OccupationalTherapy.com Phone: 866-782-9924


DIR/Floortime: A Practical Tool For Occupational Therapy Practitioners

DIR/Floortime: A Practical Tool For Occupational Therapy Practitioners
Gina Taylor, MS, OTR/L, HPCS
September 3, 2019

To earn CEUs for this article, become a member.

unlimited ceu access $99/year

Join Now
Share:

Overview

  • DIR Model
  • Functional Emotional Developmental Capacities
  • How to use DIR
  • Floortime as an Intervention
  • How to use Floortime
  • Goal attainment
  • Questions

I am really excited to talk about DIR/Floortime today. It was one of the tools that helped me as a new clinician to work with children. I am hoping that after this webinar you will feel like you have some new tools and ideas that you can implement immediately. We are going to cover a lot of material today. I am going to give you a brief overview of the DIR model, and we are going to look at the functional emotional developmental capacities are. We are going to look at the DIR model and then see how the Floortime can be an intervention in OT sessions. We are also going to look at how to use Floortime and the DIR model for goal attainment.

What Is The DIR Model?

  • The D stands for Developmental
  • The I stands for Individual Differences
  • The R stands for Relationship-based

It includes an assessment portion that is completed by clinicians, parents, educators, and the interdisciplinary team. The DIR focuses on speech-language, OT, mental health, any educators that would be working with the child, and the families as well. The intervention plan is typically home-based. It is based on developmentally appropriate activities for the family to complete. These are structured Floortime sessions, semi-structured problem-solving, which we will get into more detail as we go through today, sensorimotor and visual activities, and peer play, typically with one other child, to build on these functional emotional developmental capacities.

The "D" stands for developmental. We are looking at where the child is at developmentally with their functional emotional developmental capacities. The "I" is looking at the individual differences of that particular child, and these are typically sensory-based. This was something that also drew me to the DIR model because it immediately acknowledged the sensory aspect that each individual person has. This applies to all of us as we all have sensory preferences, not just the kids that we work with. And then, the "R" is relationship-based. It is focused on building rapport with the child, and that is both the parents and the clinicians. The DIR model is really an alternative to behaviorism. It is focused on children with autism spectrum disorders or other developmental challenges, but as I said, it can be used with children of any age.

Floortime

Floortime is a specific technique or intervention. We think of DIR as the model and Floortime as the intervention, and there are some basic principles to using Floortime. The first one is to follow the child's lead. We see what the child is doing, and we join in. We are going to join in at their developmental level. If they are doing an activity that is much younger than their chronological age, we are still going to join in with them at the level they are at. I struggled with trying to figure out where to begin, and this model gave me a very clear starting place. It focuses on creating appropriate play environments. This is very similar to a sensory integration frame of reference. Another basic tenet of Floortime is circles of communication. These are interactions between the child and the play partner going back and forth. One person starts an interaction, and that could be verbal or nonverbal, and then we are looking for the child to either close the circle by giving us a response back or opening another circle by creating another action or activity out of that. We want to be able to broaden the child's range of processing. This is emotional, sensory, and motor problem-solving processing. We are looking at all those different components as part of a Floortime session.

Functional Emotional Developmental Capacities (FEDC)

  • Functional: focused on the outcomes of multiple areas of development
  • Emotional: the emotions are leading the entire team

They are really the meat of when we are looking at where to interact with children. It identifies how a child can integrate all the separate abilities that they have. These are their emotional, language, sensory, spatial, and motor abilities, and how these all work together. This is what creates that functional emotional developmental capacity. Emotions lead the way of development. We need emotional or affect signaling to put meaning to motion. Thus, when we are looking at where a child is on a functional emotional developmental capacity level, we are looking at how all these things are integrated together. We know that children with autism often learn or are taught skills in an isolated fashion, and they have a hard time integrating them into functional use. This can be either motor or social skills. However, when we look at a child through a DIR model, we are looking at these functional emotional developmental capacities and seeing their strength and areas they need to develop. We then design our interventions to address these functional emotional developmental capacities. We are going to go through all six of them and talk about what behaviors or questions you might ask to identify strengths within a particular developmental capacity. We are also going to talk about some challenges for each of these areas.

FEDC 1: Shared Attention and Regulation

  • Mastered by three months
  • Self-regulation and shared attention
  • Purposeful movements
    • Moving head towards voice/people
    • Rhythmic movements of the baby and caregiver

Functional emotional developmental capacity level one is described as shared attention and regulation. It is mastered by infants at three months, and it is the beginning of purposeful movement like moving the head towards a voice. Some questions we might ask a caregiver are, "Does your infant show interest in things around them? Do they turn their head toward sights and sounds?" These are movements we may see initially in an infant, and in other children.

  • Sensory Affect Motor Pattern (SAM): Affect links sensation coming in with the coordinated motor pattern
    • Pleasurable affect initiates turning towards and coordinated movements.
    • Early affect connection is important for the first stage and promoting further development in emotions, cognition, language, and social skills.

We might see problems in this area with self-regulation or an inability to maintain shared attention. If we have an upset child, we might work on co-regulation. Using our emotional state, we can help to calm them down. If they are having trouble with shared attention, we might use enticement or enticing them into our world, We want to get them involved in something that is in their environment by using a high affect and lots of gestures. We want them to turn and look at something in their environment. This is the beginning of a connection between a feeling, a pleasurable affect, and a coordinated movement. This is really important in developing further skills and the development of emotion, cognition, language, and social skills. Again, the ability to have a pleasurable feeling while coordinating movements is a basic foundation for developing other levels.

  • Core Deficit: lack of sustained, purposeful attention, dysregulated states, fleeting engagement (may include self-absorption)

A core deficit in this area will be a lack of sustained purposeful attention. There can be dysregulated states, tantrums, difficulty expressing feelings, or fleeting engagement. A child can be self-absorbed with a particular activity. One of the steps that we might take would be to learn where the child's boundaries are. For example, as we approach a child, they begin to become distressed. We may need to back up spatially to give them more space. This could be their body's boundary, or it could be a play boundary. As we approach a child, if they are bouncing a ball back and forth, for instance, and we approach with our ball, they may start to vocalize and move away from us. That is their boundary. At that point, we might back up a little bit and start bouncing our ball near them and see if that helps get some shared attention. They might look at our ball and then look back at their ball, but they are able to stay regulated even as we are coming into their space. Another area that we might work on would be to join the child in a repetitive action. This might be a sensory-based action or it may be a lack of motor planning. We may join them there so we can build on that. And then, we might look at providing sensory input with the activity. At level one, for shared attention and regulation, we are looking at helping the child co-regulate so that way they are available to move through other levels.

FEDC 2: Engagement

  • Emerging at 2-4 months, mastered by 5 months
  • Warm smiles at caregivers
  • Synchronous vocalizations and arm movements
  • Broadening emotional range (protest, delight, curiosity)
  • “Falling in love” with the human world
  • Emerging attachment and relationships

Engagement, Level 2, is typically mastered by five months. We might ask a caregiver, "Does your baby seem happy to see you? Are they happy to see other people? Do they smile, make sounds, or move their arms in ways that indicate pleasure when they see a preferred caregiver?"  This is the beginning of engagement. It is also called "falling in love" with the human world. We are looking for emerging attachment and relationships.

  • Core Deficit: brief engagement, passive two-way communication with more responding than taking initiative, may include aimless or avoidant behavior

Again, we need to join the kids at their level and this is going to vary for different children. It might be a child that moves from activity to activity. We have all seen these kids. They come into our clinics, and they get one thing out and then drop it on the floor. They move five feet, get another thing out, and drop it on the floor. We need to engage them at this point so they stick with one activity. By staying engaged with us, they are building that relationship component. If a child is moving from activity to activity, we want to use really high affect. We want to use a lot of high-pitched vocal tone s and gestures to get them engaged as one strategy. We might do some playful blocking. If the child is going from one space or one activity to another, we might get in their way, and we want to build on any island of interaction that they have. Even if they are moving around us, but they make eye contact, that would be considered an island of interaction. We might build on that and make a joke out of it next time, and get another toy and bring it back into that interaction to get that engagement. We have other children that just avoid the activity that we are using for engagement. This is often a good place to introduce sensory-based play. We want to look at what the sensory assessment told us about the types of sensory input that helps them be regulated and engaged or motivating for them. We can then use that to entice them to join us in the activity. Even if it is something like a puzzle, we might be able to incorporate that in a way by using that with a swing, a ball, or prone over a peanut ball. We are using that sensory input to engage them or entice them into an activity that they initially avoided. Other times, we might see a child that is hyperactive, and they cannot engage at all. This is another area where the DIR model would instruct us to use heavy work or the sensory component to help engage them and help them to deal with that hyperactivity.

FEDC 3: Reciprocity and Gestures

  • Emerging 3-9 months and mastered by 9 months
  • Learn cause and effect (a smile leads to a smile)
  • Learns to comprehend and respond to others’ emotional signals
  • Identifies that their own state gets different reactions from caregivers (squeals, fusses, cries)

For level three, reciprocity and gestures, we are starting to see a cause and effect. The child is starting to able to identify that their emotional state gets a reaction from their caregivers. This is also where the circles of communication begin to emerge. There is a back and forth communication, verbal or nonverbal, between the child and a caregiver or play partner. Some questions that we might ask the caregiver would be, "Does your child reach or point for something he wants or reach to be picked up? Does the child respond to people talking or playing with them? Do they imitate gestures?" We can ask these same questions with older children to give us an idea if the child has some skills at this level. The child will respond to caregivers, but they often do not initiate.

  • Children need to learn social signals and how to read and respond to social cues
    • Social skills cannot be mastered with memorized rules, even older children can learn to read and respond to social signals in an authentic way
    • Emotional signaling helps the child meet their needs and begin self-regulation
    • Self-regulation is the by-product of two way emotional signaling

The child is often using social skills, but they are not really authentic at this point. We want there to be a back and forth or the circle of communication piece. This helps the child to give and receive feedback, make meaning of that, and then give another set of feedback.

  • Core Deficit: lack of continuous flow of affective signaling and problem solving, may include repetitive or self-stimulatory behaviors

A core deficit in this area often is a lack of continuous flow of affective signaling. The child might be using scripting or non-meaningful words and phrases. We want to find a way to draw them in if that is something that the child is demonstrating to us. Perhaps, we can get some toys and to have a way to act this out. For example, if the child is saying, "Go to train," repetitively, we get out the toy train and act that out. We can also ask things such as, "Do you want to go on a train? Are we going to go see the trains? Is the train on TV?" This might be another way to get some of that reciprocity back and forth. If the child is saying, "Go to see Thomas," you might say, "See Percy?" very quizzically. The child might then look at you and say, "No, see Thomas." This is an example of back-and-forth flow.

FEDC 4: Problem Solving

  • Emerging at 9-18 months and mastery is present at 14-18 months.
  • The toddler is learning a continuous flow of back and forth communication (Circle of communication)
    • Does the child close the circle?
    • Should see 50+ circles in a row.

At level four, we really start to see further problem solving. It is more complex communication at this point, and it is usually present by 14 to 18 months in typically developing children.

  • Sense of self is forming through interactions with others and the environment. 
  • The child is learning the concepts that will form language that they have yet to learn. Words become short-handed symbols for what the child knows.
  • Learning to operate in terms of patterns not just isolated behaviors

To earn CEUs for this article, become a member.

unlimited ceu access $99/year

Join Now

gina taylor

Gina Taylor, MS, OTR/L, HPCS

Gina Taylor, MS, OTR/L, HPCS is a New Jersey licensed occupational therapist. She received her Masters Degree in Occupational Therapy from Philadelphia University and a Bachelor of Science in Equine Studies from Averett University. She is an Adjunct Professor at Raritan Valley Community College Occupational Therapy Assistant program, certified in Sensory Integration, DIR/Floortime, Infant Massage and is a board certified Hippotherapy Clinical Specialist (HPCS). Gina continues to expand her knowledge and the knowledge of other therapists about hippotherapy used as a treatment strategy through fieldwork student supervision, national conference presentations and her involvement with the American Hippotherapy Association, Inc. as faculty member, online education sub-committee chair, past Board Member and previous Education Committee Chairperson. Gina has a private practice providing occupational therapy services as well as workshops and consultation for those interested in equine assisted activities and therapy.



Related Courses

DIR/Floortime: A Practical Tool For Occupational Therapy Practitioners
Presented by Gina Taylor, MS, OTR/L, HPCS
Video
Course: #4240Level: Introductory1 Hour
DIR/Floortime is an excellent approach and tool for the OTP to structure their understanding of a child’s functional developmental emotional capacities. Using this understanding, the OTP can move into effective interventions with children and families to meet them where they are at.

Shinrin-Yoku: An Occupational Therapy Exploration
Presented by Gina Taylor, MS, OTR/L, HPCS
Video
Course: #4476Level: Introductory1 Hour
Forest bathing has a growing body of evidence to support it as a method of health promotion and recovery. Occupational therapy practitioners can learn more about the application of forest bathing through invitations and for specific patient populations.

Introduction to Hippotherapy for Occupational Therapy Practitioners
Presented by Gina Taylor, MS, OTR/L, HPCS
Video
Course: #4036Level: Introductory1 Hour
This course will introduce occupational therapy practitioners to the use of the horse, horses’ movement and the equine environment as a treatment tool. Occupational therapy practitioners will be introduced to hippotherapy in relation to the occupational therapy practice framework.

Joint Hypermobility Syndromes: Assessment and Intervention
Presented by Valeri Calhoun, MS, OTR/L, CHT
Video
Course: #5376Level: Intermediate1 Hour
This course will cover upper extremity assessment and treatment strategies for the pediatric/young adult population affected by joint hypermobility syndromes. The treatment focuses on both orthopedic strategies along with adaptive methods for these individuals.

Rhythm and the Neurological Plexuses: Better Understanding Autism to Enhance Therapy Interventions; Part 1
Presented by Varleisha Gibbs, PhD, OTD, OTR/L
Video
Course: #3595Level: Advanced1 Hour
With current research advances in neurology, practitioners must revisit the evidence for best practice and to enhance intervention techniques for addressing the challenges of Autism. This course reviews the nine neurological senses, neuronal oscillations, and the autonomic neuronal plexuses to better understand the symptoms related Autism.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.