DIR®/Floortime™

Sharon Duval, M.A., CCC/SLP

The Monarch School

www.monarchschool.org

Autism One 2008 Conference

 DIR® is the Developmental
Individualized Relationship
Approach developed by Stanley
Greenspan, M.D. and Serena
Wieder, Ph.D.
It is a developmental approach that
engages a child at his/her current
level of functioning, works with the
unique features of their nervous
system and utilizes intensive
interaction experiences to enable
them to master new
capacities.
 •“D” REPRESENTS FUNCTIONAL
DEVELOPMENTAL LEVELS
• In the last 10-20 years,The Interdisciplinary
Council on Developmental and Learning
Disorders put together what they call a functional
developmental roadmap that reflects their
understanding of the core levels that synthesize
and integrate all of the developmental
capacities. www.icdl.com
“I” REPRESENTS INDIVIDUAL
DIFFERENCES IN
PROCESSING
“R” REPRESENTS INTERACTIVE
RELATIONSHIPS AND USE OF
AFFECTS
 6 Core Functional Developmental
Levels
• 1) Regulation and shared attention
• 2) Engagement
• 3) Two-way communication
• 4) Interactive problem solving
• 5) Functional use of ideas
• 6) Building bridges between ideas
 •Variations exist in underlying motor and
sensory processing, i.e. regulatory
capacities.
•These are the important underlying
processing capacities that are behind
children’s worrisome behaviors such as
self/absorbed/withdrawn, self -stimulation
/repetitive movement, rigidity, inflexibility,
difficulty making transitions, aggression,
self-abuse, destructive behaviors.

• Children are individually different in the way they

process information.
Studies have documented that
interactive experiences can
actually change the physical
structure of the brain.
 Affect, emotions and
relationships are important for the
growth of the brain and mind.
The mind and brain grow most
rapidly as an outgrowth of
interactive experiences.
 After 20 years of studying
large numbers of children and
their families, the fundamental
types of interactive experiences
were identified that are most
critical for healthy development.
CRITICAL FEATURES OF THESE
INTERACTIONS
•Interactions which feature warmth and security
•Interactions which feature regulation so that the
child is not overwhelmed
•Interactions which feature a lot of relatedness
and engagement
•Interactions which feature a lot of back and forth
emotional signaling and gesturing
•Interactions which feature problem solving
•Interactions which feature using ideas in a
meaningful and functional way
•Interaction which require thinking and reasoning
 Most essential are lots and lots of
interactions with children that
exchange emotions and have to do
with the fundamental sense of
relatedness.
• Language, cognition (including math and
quantity concepts), as well as emotional
and social skills are learned through
interactive relationships which involve
affective exchanges.

• Without fundamental relating, language

and cognition do not develop well.
 Affective Exchanges
• A child can control and regulate emotions and
facial expressions that convey emotions much
earlier than they can control motor behavior
• Emotions lead the way all the way through
• Emotions activate the motor system
• Emotions are the organizer for all parts of the
mind.
• They are especially
important when we
get to abstract thinking.
 Two levels for Child to learn
emotional concepts
• Lived emotional experience
• Must live every word first to understand it.
A Relationship-based approach
to children with special needs
that is family, cultural and
community based.
 Relationships and emotional
interactions occur within
• Child/caregiver
• Child/educator
• Child/therapist
• Whole family pattern
• Cultural and community contacts
 The DIR® Approach enables
caregivers, educator and
therapist to construct a
comprehensive program to
mobilize each child’s intellectual
and emotional growth.
 DIR® Comprehensive Program
includes:
• A model for assessment

• A model for intervention

 DIR® MODEL OF
ASSESSMENT
• Begins with a review of a child’s current
functioning, history and observations of
the child with caregivers.
• The best assessments take place over a
period of time rather than in the space of a
single day.
 OBERVATIONS OF CHILD WITH
CAREGIVER INCLUDE
• Looking at biological challenges – individual processing differences
and motor profile.
• Identifying individual differences in each child’s strengths and
weaknesses.
• Looking at the way child relates to caregivers and the way his/her
caregivers relate to him – patterns of interaction.
• Observing the use of language, cognitive capacities and overall
health.
• Observing where the child is in Functional Developmental Levels.
• We observe the ways in which his profile influences his interactions
with caregivers and ways in which caregiver patterns influence his
developmental progress.
Parent/child interactions reveal
the child’s capacity for relating
and interacting and may the
venue in which the child is
most likely to perform at his
highest level.
 Standardized Tests
• If needed, standardized tests are used
after the child is observed interacting and
playing with caregivers.
DIR® MODEL OF INTERVENTION
• Construct a child’s unique profile which
includes his functional abilities.
 Child’s Individual Profile includes:

• Identifying unique processing differences in

terms of how the child reacts to sensations,
processes information, plans actions, and
sequences behavior and thoughts.
• Level of functional emotional, social, and
intellectual capacities
• Typical and necessary interaction patterns
• Family patterns.
 The profile enables parents and
professionals to construct an
intervention plan geared to each
child’s individual characteristics.
 Comprehensive Functional
Developmental Intervention
Program

• Specific Therapies
• Home program
• School program
• Family support
• Medical Intervention
 Home Program
• Spontaneous developmentally appropriate
interactions (Floortime™)
• Semi-structured problem solving
interactions
• Motor, sensory, and visual/spatial
activities.
 CONNECTED CHOICE ACTIVITIES:
•         Play a Board Game
•         Puzzles with Someone
•         Make or Build Something with Someone
SOLO CHOICE ACTIVITIES:
•         Build something with Legos
•         Build a model
•         Read a book on a favorite topic
•        Play an approved computer game
 MOVEMENT CHOICES:
•         Play with neighborhood kids
•         Jump on trampoline
•         Play actively with dog
•         Play creatively and actively outside

•         Swim
•         Play basketball
•         Ride bike
•         Skate
 School Program
• Class Structure
• Spontaneous developmentally appropriate
interactions (Floortime™)
• Semi-structured problem-solving
interactions

• Motor, sensory, and visual/spatial

activities.
FLOORTIME™
 Intervention Strategies to Develop
Mutual attention and Engagement
• Follow child’s lead and join them – it does
not matter what they do as long as they
initiate the move
• Persist in your pursuit
• Treat what the child does as intentional
and purposeful – give new meanings
• Help child do what they want to do
• Position yourself in front of the child
• Invest in whatever they initiate or imitate
• Join perseverative play
• Do not treat avoidance or “no” as rejection
• Expand, expand, expand – keep going,
play dumb, do wrong move, do as told,
interfere, etc.
• Do not interrupt or change the subject as
long as it is interactive
• Insist on a response