugs and rock and roll! He has a good sense of
humor and is very appealing. I don’t think you would notice he had autism on first glance,
but after a while you might see that he is different. He’d want to talk about
skateboarding. And he has poor judgment, and no theory of mind. When he
grows up, he won’t be able to live on his own. He’ll probably live in
supervised setting but I think he will be able to have a job. He reads and
writes. He’s happy.
What would you add?
Stan [Greenspan] and Serena started talking about this model
a long time ago. Nowadays, these principals are getting a lot more attention
from neuroscientists. Finally the science is catching up.
For more information and free resources on DIR Floortime and
other interventions for developmental disabilities, visit Profectum.org and KidsAttune.org
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