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The floortime or Developmental, Individual-differences, Relationship-based (DIR) model is a developmental model for assessing and understanding any child's strengths and weaknesses. This model was developed by Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation. [1]
The Developmental, Individual-difference, Relationship-based (DIR) model is the formal name for a new, comprehensive, individualized approach to assess, understand, and treat children who have developmental delays (including, but not limited to: Autism Spectrum Disorder). Focusing on the building blocks of typical development, this approach is also referred to as the "Floortime" or "DIRFloortime" approach. However, Floortime is actually a strategy within the DIR model that emphasizes the creation of emotionally meaningful learning exchanges that encourage developmental abilities.
The goal of treatment within the DIR model is to build foundations for typical development rather than to work only on the surface of symptoms and behaviors. Here, children learn to master critical abilities that may have been missed along their developmental track. For example, Autism Spectrum Disorder (ASD) has three core/primary problems: (1) establishing closeness, (2) using emerging words or symbols with emotional intent, and (3) exchanging emotional gestures in a continuous way. Secondary symptoms (perseveration, sensory-processing problems, etc.) may also exist. Thus, treatment options are based on particular underlying assumptions. The DIR model is based on the assumption that the core developmental foundations for thinking, relating, and communicating can be favorably influenced by work with children's emotions and their effects.
The DIR model was developed to tailor to each child and to involve families much more intensively than approaches have in the past. Through the DIR model, cognition, language, and social and emotional skills are learned through relationships that involve emotionally meaningful exchanges. Likewise, the model views children as being individuals who are very different and who vary in their underlying sensory processing and motor capacities. As such, all areas of child development are interconnected and work together beneficially.
The Floortime Model is a developmental intervention focusing on affection, with a fundamental assumption that emotions are the foundation of a child's development. It involves meeting a child at his or her current developmental level, and challenging them to move up the hierarchy of milestones outlined in the DIR Model. Once the child connects with the adult specific techniques are used to challenge and entice the child to move up the developmental ladder.
The DIR/Floortime Model calls for 15 hours/week of parent and clinician-conducted intervention, with the parent implementing the method in 20- to 30- minute sessions for 8–12 times per day. During each Floortime session, the child takes the lead by using pretend play and conversations. Parents and often therapists follow the child with playful positive attention while tuning into the child's interests. [2]
The DIR model is based on the idea that due to individual processing differences children with developmental delays, like ASD, do not master the early developmental milestones that are the foundations of learning. DIR outlines six core developmental stages [3] that children with ASD have often missed or not mastered:
Most typically developing children have mastered these stages by age 4 years. However, children with ASD struggle with or have missed some of these vital developmental stages. [4]
The DIR Model and the Floortime Approach work in two general parts: Assessment and Intervention. Within each of these two categories, there are further steps and strategies.
The initial step for assessment is [Screening]. The creator of the DIR Model, Stanly Greenspan, developed a measuring tool, the Greenspan Social-Emotional Growth Chart (GSEGC), to aid parents, caregivers and clinicians in this beginning step of assessment. This tool is a basic 35-item questionnaire that evaluates a child according to the social-emotional milestones he or she has met. [5] This preliminary step is a quick method to screen children for risk or diagnosis of Autism Spectrum Disorder (ASD) or Pervasive Developmental Disorder (PDD).
Following the initial screening process is conducting a [Comprehensive Functional Developmental Evaluation]. A child that has been screened with the GSEGC and displays significant developmental delay will then proceed to this step. In this process, a single clinician or clinicians of multiple disciplines (i.e. pediatrics, speech therapy, occupational therapy, psychology, etc.) must spend a significant amount of time observing a child. Specifically, the clinician(s) must be able to characterize how the degree to which a child is able to interact with others as it relates to developmental level. [6]
In the final step of Assessment an [Individual Developmental Profile] is created based on the Comprehensive Functional Developmental Evaluation [7] performed on the child. This profile is made to characterize a child's socio-emotional capacities. Through this profile, the DIR Model is able to tailor its intervention strategies uniquely to each child. [8]
Once the Assessment phase is completed the Intervention period is initiated. There are four different areas that the Floortime Approach aims its interventions: 1) Home 2) Educational Programs 3) Therapies 4) Play Dates.
First, the strategies and exercises laid out in the Home Intervention are of great importance for a child. It involves three core interactions: floortime; semi-structured, problem-solving interactions; and motor, sensory, perpetual-motor, and visual-spatial physical activities. [9] [ unreliable medical source? ] This home intervention, done primarily by the parents and family, is integral to the Floortime Approach. [10]
| INTERVENTION | ACTIVITY |
|---|---|
| Floortime | Play with child by following their lead |
| Semi-structured Problem Solving | Create tasks that build of the child's interests to encourage and nurture his or her problem solving skills |
| Motor, Sensory, and Perceptual-Motor Activities and Visual-Spatial Activities | Engage child in activities that are tailored to his or her unique needs as it relates to motor, sensory, and perceptual-motor and visual-spatial activities |
[11] [ unreliable medical source? ]
Second, interventions can also be applied through Educational Programs. Just as in the Home Interventions, the three core interactions are utilized in schools. Instead of primary caregivers carrying out these interactions it will be the responsibility of the teachers, teacher assistants, or peers. As an added efficiency measure, Individualized Educational Plans (IEP) can be collaboratively created and tailored for a child by his or her primary caregivers, teachers, or clinician. The IEP is developed with the purpose of outlining the goals of improvement for a child's specific developmental needs. [12]
Another component of the DIRFloortime Model Intervention is a multi-disciplinary approach through different therapies. According to a child's Individual Developmental Profile, primary caregivers or clinicians can determine what types of therapy will benefit a child based on his or her developmental need. . [13] [ unreliable medical source? ] Greenspan highly recommends the use of adjuvant therapies including Speech Therapy, provided by Speech Language Pathologists, and Sensory Integration Therapy, provided by Occupational Therapists. [14] As a child's primary occupation is play, Occupational Therapy is a particularly relevant field to the Floortime Method. [15]
In 2020, Boshoff et al. concluded in their systematic review over nine studies that an increase in children's socio-emotional development is observed through various outcome measures and consistent with the focus of the model. Other areas of development have received limited focus by existing studies. [2]
The effectiveness of Floortime was examined in four randomized controlled trials in which the control group receive the usual therapies (e.g., speech therapy, occupational therapy). [16] [17] [18] No evidence of effectiveness has been found across the many trials that have been performed [19] Language function in the Floortime groups did not improve beyond what was observed in the controls. No adverse effects of Floortime have been reported. [20]
Asperger syndrome (AS), also known as Asperger's syndrome, formerly described a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior, interests, and activities. The syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses that were merged into ASD by relatively unimpaired spoken language and intelligence.
The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Diseases (ICD).
Occupational therapy (OT) is a healthcare profession that involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to improve mental and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). While OTs and OTAs have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments.
Relationship Development Intervention (RDI) is a trademarked proprietary treatment program for autism spectrum disorders (ASD), based on the belief that the development of dynamic intelligence is the key to improving the quality of life for autistic people. The program's core philosophy is that autistic people can participate in authentic emotional relationships if they are exposed to them in a gradual, systematic way. The goal of treatment is to systematically build up the motivation and tools for successfully interacting in social relationships, to correct deficits in this area that are thought to be common to all autistic people.
Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, motor disorders, and autism spectrum disorders. In broader definitions ADHD is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.
Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from unavailability of normal socializing care and attention from primary care giving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between three months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder.
Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".
Stanley Greenspan was an American child psychiatrist and clinical professor of Psychiatry, Behavioral Science, and Pediatrics at George Washington University Medical School. He was best known for developing the floortime approach for attempting to treat children with autistic spectrum disorders and developmental disabilities.
Reading for special needs has become an area of interest as the understanding of reading has improved. Teaching children with special needs how to read was not historically pursued due to perspectives of a Reading Readiness model. This model assumes that a reader must learn to read in a hierarchical manner such that one skill must be mastered before learning the next skill. This approach often led to teaching sub-skills of reading in a decontextualized manner. This style of teaching made it difficult for children to master these early skills, and as a result, did not advance to more advanced literacy instruction and often continued to receive age-inappropriate instruction.
The following outline is provided as an overview of and topical guide to autism:
Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.
Dyadic developmental psychotherapy is a psychotherapeutic treatment method for families that have children with symptoms of emotional disorders, including complex trauma and disorders of attachment. It was originally developed by Arthur Becker-Weidman and Daniel Hughes as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers. Hughes cites attachment theory and particularly the work of John Bowlby as theoretical motivations for dyadic developmental psychotherapy.
Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism,Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.
Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulty with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.
Rebecca School is an independent private day school in New York City that specializes in teaching children ages four to twenty-one who have a range of neurodevelopmental disorders, including autism spectrum disorder (ASD). The school was founded in 2006 and uses a special teaching method known as Floortime/DIR developed by Stanley Greenspan, M.D., a child psychiatrist and specialist in autism education who died in 2010. Greenspan's method was a change from the more traditional methods that sought to change behavior through conditioning using rewards and punishments. His method focuses on children's ability to build relationships. Rebecca School's space and facilities on East 30th Street were specially designed for the needs of autistic and special needs children, based on Dr. Greenspan's ideas. The school utilizes not only teachers who are trained to work with special needs students, but also social workers who work with the families of the students.
A late talker is a toddler experiencing late language emergence (LLE), which can also be an early or secondary sign of an autism spectrum disorder, or other developmental disorders, such as fetal alcohol spectrum disorder, attention deficit hyperactivity disorder, intellectual disability, learning disability, social communication disorder, or specific language impairment. Lack of language development, comprehension skills, and challenges with literacy skills are potential risks as late talkers age. Outlook for late talkers with or without intervention is generally favorable. Toddlers have a high probability of catching up to typical toddlers if early language interventions are put in place. Language interventions include general language stimulation, focused language stimulation and milieu teaching.
Sensory processing disorder is a condition in which multisensory input is not adequately processed in order to provide appropriate responses to the demands of the environment. Sensory processing disorder is present in many people with dyspraxia, autism spectrum disorder and attention deficit hyperactivity disorder. Individuals with SPD may inadequately process visual, auditory, olfactory (smell), gustatory (taste), tactile (touch), vestibular (balance), proprioception, and interoception sensory stimuli.
Daniel Messinger is an American interdisciplinary developmental psychologist, and academic. His research works span the field of developmental psychology with a focus on emotional and social development of children and infants, and the interactive behavior of children in preschool inclusive classroom.
The Early Start Denver Model (ESDM) is a form of intervention directed at young children that display early signs of being on the autism spectrum proposed by American psychiatrists Sally J. Rogers and Geraldine Dawson. It is intended to help children improve development traits as early as possible so as to narrow or close the gaps in capabilities between the individual and their peers.
The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.
