DIR Model Floortime. Gary Jones Ph.D. Rachel Ottley OTR/L

Transcription

1 DIR Model Floortime Gary Jones Ph.D. Rachel Ottley OTR/L Oklahoma Statewide Autism Conference November 6 & 7, 2009

2 ICDL Interdisciplinary Council Developmental Learning Disorders

3 Founders of the ICDL Stanley I. Greenspan, M.D., child psychiatrist Serena Wieder, Ph.D., psychologist

4 What is DIR? Developmental Individual-Differences Relationship-Based Model

5 The D in DIR Functional Emotional Developmental Levels Opens pathways for Normal emotional development A fully developed sense of self Cognitive development Higher-level thinking Development of relationships Partial mastery of a stage leads to constrictions in relating, communicating, and thinking.

6 The 6 Functional Emotional Developmental Levels Level 1: 0-3 mo Self Regulation and Interest in the World Level 2: 2-7 mo Intimacy, Engagement, Forming Relationships Level 3: Two-Way Communication 3-10 mo Reciprocal Emotional Signaling/Intention

7 FEDL continued Level 4: Complex Communication 9-18 mo Shared Social Problem Solving Mood Regulation Sense of Self Level 5: Emotional Ideas mo Creating Ideas and Elaboration Level 6: Emotional Thinking mo Connecting Ideas & Logical Reasoning Sense of Reality

8 The I in DIR Individual-Differences Register and React Process, Organize, and Integrate Motor Planning and Sequencing

9 The R in DIR Relationship Central organizer of the child Built on affective interactions Affect is the fuel of interaction Language is the vehicle

10 What is Floor Time? Systematic approach Mobilizes emotional development Opens up all the Intelligences

11 Guiding Principles of Floor Time 1. Follow the child s lead. 2. Work within the child s individual sensory profile. 3. Use facial, gestural and vocal communication. 4. Engage the child in whatever way it takes. 5. Embrace all the emotions. 6. Open the door to symbolic play.

12 Level 1: Self Regulation and Interest in the World Learn to take in sights, sounds, touch, taste, smell, movement without being overwhelmed Develop a modulated and regulated sense of togetherness Focused, organized, & calm even under stress

13 Sensory and emotional regulation work together Affect links sensations coming in to a coordinated motor response Child and parent learn what draws child s attention and calms them

14 Core deficits Lack of sustained, purposeful attention Dysregulation Withdrawing from the world Hyperfocus on one type of input

15 Level 2: Intimacy, Engagement, Forming Relationships Shared moments of joy Relationship grows through mutually enjoyable interactions Definite interest in the human world

16 Experience all emotions & sustain engagement through them Increased engagement individual differences

17 Core deficits Fleeting engagement Self absorption Sensory processing challenges make interactions with others confusing, scary or painful Limited mutually enjoyable interactions

18 Strategies for Strengthening Levels 1 & 2 Be a detective preferred sensory system Takes cues from child in terms of what brings them pleasure Join object of their attention or their game Interact, not just passively follow Stretch child s shared attention

19 Sensory hypersensitivities & cravings can limit attention and lead to dysregulation The right sensory input can help a child stay engaged and strengthen engagement Use motivating interest, activities and objectives to harness emotional energy of the child Be a good co-regulator

20 Persist over multiple rejections Use playful obstruction Look for synchrony and timing Do whatever it takes to create an interaction

21 Level 3: Two-Way Intentional Communication Beginning to utilize a gestural system of communication hands, face, feet, posture Also emerging vocalizations & vocal tone for communication Emotional and social interactions, as well as making needs known

22 Back and forth communication circles of communication Circles of Communication with Intention 3-4 circles by 8-10 months circles by months 30 to a continuous flow by months

23 Learn social reciprocity & begin to interpret social signals Learn affect based cause and effect Respond to other s emotional signals Uses repair strategies Enjoy each other s company

24 Core deficits Brief interactions Passive two way communication adult initiated Aimless or avoidant behavior Difficulty interpreting and responding to non verbal cues

25 Strategies for Strengthening Level 3 Respond to verbal and non verbal attempts to communicate Treat everything as purposeful WAIT Be animated Increase own non verbal and gestural communication Welcome all emotions

26 Be helpful, but don t do it for them Use developmentally appropriate toys & interaction Can t teach social skills with memorized rules have to learn and interpret social signals and how to respond to them

27 Level 4: Purposeful Complex Communication Communication is increasingly spontaneous and is driven by a purpose. Child recruits others to help them solve problems. Long chains of interaction - 30 to 40 in a row. Mood is regulated by communicating needs.

28 Strategies for Strengthening Level 4 Expand the conversation with simple what, who, where questions. Create a need for the child to be more specific (e.g. pretend to be confused). Identify problems that must be solved for the play to continue & encourage brainstorming.

29 Level 5: Creating & Elaborating Symbols (Ideas) Capacity to represent or symbolize experience Pretend play is now possible. Imagination elaborates symbols. Emotions can now be expressed through words instead of actions.

30 Strategies for Strengthening Level 5 Join the child in dramatizations of their ideas. If he is cooking -- be the customer. Integrate emotions into the play. If her doll is knocking over furniture -- provide an emotion She must be mad! Provide a third party to offer solutions or explanations.

31 Level 6: Building Bridges Between Symbols Ideas are connected through logical thinking. Child can answer why questions. Play takes into account concepts of time, space, quantity and quality. Play is more sequential and less chaotic.

32 Strategies for Strengthening Level 6 Express confusion if the child s play doesn t make sense There are 2 moms? Express shock if the child s play contradicts reality Your dog can fly? Demonstrate a logical reaction to certain behaviors My puppy gets scared when someone yells at him.

33 Websites Conferences and training Publications Parent friendly Web radio archives

34 References Greenspan, S.I., G. A. DeGangi, and S. Wieder The Functional Emotional Assessment Scale (FEAS) for Infancy and Early Childhood: Clinical & Research Applications. Bethesda, MD Greenspan, S.I., and S. Wieder The Child with Special Needs: Encouraging Intellectual and Emotional Growth. Cambridge, MA: Perseus Books. Greenspan, S.I., and S. Wieder Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Cambridge, MA: Perseus Books. Greenspan, S.I., and D. Lewis The Affect-Based Language Curriculum (ABLC). Bethesda, MD:ICDL Interdisciplinary Council on Developmental and Learning Disorders' Clinical Practice Guidelines: Redefining the standards of care for infants, children, and families with special needs. Bethesda, MD:ICDL

35 Contact Information Rachel Ottley, OTR/L TherapyWorks 7608 E. 91 st St. Tulsa, OK Phone: