DIR/Floortime: History

Transcription

1 Floortime

2 DIR/Floortime: History Founder: Dr. Stanley Greenspan, MD Floortime is a part of a larger philosophy of DIR: Developmental, Incidental-Differences, Relationship- Based intervention. Floortime video: ure=related Why learn about floor time?

3 DIR Developmental: Children s development is based on them meeting certain developmental guidelines. 1: Self-Regulation and Interest in the World 2: Intimacy 3: Two-Way Communication 4:Complex Communication 5: Emotional 6: Emotional Thinking

4 DIR Individual Differences: Specifically, motor planning & sensory sensitivities

5 DIR Relationship-Based: Floortime is the centerpiece of this element Focused on the parent-child relationship as the center of treatment.

6 DIR Definition: Floortime, a systematic way of working with a child to help him climb the developmental ladder, is the heart of what we call the developmental approach to therapy. It takes the child back the first milestone he may have missed and begins the developmental process anew. By working intensively with parents and therapists, the child can climb the ladder of milestones, one rung at a time, to begin to acquire the skills he is missing. What is a developmental approach? How does it differ from behavioral programming?

7 Floortime Consists of 3 parts: Parents do Floortime with their child, creating the kinds of experiences that promote mastery of the milestones. Floortime = minute period where parents interact with their child. All other professionals and educators use the same principles. Parents work on their own responses to create a family pattern that supports the growth of all family members.

8 Goals of Floor Time Intervention To help the child: become more alert take more initiative become more flexible tolerate frustration sequence longer actions - plan and execute them mediate process of finding solutions communicate gesturally and verbally take pleasure in learning

9 Step One: OBSERVATION Both listening to and watching a child are essential for effective observation. Facial expressions, tone of voice, gestures, body posture, and word (or lack of words) are all important clues that help you determine how to approach the child, e.g.:

10 Step Two: APPROACH - OPEN CIRCLES OF COMMUNICATION Once a child's mood and style have been assessed, you can approach the child with the appropriate words and gestures. You can open the circle of communication with a child by acknowledging the child's emotional tone, then elaborating and building on whatever interests the child at the moment.

11 Step Three: FOLLOW THE CHILD'S LEAD After your initial approach, following a child's lead simply means being a supportive play partner who is an "assistant" to the child and allows the child to set the tone, direct the action, and create personal dramas. This enhances the child's self-esteem and ability to be assertive, and gives child a feeling that "I can have an impact on the world." As you support the child's play, the child benefits from experiencing a sense of warmth, connectedness and being understood.

12 Step Four: EXTEND AND EXPAND PLAY As you follow the child's lead, extending and expanding a child's play themes involves making supportive comments about the child's play without being intrusive. This helps the child express own ideas and defines the direction of the drama. Next, asking questions to stimulate creative thinking can keep the drama going, while helping the child clarify the emotional themes involved, e.g.: suppose a child is crashing a car: Rather than ask critically, Why are those cars crashing? You may respond empathetically, Those cars have so much energy and are moving fast. Are they trying to get somewhere?

13 Step Five: CHILD CLOSES THE CIRCLE OF COMMUNICATION As you open the circle of communication when you approach the child, the child closes the circle when the child builds on your comments and gestures with comments and gestures of own. One circle flows into another, and many circles may be opened and closed in quick succession as you interact with the child. By building on each other's ideas and gestures, the child begins to appreciate and understand the value of two way communication.

14 Facts about Floortime The core concept of this approach: Parents follow the child s lead. Example of rolling cars

15 What does a Circle look like? Child engages in a behavior Adult approaches child and engages them Child responds in some way

16 What to do if Child perseverates? Join in Child refuses? Give them something else that they can refuse Child scripts? Child moves away? Make up your own script Child is aggressive? Playfully obstruct Child protests? Say no no no to encourage self-regulation Repairs the situation

17 Video Clips 1kU&feature=related BG0&feature=channel

18 Research Basis for Floortime Indirect support from National Academy of Science Report (2001) which stated that services should be tailored to the child s needs, and there is currently insufficient research on any of the treatment approaches for treating children with autistic spectrum disorders. It also noted that behavior programs were becoming more developmental in their approaches.

19 Benefits of Floortime a. Theoretically based on where child is in development (child-specific treatment) b. Theoretically systematic (builds on each milestone) c. Involves parents in child s treatment d. Sounds appealing because of the focus on social development, which is a high priority (often the highest) of parents.

20 Disadvantages of Floortime a. Not intensive enough: six-to ten minute sessions per day b. Does not target problem or selfstimulatory behaviors c. Requires parents to be therapists, and has very high demands on what that parent s emotional tone should be like.

21 An Example of a Floortime Family We altered our lives. We took Jacob to his therapies. We stopped watching TV. I gave up all sports. We stopped going out. We changed our diet. Rebecca began shopping at four different stores for food: the supermarket, two different health food stores and the kosher butcher. We blew bubbles, used sign boards, and put pictures of family members, therapists and foods on our walls. We used brushes, lotions, vibrators and massagers. We sprinkled vitamins in his food and bought cases of pear juice. We bought organic fruits and vegetables and sugarless lollipops. We learned sign language. We sat through three cycles of Tomatis auditory training. We went to a nutritionist and a homeopathic physician. We drilled into our ceiling and put up a therapeutic swing and nailed a 4 foot by 4 foot mirror into our den wall. Each therapist gave us a list of daily actions we were to take. We couldn t keep track of everything so we made lists and charts. Massage cheeks twice a day. Blow bubbles once a day. Vibrator twice a day. Massage palate once a day. Lotion once a day.

22 An Example of a Floortime Family Jake s progress was rapid and remarkable. After less than two weeks he was more connected and his non-verbal communication began to strengthen Within one month he began to engage in symbolic play. His non verbal communication developed rapidly By the following summer he was speaking in full sentences. Today he speaks for days at a time. He talks from the moment he wakes up to the moment he falls asleep, as if he is making up for lost time. He wants to know everything.

23 An Example of a Floortime Family Jake still does some things that one might consider odd. When he gets excited, often in play or while watching a movie, he shakes his head and runs back and forth. He hums a lot. You might say he has a difficult time modulating his emotions. On the other hand, you might say that he has a wonderful capacity for pure, visceral joy -- a quality many people in our society could benefit from.

24 An Example of a Floortime Family While the academics of school seem to be going wonderfully for Jacob, his relationships with his peers still seem to be a challenge. He is not quite there yet. We organize as many play dates as we can and they seem to go fine. Friends will now stay over for 2-3 hours. Because his interests are different from that of his peers, not all his classmates want to get together. Our list of available play date partners seems limited to a small cadre of friends.

25 An Example of a Floortime Family Group situations are more difficult for Jacob and generally, he finds himself on the periphery. Kids make fun of him. He doesn t participate in sports with them. They say he is different and it breaks my heart Sports and athletics are difficult. More often than not we both end up angry and frustrated

26 An Example of a Floortime Family Floor time still provides rich, wonderful opportunities for circles of communications. His imagination is lovely, rich and multilayered.