DIR/Floortime

DIR/Floortime is a developmental treatment approach
for autism spectrum disorders introduced by
Dr. Stanley Greenspan and
Serena Wieder, PH.D.

The formal name for this approach is the
Developmental, Individual-difference,
Relationship-based (DIR) model.
Floortime is a basic strategy within the DIR model
but the common name for this treatment.

Come and see the bubbles Brady (visual and audio voiceover) 

Therapist:
When I first met him Brady was almost non-verbal. He was very observant. He was very interested in the people around him, but when left on his own he would choose to play individually, kind of isolated play. 

Therapist with Brady:
Sing with 

Therapist:
He just really didn’t know how to initiate interaction, didn’t know how to seek it out, but he did enjoy it once he was in the moment. He watched his siblings from afar, but would not approach them to join, and he really just didn’t know how to initiate interaction. 

Mother of all three children with therapist and children:
Oh, my goodness.

Mother with Father:
I think the first signs we noticed was that he was so quiet. He wasn’t speaking, he stayed over by himself, he didn’t join in with things. He was always affectionate, and his eye-contact with us was fine, but new people, really, he was very quiet and shy with. 

Father with Mother:
There were other things that concerned us, other quirky things: running the room, he would run from one end of a room to another and do it back and forth at lot. Or, you know, things like trying to test the ground. He would rub his forehead against the ground. Things like that. There were certainly quirky things that we thought, you know, this is something we probably ought to look into some more. 

Doctor:
When I was in my residency I was very interested in what was called ‘child life,’ which was understanding the whole child’s experience being in the hospital: the emotional experience and what it was like for their parents as well. And then I became interested and studied child development, and we learned about cognitive development, we learned about cerebral palsy, different kinds of disabilities, a lot about premature infants, but there was no unifying theoretical framework to look at child development. 

Father with Brady:
Stop. Go. Uh, oh. That’s your water cup. What happened? Brady. No, no. No throwing your food. 

Doctor:
In terms of typical social, emotional development, there, no framework existed, and that’s when I began to learn about Dr. Greenspan, the DIR/Floortime approach, and it was just such a delight to read it because it put together these disparate pieces. Well, the core of the DIR/Floortime model is emotion or understanding the child’s internal emotional life and how that is the central organizing factor for development, how their motivations for learning are all grounded within their emotional experience. 

Mother and Therapist (blowing up balloon) with Brady:
More? Bigger. Little more. Little more.

Father with Mother:
Brady, at first I think was reluctant or difficult and maybe didn’t want to participate with what the therapist wanted to do with him, or didn’t know what was going on and getting kind of upset with that. But as time has gone on and he’s gotten used to it and spent more time with it, he’s really, I mean I think he’s really enjoyed it.

Therapist:
My initial goal with working with Brady was to really find what interests him, to find the kind of activities that brought him pleasure and joy, and to try to build on those activities. Obviously the goal is to increase communication. He is definitely able to communicate, however he does not choose to do so spontaneously. And so I think just slowing down the process of things, enticing him into activities that he already enjoyed and modeling ways for him to approach others. He still uses a lot of gestures: for example, he uses tapping like this for more, he says ‘done’ when, or ‘bye’ when he wants to complete an activity, he loves having people sit close to him that are familiar, he, we do a little clapping game to music where we clap our hands together. He really, his face lights up, and I think, you know, he enjoys people and I think he enjoys being around them. He laughs and smiles, he especially loves just simple, physical play with his family members: you know, being lifted and swung and tickled and, you know, he just lights up and he laughs and he shows a lot of affect and I think that’s a big strength and it’s a great place to start building from. 

Doctor:
Another misunderstanding that happens frequently with DIR/Floortime is that people think we’re just following the child’s lead all the time. And they’ll say, ‘Well, if we’re just following the child’s lead, how are they ever going to learn anything new?’ or ‘They don’t do anything, so what is there to follow?’ Actually, following their lead is part of that emotional attunement, trying to really understand where that child is emotionally and what’s of interest to them. And building on their interest, so if they really like trucks and they seem to be obsessed with trucks, rather than taking the truck away we’ll try and join them in their interest in trucks and then challenge them. We, there’s a second part of Floortime, joining in their lead and then challenging them to extend beyond that to extend to higher milestones of interaction around the area of interest. 

Mother with Father:
I think when we found out that Ellie was on the autism spectrum, it was more like ‘Oh, well, they’re so different.’ And I think that, we had read all this stuff and all these books and Brady has a lot of the things you find in books, and Ellie has the ones you have to go a little bit further. You have to, ‘Oh, they could have this and they could have that,’ and that, you know, and so it was kind of like, ‘O.K., we’ll do the same things, we’ll, you know, push Ellie the way we push Brady. We’ll push Ellie along and also with Jack.’ So he is also attending the special day class. So it’s all three. 

Filmmaker:
That must be hard.

Mother with Father:
Yeah, yeah. It’s just a little more work. 

Therapist:
Part of Floortime is parent coaching, and the parents have been really great. They already knew a lot of strategies.

Doctor:
We’re thinking about creating the, supporting a relationship between the child and their parents. And it makes it a very complex model in the sense that every parent is quite unique themselves as well as the child is unique. And each parent has their own strengths and weaknesses. Dr. Greenspan talked about at different points in development, parents’ strengths and weaknesses may be more supportive or less supportive. 

Father with Mother:
We two of us were drawn to the Floortime model, the idea that the child’s development was sort of driving things and the child’s interests were driving things. The way I’ll describe them isn’t going to be perfect, but my view of the ABA side was they were going to learn certain skills that might stick or might be gone once the reward was gone, whereas with the developmental side it was going to be much more focused on the child, on them, on what they wanted. So that was very appealing to me. 

Mother with Father:
And I think we chose the Floortime because we were kind of already doing that with them. We were constantly on the ground playing with them, getting them to be involved and interact with us, so it was kind of just what we do anyway. So I think it seemed like a more natural way to go. I think we’re very lucky that we found something that does Floortime so close to us.

Doctor:
There are areas where it’s very difficult to access someone with DIR/Floortime training specifically. However, there are a lot of materials that are available now on the internet as well as books and support groups where parents can access this information. I think that was certainly Dr. Greenspan’s idea, that these ideas should be available for families to access through reading his books, through looking at his videotapes, and the information’s available.

Father with Mother: Therapy has been about giving our kids the tools, but they’ve also come by giving us the tools too.