DIR and Floortime: DIR and Floortime Gladys Wong, ST, Caritas HK Cousin Chan, ST, The Spastics Association of HK


DIR model – What is it?: DIR model – What is it? Pioneered by Drs. Stanley Greenspan and Serena Wieder A framework for a comprehensive, developmentally based approach to working with children with special needs Takes into account the child's feelings, relationships with caregivers, developmental level and individual differences in a child's ability to process and respond to sensory information


Slide3: D = Developmental Functional developmental capacities that integrate the most essential cognitive and affective processes I = Individual differences Biologically based differences in sensory processing, modulation, muscle tone, and motor planning and sequencing R = Relationships & affect Affective interactions build social and emotional developmental, intelligence, and morality


Treatment Goals in using DIR model: Treatment Goals in using DIR model To help the child master the healthy emotional milestones that were missed in his/her early development and that are critical to learning Building these foundations helps children overcome their symptoms more effectively than simply trying to change the symptoms alone


DIR model: DIR model Biologically Based Individual Differences Family, Community, Culture Child-Caregiver Interactions To master functional developmental capacities


Slide6: Affect- based Functional Developmental Evaluation Screening Developmental History Family Patterns Biomedical Assessment Review of Current Functioning Child/Caregiver Interactions Educational Program/ Peer Interactions Auditory Processing Sensory Processing Sensory Modulation Motor & Perceptual Motor Functioning *For details, see The ICDL Diagnostic Manual (ICDL-DMIC)


Slide7: Developmental Profile Biomedical Factors Individual Differences Functional Developmental Capacities Caregiver /Child Interactions & Family Patterns


DIR -- training: DIR -- training 2 major components: Child takes the lead to enhance interaction, e.g. the Floortime component Adult takes the lead to create new skills, e.g. semi-structured problem-solving interactions Interactions begin with child’s natural interests Then child learns how to respond to caregiver’s emotional gestures, behaviours, and /or words


Slide9: Affect is the central role in all learning and the model. It is affect that will help the child initiate actions, respond to others, generate ideas, find meaning, and symbolize experience.  Child should be challenged to keep reaching toward higher levels of interactions, problem solving, symbolic thinking and abstraction. Relationship and pleasure are essential for learning to be meaningful and progressive.


Functional Developmental Capacities: Functional Developmental Capacities Focus & attention Engaging & relating Simple two-way gesturing Complex problem-solving Creative use of ideas and symbols Analytic/logical thinking


Six Functional Emotional Development Levels (FEDL): Six Functional Emotional Development Levels (FEDL) Level 1: Shared attention and regulation (by 3 months) Ability to maintain a calm and focused state, respond to stimuli, e.g. look at/listen to/follow movement...


Six Functional Emotional Development Levels (FEDL): Level 2: Engagement and relating (by 5 months) Ability to show preference to attachment, e.g. shows affection towards caregiver by smiling / vocalizing to her or goes to her Six Functional Emotional Development Levels (FEDL)


Six Functional Emotional Development Levels (FEDL): Level 3: Two-way intentional affective signaling and communication (by 9 months) Ability to initiates intentional actions Ability to responds to adults’ initiation, and builds on adults’ action Ability to use language / gestures / voice during interaction Six Functional Emotional Development Levels (FEDL)


Six Functional Emotional Development Levels (FEDL): Level 4: Long chains of co-regulated emotional signaling (by 18 months) Ability to respond and initiate reciprocal back and forth chains of interactions e.g. mo introduce cup  child touch cup  mo drink with cup  child imitate and pour into cup  give to mom … Six Functional Emotional Development Levels (FEDL)


Six Functional Emotional Development Levels (FEDL): Level 5: Emotional ideas - representational capacities and elaboration (by 30 months) Ability to symbolize experience, to do pretend play or use language to convey emotional intention Ability to share ideas with others and represent ideas through play / activities Six Functional Emotional Development Levels (FEDL)


Six Functional Emotional Development Levels (FEDL): Level 6: Emotional thinking (36-48 months) Ability to make connections between different internal representations or emotional ideas (e.g. “I’m mad because you’re mean”) Ability to explain feelings for actions/events A foundation for higher level thinking, problem solving, ability to separate fantasy from reality Six Functional Emotional Development Levels (FEDL)


Floortime: Floortime Key concepts: Follow child’s lead Build on child’s own interests - may not be toys Open and close the circle of communication encourage interaction – use adult’s own affect and action, make the child engage with us – let child respond to us, build on what we said or done


Slide18: Be creative and playful- depends on the child’s developmental level, choose different toys to create a play environment Avoid structured games to reduce creative interaction; play obstructively to encourage interaction Uninterrupted 20-30 mins play Stay patient and relaxed


Slide19: Never stop an enjoyable activity Only rule for child: No hitting, No breaking, No hurting


Goal behavior Floortime activities: Goal behavior Floortime activities Linking Goals to Floortime Activies


Goal behavior Floortime activities: Goal behavior Floortime activities


Goal behavior Floortime activities: Goal behavior Floortime activities


Goal behavior Floortime activities: Goal behavior Floortime activities


Goal behavior Floortime activities: Goal behavior Floortime activities