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DIR® FLOORTIME™

ASSESSING AND SUPPORTING THE DEVELOPMENT OF CHILDREN WHO HAVE DIFFERENT TRAITS WITH DEVELOPMENTAL APPROACH

Infancy and early childhood is a period that is important in terms of emotional, social, language, cognitive, motor, and sensory perception regulation development. It is essential for developmental approach to consider the relationship between the baby/children parent, family, and environment, while observing the infant/child

Dr. Stanley Greenspan, Child Psychiatrist, suggests transforming the relationship between children and their family into interactive relation that contains trust and pleasure and play. Briefly, with the approach called FLOORTIME™ by Dr. Greenspan, shows that parents understand their children better and it is possible to support their development, while it is easier to cope with every day problems of children. Dr. Greenspan has various published scientific articles and books about FLOORTIME™ which is the product of his long years of work that is supported by NIH (National International Health Organization). Later on, he started to apply this approach with children who have severe difficulties and their families, while he developed the model DIR® FLOORTIME™ with Psychologist Serena Wieder.

DIR® FLOORTIME™ presents multi-dimensional system to support the assessment and development of babies and children, who show different developmental characteristics. Children with Autism Spectrum Disorder (ASD), developmental retardation, Down Syndrome, speech and language disorders, attention, emotional and impulsivity problems are the children, who are part of this group.

DIR: It is developed by gathering the first letters of the words the developmental, individual and relationship based, which summarize what kind of an approach it is for assessment and therapy of the model

D DEVELOPMENTAL
I INDIVIDUAL
R RELATIONSHIP BASED

D: DEVELOPMENTAL:
Dr. Greenspan specified six developmental levels, which defines cognitive and emotional development, in order to understand and assess better, the development of the baby and the child. These developmental levels provide us possibility to approach to the child in a way that, not only considering the child’s chronological age, but understanding, which level that the child belongs to developmentally. This is the important difference that discriminate developmental approach from the other methods.

If we were to summarize the developmental levels briefly:
1. To be able to stay calm and obtain attention,
2. To maintain and establish shared attention,
3. To be able to receive and deliver emotional and social messages, which includes all kinds of communicational signals,
4. To be able to solve problems together and to organize behaviors in direction of a certain thought with another person.
5. To play symbolic and creative games, associating by building bridge between thoughts.
6. Developing logical thinking.

These developmental characteristics are important to develop academic skills as well as establishing and maintaining social relationship automatically.

I: INDIVIDUAL:
Each child has individual characteristics to regulate himself, such as, calm one self and response to stimuli. Some children might react extremely to stimuli that they perceive with their senses, such as, light, sound, taste, touch, etc. They might show differences when using the process of the stimuli. It is important to take in consideration that these characteristics will influence the child’s communication and his compatibility with the environment that he is included. Accordingly, these characteristics, also, will influence the development and the apprehension of the child.

R: RELATIONSHIPBASED:
The child meets with lots of people such as parents, relatives, peers, educators and therapists in the social environment that he belongs to. These individuals will constitute foundation which supports the child’s development with interaction that is based on warm and trustful reciprocity.

HOW DOES THE ASSESSMENT APPLIED IN DIR® FLOORTIME™?:
A developmental assessment is presented in this model, instead of obtaining child’s chronological age and applying a question & answer test on the table in order to retrieve certain scores to compare the child with his peers. Outline of this assessment can be summarized as follows:

-Detailed information is obtained about child’s development since birth by interviewing the family.
-The essential part of the assessment is to observe the interaction of the child with his mother, father, or caregiver. Thereby, it becomes possible to notify the pathway that the parents must follow through out the therapy process and to support their child. Separate sheets of assessment forms are utilized for child and parent in the course of observation.
- The assessment is functional. It does not asses child’s skills or IQ levels. However, it observes child’s performance as a social individual by assessing child’s coherence and relaxation in his environment, interaction with individuals, the way he plays with the toys and the way he uses the materials.

Starting from level of 0-3 months within FEDL Functional Emotional Development Levels, child’s performance and the level of his performance are determined according to the observation. With this, it executes what affected and restricted child’s performance in these levels.

-Child’s individual differences and the way he copes with these differences are assessed according to the observation. Affects of the way the child assesses the information perceived through senses, sensory sensibilities and general development are determined. This is the essential part of assessing individual differences such as, overreacting to certain sounds, inability to touch slippery and flexible materials, unable to touch different surfaces, disliking when the child is touched, and having hard time to tolerate grainy foods.

- The child’s strong aspects and aspects those are needed to be supported are determined by monitoring peer interaction and socialization skills of the child.
- While communicational characteristics and speech and language skills are evaluating, not only word usage and comprehension of the receptive language are assessed, at the same time, non-verbal communication, the way emotions are expressed, reaction to emotions of others, intention to communicate and shared communication are also assessed.

DIR model is presenting various scales that depend on observation, in respect of the developmental road map, so the babies and the children with different developmental characteristics could be assessed. Professionals who have completed their educations in different lines of work such as psychiatrists, psychologists, educators, speech and language therapists, and occupational therapists could use DIR model within their occupational education and they could apply the assessment and choose appropriate goals to support the development.

Therapy:
The goals that are determined for the therapy are shared with the family. It is important for families to meet with the child’s level according to development age, which the results of the assessment showed, as well as it is important for families to identify the developmental characteristics of the level that their child belongs to. Then, how the individual differences effect the daily life is shared with the family. For example: It should be taken into consideration that in order to interact with If the child is affected from bright light and loud noise it is important to eliminate these factors. This is important take into consideration these factors when interacting with children. For instance shutting the curtains and dimming the light could help child with these differences to interact.

The essential part of therapy is to have mutual interaction with the child while maintaining a relationship, which evolves warmth, love and trust. FLOORTIME™ can be summarized as interacting and playing with this principle while supporting child’s emotional, social, and intellectual development.

What is FLOORTIME™?
Briefly, FLOORTIME™ can be summarized as, playing with interaction that includes warmth, emotion and trust, while considering child’s individual differences and the characteristics of the developmental level that he belongs to. It is important to develop and learn child’s social, emotional, and cognitive capacities by deriving from child’s emotions and the subject and materials that he is interested in. The therapist, who is applying FLOORTIME, interacts with children according to specified goals that are derived from the assessment results. However, the main goals are to educate and support the parents about the ways that they can apply these principles into their daily lives. The role of the therapist is to guide the family, develop new goals, and be model about the ways in reaching to these goals. Also, the therapist looks for solutions and presents proper ways to approach to the problems that are encountered in the daily life of the child, according to the characteristics and individual differences that are special for him.

HOW DOES THE FLOORTIME PRACTICED?
The first step is to getting to know the child. The therapist guides the family about this subject. Shortly, we can start by observing the child, understanding his intention and joining to the child. With the lead of the child, the interaction is started with a game or a toy that interests the child. However, the aim is to develop this interaction in accordance with specified goals. Meanwhile, the aim is to bring up the child within his developmental levels by rendering an enjoyable and prolonged the interaction. At this point, it is important to apprehend, why FLOORTIME™ is a therapeutic approach and it is crucial to understand the difference between any type of playing style and FLOORTIME™.

Many mothers and fathers emphasize the importance of emotional and social bond by using the expressions such as, “I understood that I am a mother”, “I feel that there is a bond building between us” after meeting with this technique.

WHO CAN PRACTICE THE FLOORTIME?
Everyone. The mothers and fathers, who want to become FLOORTIME™ practitioners, could retrieve meeting seminars that are made over the Internet through ICDL’s web site. So, they can have broad information about DIR® FLOORTIME™; www.icdl.com. Also, you may join to family seminars that we organize as Günışığı Child Center.

However, if you wish to create your child’s therapy program by implementing FLOORTIME™, you will need a therapist who can identify the educational goals by doing an assessment and maintain your education by working with you and your child. This therapist may belong to any one of the various occupational groups such as psychologist, speech and language therapist, and educator. However, this therapist should be a clinician who has received the proper trainings from ICDL in order to become a sufficient practitioner.

As Günışığı Child Center team, we received and still receiving FLOORTIME™ training and our FLOORTIME™ team members are composed of different occupational groups such as speech and language therapists, clinical psychologists and developmental psychologists. We are pleased to be pioneer FLOORTIME™ in our country. As a team, we are maintaining our training by attending the summer institute programs that are provided in USA and we are receiving clinical supervision from the professionals, who are in abroad by video conference connections. Additionally, Rosemary White OTR (ICDL faculty), occupational therapist and ICDL trainer, has supported our work by providing clinical supervision and conducting seminar in İstanbul in 2009 and 2011, in order to aid us to understand better the individual differences of children as we create their programs.

The professionals, who desire to become a FLOORTIME™ therapist, may attend online courses provided by icdl.Please visit www.icdl.com for detailed information. We are proudly announce the first DIR Floortime Introductory Course in Istanbul at April 13-14 2013.

Overlook at the Psycho-educational Process and Results in Autism Spectrum Disorder

Principles of Applied Behavior Analysis (ABA) evaluate the behaviors that are based upon IQ, pre-academic skills and reaction. However, DIR FLOORTIME evaluates and supports the development in a functional way. In National Research Council, 2001, the importance of being able to initiate communicational skills of one self in functional activities and generalizing the language skills in different environment and activities, in order to evaluate development, is emphasized.*

*Lord Catherine; Mc Gee, James(ed) Committee on Educational Interventions for Children with Autism. Division of Behavioral and Social Sciences and Education, National Research Council. Washington DC: National Academy press (2001) p217.

Gunisigi Child Center Assessment and Therapy Services - Istanbul